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ACCREDO HEALTH GROUP, INC.
DSH050017 MERCY GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MERCY GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050017
Entity Address
4001 J STREET
SACRAMENTO, CA 95819
Medicare Provider Number
050017
Participating Start Date
4/1/2005
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
6272 LEE VISTA BLVD STE 100
ORLANDO, FL 32822
Pharmacy Comments
Contract Details
Approval Date
8/7/2019
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
Bonnie Helen Jenkins, CFO
(916) 453-4459
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
8/7/2019
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