TEAMSTERS CALIFORNIA STATE COUNCIL PRODUCERS ALLIANCE OF CANNERY AND FOOD PROCESSING UNIONS OF CALIFORNIA JOINT BENEFIT TRUST CHAIR, Maria Ashley Alvarado ADMINISTRATOR CO-CHAIR, Stacey Cue 4160 Dublin Blvd., Suite 400 Dublin, California 94568-7756 PHONE: (925) 833-7306 FAX: (925) 833-7301 DESIGNATED HIP/KNEE HOSPITALS Reimbursement for any single routine hip or knee joint replacement performed as an inpatient service is limited to $35,000, not including the professional fees. The facilities listed on the back of this form will perform the procedure for $35,000 or less. If you go to any other facility, you will be responsible for the difference between the charge and $35,000. **This form is not a guarantee of payment; enrollee must be eligible at the time of service. ** HOSPITALES DESIGNADOS PARA CADERAS/RODILLAS Los pagos para cualquier reemplazo rutinario único de cadera o de articulación de la rodilla será limitado a $35,000, no incluyendo los honorarios de los doctores (profesionales). La lista de estos lugares que harán esto servicios por $35,000 o menos, se encuentran al reverso de esta hoja. Si usted va a algún otro lugar que no sea uno que esta en esta lista, usted será responsable por la diferencia entre el cargo total y los $35,000 que JBT pague. ** Este formulario no es una garantía de pago, afiliado debe ser elegible en el momento del servicio.** JBT_HIP&KNEE REV 5/2020 Designated Hip and Knee Facilities Facility Address City Phone Adventist Medical Ctr 115 Mall Road Hanford 559-582-9000 Alameda Hospital 2070 Clinton Ave Alameda 510-522-3700 Alvarado Hospital 6655 Alvarado Road San Diego 619-286-7374 Arroyo Grande Community Hospital 345 S Halcyon Rd Arroyo Grande 805-489-4261 Bakersfield Memorial Hospital 420 34th Street Bakersfield 661-327-1792 Barton Memorial Hospital 2170 South Ave So Lake Tahoe 530-541-3420 Cedars-Sinai Marina Del Rey Hospital 4650 Lincoln Blvd Marina Del Rey 310-823-8911 Comm Hospital of Monterey Peninsula 23625 Holman Hwy Monterey 831-624-5311 Comm Memorial Hospital San Buenaventura 147 N Brent Street Ventura 805-652-5011 Dameron Hospital 525 W Acacia Street Stockton 209-944-5550 Desert Regional Medical Center 1150 N Indian Canyon Dr Palm Springs 760-323-6511 Eisenhower Medical Center 39000 Bob Hope Drive Rancho Mirage 760-340-3911 El Camino Hospital 2500 Grant Rd Mtn View 650-940-7000 El Camino Hospital 815 Pollard Rd Los Gatos 650-940-7000 Enloe Medical Center 1531 Esplanade Chico 530-332-7300 French Hospital Medical Center 1911 Johnson Ave San Luis Obispo 805-543-5353 Fresno Surgical Hospital 6125 N Fresno Street Fresno 559-431-8000 Good Samaritan Hsp - San Jose 2425 Samaritan Drive San Jose 408-559-2011 Good Samaritan Hsp - Los Angeles 1225 Wilshire Blvd Los Angeles 213-977-2121 Healdsburg District Hospital 1375 University St Healdsburg 707-431-6500 Hoag Orthopedic Institute 16250 San Canyon Ave Irvine 855-999-4641 Huntington Memorial Hospital 100 W California Blvd Pasadena 626-397-5000 John Muir Medical Center - Concord 2540 East St. Concord 925-682-8200 John Muir Medical Center - Walnut Creek 1601 Ygnacio Valley Rd Walnut Creek 925-939-3000 John F Kennedy Memorial Hospital 47111 Monroe Street Indio 760-347-6191 Kaweah Delta Hospital 400 W Mineral King Ave Visalia 559-624-2000 Loma Linda University Medical Center 11234 Anderson Street Loma Linda 866-436-2098 Long Beach Memorial Medical Center 2801 Atlantic Ave Long Beach 562-933-2000 Los Robles Regional Medical Center 215 W West Janss Rd Thousand Oaks 805-497-2727 Mercy Medical Center Redding 2175 Rosaline Ave Redding 530-225-6000 Methodist Hospital of Sacramento 7500 Hospital Drive Sacramento 916-423-3000 Mission Hospital Regional Medical Center 27700 Medical Center Rd Mission Viejo 949-364-1400 Natividad Medical Center 1330 Natividad Rd Salinas 831-647-7611 O'Connor Hospital 2105 Forest Ave San Jose 408-947-2500 Placentia Linda Hospital 1301 N Rose Drive Placentia 714-993-2000 Queen of the Valley Medical Center 1000 Trancas Street Napa 707-252-4411 Salinas Valley Memorial Hospital 450 E Romie Lane Salinas 831-757-4333 San Antonio Community Hospital 999 San Bernardino Road Upland 909-985-2811 San Joaquin Community Hospital 2615 Eye Street Bakersfield 661-395-3000 Santa Rosa Memorial Hospital 1165 Montgomery Drive Santa Rosa 707-546-3210 Sierra Vista Regional Medical Center 1010 Murray Street San Luis Obispo 805-546-7600 Sonora Regional Medical Center 14542 Lolly Lane Sonora 209-536-5000 St Agnes Medical Center 1303 E Herndon Ave Fresno 559-450-3000 St Helena Hospital 10 Woodland Road Saint Helena 707-963-3611 St John’s Health Center 2121 Santa Monica Blvd Santa Monica 310-829-5511 St Joseph's Hospital - Orange 1100 W.Stewart Dr Orange 714-633-9111 St Jude Medical Center 101 E Valencia Mesa Drive Fullerton 714-871-3280 St Vincent Medical Center 2131 W 3rd Street Los Angeles 213-484-7111 Stanford University Hospital 300 Pasteur Drive Palo Alto 650-723-4000 Stanislaus Surgical Hospital 1421 Oakdale Road Modesto 209-572-2700 Torrance Memorial Medical Center 3330 West Lomita Blvd Torrance 310-325-9110 Twin Cities Community Hospital 1100 Las Tablas Road Templeton 805-434-3500 UC Davis Medical Center 2315 Stockton Blvd Sacramento 916-734-2011 UCSD Medical Center 200 W Arbor Dr. San Diego 858-657-7000 Valley Presbyterian Hospital 15107 Vanowen Street Van Nuys 818-782-6600 Valleycare Medical Center 5555 W Las Positas Blvd Pleasanton 925-847-3000 JBT_HIP&KNEE REV 5/2020 .