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CORAM HEALTHCARE CORP OF SOUTHERN CALIFO
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
CORAM HEALTHCARE CORP OF SOUTHERN CALIFO
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
3002 DOW AVENUE
STE 104
TUSTIN, CA 92780
Pharmacy Comments
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/30/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kristi Liberatore, Chief Financial Officer
(714) 771-8281
Contract Pharmacy Representative
St. Joseph Hospital, Orange
Kristi Liberatore, Chief Financial Officer
(714) 771-8281
Signed By Date
10/13/2017
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