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ST JOSEPH'S MCAULEY PHARMACY
DSH050191 ST. MARY MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. MARY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050191
Entity Address
1050 LINDEN AVENUE
LONG BEACH, CA 90813-3393
Medicare Provider Number
050191
Participating Start Date
1/1/2017
Last Recertification Date
9/3/2024
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
7/10/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Leon Choiniere, Vice President/Chief Financial Officer
(562) 491-9191
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
7/10/2019
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