Covered Entity Details

DSH050069Q ST. JOSEPH HOSPITAL OF ORANGE (Active) - information as of 6/3/2025 12:05:34 PM

Main Details

Name

ST. JOSEPH HOSPITAL OF ORANGE

Subdivision Name

Radiology - MRI SJOP

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050069Q

Medicare Provider Number

050069

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/3/2014

Participating Start Date

4/1/2014

Participating Approval Date

1/15/2014

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

St. Joseph Hospital, Orange
Eileen Haubl, Chief Financial Officer
(949) 364-1400 Ext: 5408

Primary Contact

St Joseph Hospital
Richard T Sakakura, Clinical Pharmacist 340B Specialist
(714) 771-8021

Addresses

Street Address

1140 W. La Veta Ave
Orange, CA 92868

Billing Address

Providence St. Joseph Health System
PO Box 696431
San Antonio, TX 72869

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
CA		1558575746

Shipping Addresses

Shipping Address 1

St. Joseph Hospital of Orange
1100 West Stewart Drive
Orange, CA 92868

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH050069AA	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Pelvic Health - Caloggero Pelvic Health	363 S Main Street	Orange	CA	Active
DSH050069AB	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	PET Scan - SJOP - PET Scan - SJOP	1140 W La Veta Ave	Orange	CA	Active
DSH050069C	Child	DSH	St. Joseph Hospital of Orange	Santa Ana Dialysis	2212 E 4th St	Santa Ana	CA	Terminated
DSH050069D	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Radiation Therapy - CCPT	1000 W. La Veta Ave	Orange	CA	Active
DSH050069F	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	MDC Operations - CCPT	1000 W. La Veta Ave	Orange	CA	Active
DSH050069G	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Infusion Center - CCPT	1000 W. La Veta Ave	Orange	CA	Active
DSH050069H	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Mammography-CCPT	1010 W. La Veta Ave	Orange	CA	Terminated
DSH050069J	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Wound Care Center	1140 West La Veta Ave	Orange	CA	Active
DSH050069K	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Physical Therapy - O/P	1310 West Stewart Ave	Orange	CA	Active
DSH050069L	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Radiology - U/S (SJOP)	1140 W. La Veta Ave	Orange	CA	Active
DSH050069M	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Sleep Center	1300 W. Palmyra	Orange	CA	Terminated
DSH050069N	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	PACU - SJOP	1140 W. La Veta Ave	Orange	CA	Terminated
DSH050069P	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Radiology - Nuc Med (SJOP)	1140 W. La Veta Ave	Orange	CA	Active
DSH050069Q	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Radiology - MRI SJOP	1140 W. La Veta Ave	Orange	CA	Active
DSH050069R	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Maternal Fetal Testing - SJOP	1140 W. La Veta Ave	Orange	CA	Terminated
DSH050069S	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Pre-OP SJOP	1140 W. La Veta Ave	Orange	CA	Terminated
DSH050069T	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Cardiac Rehab - SJOP	1140 W. La Veta Ave	Orange	CA	Active
DSH050069U	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Cardiology - SJOP	1140 W. La Veta Ave	Orange	CA	Active
DSH050069V	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Endoscopy Center - SJOP	1140 W. La Veta Ave	Orange	CA	Terminated
DSH050069W	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Radiology - Diag (SJOP)	1140 W. La Veta Ave	Orange	CA	Active
DSH050069X	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	CT Scan SJOP	1140 W. La Veta Ave	Orange	CA	Active
DSH050069Y	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Blood Donor Center - SJOP	1140 W. La Veta Ave	Orange	CA	Terminated
DSH050069Z	Child	DSH	ST. JOSEPH HOSPITAL OF ORANGE	Surgery Center - SJOP	1140 W. La Veta Ave	Orange	CA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 6:21:10 PM	8/20/2024 2:10:19 PM	8/20/2024 2:10 PM
Details	Last Recertification Date	Update	Recertification	8/31/2022 11:33:03 AM	8/29/2023 6:21:10 PM	8/29/2023 6:21 PM
Details	Last Recertification Date	Update	Recertification	8/31/2021 7:41:02 PM	8/31/2022 11:33:03 AM	8/31/2022 11:33 AM
