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CREDENA HEALTH LLC
DSH050069 ST. JOSEPH HOSPITAL OF ORANGE
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Covered Entity Details
Entity Name
ST. JOSEPH HOSPITAL OF ORANGE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050069
Entity Address
1100 WEST STEWART DRIVE
ORANGE, CA 92868
Medicare Provider Number
050069
Participating Start Date
7/1/2012
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
CREDENA HEALTH LLC
Pharmacy Address
7376 SW DURHAM RD
PORTLAND, OR 97224
Pharmacy Comments
Contract Details
Approval Date
1/17/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eileen Haubl, Chief Financial Officer
(949) 364-1400 Ext: 5408
Contract Pharmacy Representative
Providence St. Joseph Health
Glenn W Wachter, Outpatient Ops Strat Exec Dir, Pharmacy
(503) 962-1743
Signed By Date
1/17/2024
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