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MCCARTHY PHARMACY INC
DSH050191 ST. MARY MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. MARY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050191
Entity Address
1050 LINDEN AVENUE
LONG BEACH, CA 90813-3393
Medicare Provider Number
050191
Participating Start Date
1/1/2017
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
MCCARTHY PHARMACY INC
Pharmacy Address
MCCARTHY DRUGS
12025 SAN VICENTE BLVD
LOS ANGELES, CA 90049
Pharmacy Comments
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leon Choiniere, Vice President/Chief Financial Officer
(562) 491-9191
Contract Pharmacy Representative
Mordechai Nikfar, Owner/Pharmacist in Charge
(310) 452-1105
Signed By Date
4/13/2017
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