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DSH050084 ST JOSEPH'S MEDICAL CENTER (Active)
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Main Details
Name
ST JOSEPH'S MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050084
Medicare Provider Number
050084
Additional Details
Current Program Status
Active
Registration Date
12/4/2007
Participating Start Date
1/1/2005
Participating Approval Date
12/4/2007
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Dignity Health, St. Joseph's Medical Center
Michael Herrera, CMO
(209) 467-6483
Primary Contact
Dignity Health, St. Joseph's Medical Center
Pe tou Yang, Pharmacy Technician
(209) 547-5814
Addresses
Street Address
1800 N CALIFORNIA STREET
STOCKTON, CA 95204
Billing Address
Dignity Health AP
3033 N. 3rd Avenue
Phoenix, AZ 85013
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/23/2005 DELETE MED# (WAS PHB161000)
12/04/2007
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