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DSH050191 ST. MARY MEDICAL CENTER (Active)
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Main Details
Name
ST. MARY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050191
Medicare Provider Number
050191
Additional Details
Current Program Status
Active
Registration Date
10/18/2016
Participating Start Date
1/1/2017
Participating Approval Date
12/14/2016
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
DIGNITY HEALTH
Sharon McNealy, Chief Financial Officer
(562) 491-9189
Primary Contact
St Mary Medical Center
Catherine Hirokawa, Director of Pharmacy
(562) 491-9773
Addresses
Street Address
1050 LINDEN AVENUE
LONG BEACH, CA 90813-3393
Billing Address
Dignity Health Accounts Payable
3033 N. 3rd Avenue
Phoenix, AZ 85013
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/22/16 participating 1/1/05 until terminated effective 3/9/15, reinstated effective 1/1/17
12/22/2016
May 2025
May 2025
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