HCAI Syfphr

Search > Results > Details

Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

PACIFIC GROVE HOSPITAL

5900 BROCKTON AVENUE
RIVERSIDE, CA 92506
http://www.pacificgrovehospital.com

License:

Acute Psychiatric Hospital
Total Beds: 68
Emergency Room: Yes
more... Link to Atlas

Contact:

Jonathan Silver
951-779-7844

OSHPD ID:

106331226

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

3/5/2008

Download:

Federal Poverty Level for Free Care:

125%

Discount Payment Effective Date:

3/5/2008

Discount Payments

FPL Range: 125%-150%
Payment Basis:
Medi-Cal
Other: 75% of the adjusted rate

FPL Range: 150%-175%
Payment Basis:
Medi-Cal
Other: 50% of the adjusted rate

FPL Range: 175%-200%
Payment Basis:
Medi-Cal
Other: 25% of the adjusted rate

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

9/1/2022

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received
Other: income reportable on Federal Income Tax returns

Language Information

Available Languages:

English
Spanish

Additional Information

Family Size	100%	150%	200%	250%	300%	350%	400%