340B Drug Pricing Program Database
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DSH050006D St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital (Terminated)
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Main Details
Name
St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital
Subdivision Name
GI Lab
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050006D
Medicare Provider Number
050006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/12/2014
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
7/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
St. Joseph Health
Kevin Klockenga, CEO
(707) 522-1520
Primary Contact
St.Joseph Health
Virginia Elizabeth Schuchard, NorCal Region 340B Program Manager
(507) 271-8661
Addresses
Street Address
2200 Harrison Ave.
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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