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DSH050168 ST JUDE MEDICAL CENTER FULLERTON (Active)
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Main Details
Name
ST JUDE MEDICAL CENTER FULLERTON
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050168
Medicare Provider Number
050168
Additional Details
Current Program Status
Active
Registration Date
4/1/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/5/2016
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
St. Jude Medical Center
Eugene E Gutierrez, Chief Financial Officer
(714) 992-3939
Primary Contact
St. Jude Medical Center
Ray Juergens, Pharmacy Director
(714) 992-3000 Ext: 4050
Addresses
Street Address
101 E. VALENCIA MESA DR
FULLERTON, CA 92835
Billing Address
St. Jude Medical Center
PO Box 696431
San Antonio, TX 78269
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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