Details	Last Recertification Date	Update	Recertification	8/28/2020 2:22:58 PM	8/31/2021 7:41:02 PM	8/31/2021 7:41 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/28/2020 2:22 PM
Contacts	Primary Contact	Update	Recertification	Amirpoor, Sy Director of Pharmacy Services St. Joseph Hospital, Orange 7147718278	Sakakura, Richard T Clinical Pharmacist 340B Specialist St Joseph Hospital 7147718021	8/28/2020 2:22 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 8:34:27 PM	8/28/2020 2:22:58 PM	8/28/2020 2:22 PM
Contacts	Authorizing Official	Update	Change Request	Liberatore, Kristi Chief Financial Officer St. Joseph Hospital, Orange 7147718281	Haubl, Eileen Chief Financial Officer St. Joseph Hospital, Orange 9493641400-5408	8/11/2020 9:15 AM
Addresses	Billing Address	Update	Recertification	St. Joseph Hospital of Orange 1100 West Stewart Drive Orange, CA 92868	Providence St. Joseph Health System PO Box 696431 San Antonio, TX 72869	8/21/2019 8:34 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 12:25:06 PM	8/21/2019 8:34:27 PM	8/21/2019 8:34 PM
Details	Last Recertification Date	Update	Recertification	11/10/2017 1:21:23 PM	8/17/2018 12:25:06 PM	8/17/2018 12:25 PM
Details	Last Recertification Date	Update	Recertification	8/19/2016 12:00:00 AM	11/10/2017 1:21:23 PM	11/10/2017 1:21 PM
Contacts	Primary Contact	Update	Recertification	Amirpoor, Sy Director of Pharmacy Services 7147718278	Amirpoor, Sy Director of Pharmacy Services St. Joseph Hospital, Orange 7147718278	10/24/2017 3:03 PM
Contacts	Authorizing Official	Update		Liberatore, Kristi Chief Financial Officer 7147718281	Liberatore, Kristi Chief Financial Officer St. Joseph Hospital, Orange 7147718281	10/4/2017 6:54 PM
Contacts	Signed By	Update		Liberatore, Kristi Chief Financial Officer 7147718281	Liberatore, Kristi Chief Financial Officer St. Joseph Hospital, Orange 7147718281	10/4/2017 6:54 PM
Contacts	Authorizing Official	Insert			Liberatore, Kristi Chief Financial Officer 7147718281	8/3/2017 7:32 AM
Contacts	Signed By	Insert			Liberatore, Kristi Chief Financial Officer 7147718281	8/3/2017 7:32 AM
Contacts	Primary Contact	Update		Zimmer, Curt Executive Director of Finance 7147718238	Amirpoor, Sy Director of Pharmacy Services 7147718278	8/3/2017 7:32 AM
Addresses	Main Address	Insert			1140 W. La Veta Ave Orange, CA 92868	3/1/2017 8:31 PM
Addresses	Billing Address	Insert			St. Joseph Hospital of Orange 1100 West Stewart Drive Orange, CA 92868	3/1/2017 8:31 PM
Addresses	Shipping Address	Insert			St. Joseph Hospital of Orange 1100 West Stewart Drive Orange, CA 92868	3/1/2017 8:31 PM
Contacts	Primary Contact	Insert			Zimmer, Curt Executive Director of Finance 7147718238	8/22/2016 6:53 AM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/19/2016 12:00:00 AM	8/19/2016 8:42 PM
Details	Last Recertification Date	Update		8/12/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 1:21 PM
Details	Last Recertification Date	Update			8/12/2014 12:00:00 AM	8/12/2014 7:40 AM
Dates	Participating Approval Date	Update			1/15/2014 12:00:00 AM	1/15/2014 3:00 PM
Details	State	Update		Pending	Active	1/15/2014 3:00 PM
Dates	Start Date	Update			4/1/2014 12:00:00 AM	1/15/2014 3:00 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH050069Q	1/10/2014 10:08 AM
Medicaid Billing	NPI: Number	Insert			1558575746	1/3/2014 4:25 PM
Details	Last Recertification Date	Insert				1/3/2014 4:25 PM
Details	Grant Number	Insert				1/3/2014 4:25 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/3/2014 4:25 PM
Details	Is Authorizing Official EHB Data	Insert				1/3/2014 4:25 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/3/2014 4:25 PM
Details	Medicare Provider Number	Insert			050069	1/3/2014 4:25 PM
Details	Entity Name	Insert			ST. JOSEPH HOSPITAL OF ORANGE	1/3/2014 4:25 PM
Details	Program Code	Insert			DSH	1/3/2014 4:25 PM
Details	Entity Subname	Insert			Radiology - MRI SJOP	1/3/2014 4:25 PM
Dates	Participating Approval Date	Insert				1/3/2014 4:25 PM
Details	State	Insert			Pending	1/3/2014 4:25 PM
Dates	Registration Date	Insert			1/3/2014 12:00:00 AM	1/3/2014 4:25 PM
Dates	Signed By Date	Insert			1/3/2014 12:00:00 AM	1/3/2014 4:25 PM
Dates	Start Date	Insert				1/3/2014 4:25 PM
Terminations	Termination Comments	Insert				1/3/2014 4:25 PM
Terminations	Termination Date	Insert				1/3/2014 4:25 PM
Terminations	Termination Effective Date	Insert				1/3/2014 4:25 PM
Terminations	Termination Reason	Insert				1/3/2014 4:25 PM