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ST JOSEPH'S MCAULEY PHARMACY
DSH050017 MERCY GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MERCY GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050017
Entity Address
4001 J STREET
SACRAMENTO, CA 95819
Medicare Provider Number
050017
Participating Start Date
4/1/2005
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ST JOSEPH'S MCAULEY PHARMACY
Pharmacy Address
500 W. THOMAS ROAD
SUITE 190
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
4/4/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/21/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bonnie Helen Jenkins, CFO
(916) 453-4459
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
4/4/2019
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