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MISSION MEDICAL PHARMACY
RRC050567-00 MISSION HOSPITAL REG MEDICAL CENTER
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Covered Entity Details
Entity Name
MISSION HOSPITAL REG MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC050567-00
Entity Address
27700 MEDICAL CENTER ROAD
MISSION VIEJO, CA 92691
Medicare Provider Number
050567
Participating Start Date
1/1/2021
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MISSION MEDICAL PHARMACY
Pharmacy Address
27800 MEDICAL CENTER RD
#99
MISSION VIEJO, CA 92691
Pharmacy Comments
Contract Details
Approval Date
7/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eileen Haubl, Chief Financial Officer
(949) 364-1400 Ext: 5408
Contract Pharmacy Representative
Mission Medical Pharmacy
Amit Patel, Pharmacy Director
(949) 364-0122
Signed By Date
7/13/2023
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