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DSH050235 PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE SAINT JOSEPH MEDICAL CENTER (Active)
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Main Details
Name
PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE SAINT JOSEPH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050235
Medicare Provider Number
050235
Additional Details
Current Program Status
Active
Registration Date
4/14/2008
Participating Start Date
7/1/2005
Participating Approval Date
4/14/2008
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Providence
Jason Kell, Chief Financial Officer
(415) 505-5231
Primary Contact
Providence Saint Joseph Medical Center
Chidi Oji Esomonu, Director of Pharmacy Services
(818) 847-3788
Addresses
Street Address
501 S BUENA VISTA STREET
BURBANK, CA 91505
Billing Address
Providence Health System Southern California DBA Providence Saint Joseph Medical Center
P.O. Box 696430
San Antonio, TX 78269
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/31/09 UPDATED ENTITY NAME (WAS PROVIDENCE SAINT JOSEPH MEDICAL CENTER)
04/14/2008
April 2025
April 2025
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