Contract Pharmacy Details

WALGREEN CO.
DSH050069 ST. JOSEPH HOSPITAL OF ORANGE

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 01232
27785 SANTA MARGARITA PKWY
MISSION VIEJO, CA 92691

Pharmacy Comments

Contract Details

Approval Date

10/15/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/6/2015
Pharmacy closed

Contacts

Covered Entity Signing Official

Kristi Liberatore, Chief Financial Officer
(714) 771-8281

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/15/2014

340B Drug Pricing Program Database