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DSH050069 ST. JOSEPH HOSPITAL OF ORANGE (Active)
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Main Details
Name
ST. JOSEPH HOSPITAL OF ORANGE
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050069
Medicare Provider Number
050069
Additional Details
Current Program Status
Active
Registration Date
12/16/2008
Participating Start Date
7/1/2012
Participating Approval Date
6/28/2012
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
1100 WEST STEWART DRIVE
ORANGE, CA 92868
Billing Address
Providence St. Joseph Health System
PO Box 696431
San Antonio, TX 78269
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/18/12 PARTICIPATING 1/1/09-12/31/10, NOT PARTICIPATING 1/1/11 THRU 6/30/12; 8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %
06/18/2012
8/31/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %
01/01/2011
April 2025
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