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INFUSION CARE PHARMACY NORTH
DSH050678 ORANGE COAST MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ORANGE COAST MEMORIAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050678
Entity Address
9920 TALBERT AVENUE
FOUNTAIN VALLEY, CA 92708
Medicare Provider Number
050678
Participating Start Date
4/1/2014
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
INFUSION CARE PHARMACY NORTH
Pharmacy Address
455 E COLUMBIA ST
SUITE 10
LONG BEACH, CA 90806
Pharmacy Comments
Contract Details
Approval Date
4/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
Steve McNamara, CFO
(714) 378-7414
Contract Pharmacy Representative
Scott Preston, Director of Pharmacy
(562) 933-0328
Signed By Date
4/14/2015
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