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ST JOSEPH'S MCAULEY PHARMACY
DSH050129 ST. BERNARDINE MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. BERNARDINE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050129
Entity Address
2101 N. WATERMAN AVENUE
SAN BERNARDINO, CA 92404
Medicare Provider Number
050129
Participating Start Date
10/1/2004
Last Recertification Date
8/19/2024
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
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Steinke, CFO
(909) 881-7196
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
4/12/2019
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