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DSH050069C St. Joseph Hospital of Orange (Terminated)
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Main Details
Name
St. Joseph Hospital of Orange
Subdivision Name
Santa Ana Dialysis
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050069C
Medicare Provider Number
050069
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/29/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/28/2012
Last Recertification Date
8/19/2016
Termination Date
Termination Reason
7/1/2017
For-Profit conversion
Contacts
Authorizing Official
St. Joseph Hospital, Orange
Kristi Liberatore, Chief Financial Officer
(714) 771-8281
Primary Contact
St. Joseph Hospital, Orange
Sy Amirpoor, Director of Pharmacy Services
(714) 771-8278
Addresses
Street Address
2212 E 4th St
Suite 101
Santa Ana, CA 92705-3811
Billing Address
St. Joseph Hospital of Orange
1100 West Stewart Drive
Orange, CA 92868
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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