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DSH050006B St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital (Active)
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Main Details
Name
St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital
Subdivision Name
North Coast Pain Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050006B
Medicare Provider Number
050006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/22/2022
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Providence St Joseph Health
Basil Saied, CFO
(707) 445-8121
Primary Contact
Providence
Jesse Peterson, 340B Program Director, South Division
(651) 324-2207
Addresses
Street Address
2705 Harris Street
Eureka, CA 95501
Billing Address
St. Joseph Hospital
2700 Dolbeer Street
Eureka, CA 95501
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2014; Terminated on 10/1/2020; Reinstated on 4/1/2022.
02/18/2022
May 2025
May 2025
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