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FORTIFY MARKET
DSH050013 St. Helena Hospital, DBA Adventist Health St. Helena
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Covered Entity Details
Entity Name
St. Helena Hospital, DBA Adventist Health St. Helena
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050013
Entity Address
10 WOODLAND ROAD
ST. HELENA, CA 94574
Medicare Provider Number
050013
Participating Start Date
4/1/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
FORTIFY MARKET
Pharmacy Address
ONE ADVENTIST HEALTH WAY
ROSEVILLE, CA 95661
Pharmacy Comments
Contract Details
Approval Date
10/23/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven Herber, CEO
(707) 963-6433
Contract Pharmacy Representative
Adventist Health
Mandy Kazminy, Pharmacy Manager
(916) 406-0188
Signed By Date
10/23/2022
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