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LIMAS PROFESSIONAL PHARMACY 1
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
LIMAS PROFESSIONAL PHARMACY 1
Pharmacy Address
2097 HARRISON AVE
EUREKA, CA 95501-3211
Pharmacy Comments
Contract Details
Approval Date
1/8/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/9/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Klockenga, CEO
(707) 522-1520
Contract Pharmacy Representative
LIMAS PROFESSIONAL PHARMACY
ROBERT LIMA, OWNER
(707) 441-8530
Signed By Date
1/8/2020
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