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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03674
12002 HARBOR BLVD.
GARDEN GROVE, CA 92840
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
11/14/2019
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
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