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ST JOSEPH'S MCAULEY PHARMACY
DSH050590 METHODIST HOSPITAL OF SACRAMENTO
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Covered Entity Details
Entity Name
METHODIST HOSPITAL OF SACRAMENTO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050590
Entity Address
7500 HOSPITAL DRIVE
SACRAMENTO, CA 95823
Medicare Provider Number
050590
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
4/5/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/21/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Anita Kennedy, VP of Operations
(916) 423-6180
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
4/5/2019
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