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RRC050567-28 MISSION HOSPITAL REG MEDICAL CENTER (Approved)
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Main Details
Name
MISSION HOSPITAL REG MEDICAL CENTER
Subdivision Name
Providence Mission Hospital - Cancer Institute PET - Cancer Institute PET
Type
Rural Referral Center
Rural
Yes
340B ID
RRC050567-28
Medicare Provider Number
050567
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/1/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/7/2025
Last Recertification Date
Contacts
Authorizing Official
St. Joseph Hospital, Orange
Eileen Haubl, Chief Financial Officer
(949) 364-1400 Ext: 5408
Primary Contact
Mission Hospital
Nha-Uyen Tran, 340B Pharmacist Specialist
(949) 364-1400 Ext: 2220
Addresses
Street Address
27799 Medical Center Road
160
Mission Viejo, CA 92691
Billing Address
St. Joseph Health Shared Services Accounts Payable
3345 Michelson Drive
Irvine, CA 92612
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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