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ESI MAIL PHARMACY SERVICE
DSH050291 Sutter Bay Hospitals, dba Sutter Santa Rosa Regional Hospital
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Covered Entity Details
Entity Name
Sutter Bay Hospitals, dba Sutter Santa Rosa Regional Hospital
Subdivision Name
dba Sutter Santa Rosa Regional Hospital
Type
Disproportionate Share Hospital
340B ID
DSH050291
Entity Address
30 MARK WEST SPRINGS ROAD
SANTA ROSA, CA 95403
Medicare Provider Number
050291
Participating Start Date
7/1/2005
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
ESI MAIL PHARMACY SERVICE
Pharmacy Address
DBA EXPRESS SCRIPTS
7909 S HARDY DR STE 106
TEMPE, AZ 85284-1112
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dan Peterson, Chief Executive Officer
(707) 576-4564
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
7/14/2022
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