340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
BRIOVARX OF MAINE INC
DSH030024 ST JOSEPH'S HOSPITAL AND MEDICAL CENTER
Print
Covered Entity Details
Entity Name
ST JOSEPH'S HOSPITAL AND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH030024
Entity Address
350 W THOMAS ROAD
PHOENIX, AZ 85013
Medicare Provider Number
030024
Participating Start Date
1/1/2005
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
BRIOVARX OF MAINE INC
Pharmacy Address
DBA BRIOVARX
53 DARLING AVE
SOUTH PORTLAND, ME 04106
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeffrey Jackson, Chief Financial Officer
(602) 406-4618
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
10/14/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session