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CREDENA HEALTH, LLC
DSH050006 St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital
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Covered Entity Details
Entity Name
St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050006
Entity Address
2700 DOLBEER STREET
EUREKA, CA 95501
Medicare Provider Number
050006
Participating Start Date
4/1/2009
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
CREDENA HEALTH, LLC
Pharmacy Address
6348 NE HALSEY ST
SUITE A
PORTLAND, OR 97213-4720
Pharmacy Comments
Contract Details
Approval Date
7/26/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Klockenga, CEO
(707) 522-1520
Contract Pharmacy Representative
Credena Health
Sanjeev Bali, Pharmacy Operations Manager
(503) 962-1707
Signed By Date
7/26/2019
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