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ACCREDO HEALTH GROUP INC
DSH050353 PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050353
Entity Address
4101 TORRANCE BLVD.
TORRANCE, CA 90503
Medicare Provider Number
050353
Participating Start Date
4/1/2007
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP INC
Pharmacy Address
2040 W RIO SALADO PKWY STE 101B
TEMPE, AZ 85281-2010
Pharmacy Comments
Contract Details
Approval Date
8/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ted Wang, CFO
(310) 303-6114
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
8/7/2017
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