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ST JOSEPH'S MCAULEY PHARMACY
DSH050242 DOMINICAN HOSPITAL
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Covered Entity Details
Entity Name
DOMINICAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050242
Entity Address
1555 SOQUEL DRIVE
SANTA CRUZ, CA 95065
Medicare Provider Number
050242
Participating Start Date
4/1/2007
Last Recertification Date
8/29/2024
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
4/8/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jim Murray, COO
(831) 462-7571
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
4/8/2019
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