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ACCREDO HEALTH GROUP, INC.
DSH050516 MERCY SAN JUAN MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY SAN JUAN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050516
Entity Address
6501 COYLE AVENUE
CARMICHAEL, CA 95608
Medicare Provider Number
050516
Participating Start Date
4/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/30/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robin Rogness, CFO
(916) 537-5153
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
7/15/2019
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