340B Drug Pricing Program Database


DSH050485F Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center (Active) - information as of 6/21/2025 10:40:25 PM

Main Details
Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center
PET Scanning - PET Scanning
Disproportionate Share Hospital
No
DSH050485F
050485


Additional Details
Active
10/2/2024
1/1/2025
10/8/2024

Contacts

MemorialCare Long Beach Medical Center
Frank Beirne, Chief Executive Officer
(562) 933-1111

MemorialCare
Suzanne French, Manager, 340B Program
(714) 486-4693

Addresses

2888 Long Beach Blvd
110
Long Beach, CA 90806

Long Beach Memorial Medical Center
17360 Brookhurst Street
Fountain Valley, CA 92708


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CA0247625,HSP40485G,HSC40485G1972514503,1891890158,1962442012,1053653782
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050485AChildDSHLong Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical CenterLBM Multi-Specialty Center - Adult specialty clinic2865 Atlantic Ave, Suite 104Long BeachCAActive
DSH050485BChildDSHLong Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical CenterCNC Ambulatory Infusion Program2810 Long Beach BlvdLong BeachCAActive
DSH050485CChildDSHLong Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical CenterTCI Specialty Center (3rd Floor)2810 Long Beach BlvdLong BeachCAActive
DSH050485DChildDSHLong Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical CenterLBMC Multi-Specialty Center - Cardiology2865 Atlantic Ave, Suite 210Long BeachCATerminated
DSH050485EChildDSHLong Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical CenterTCI SPECIALTY CLINIC - 2ND FLOOR2810 Long Beach BlvdLong BeachCAActive
DSH050485FChildDSHLong Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical CenterPET Scanning - PET Scanning2888 Long Beach BlvdLong BeachCAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateChange RequestChang, Jennifer T Executive Director, Pharmacy Services Long Beach Medical Center & Millier Children's and Women's Hospital 5629330282French, Suzanne Manager, 340B Program MemorialCare 71448646936/10/2025 7:04 AM
ContactsAuthorizing OfficialUpdateChange RequestKent, Blair Chief Executive Officer Long Beach Medical Center 5629331111Beirne, Frank Chief Executive Officer MemorialCare Long Beach Medical Center 56293311115/9/2025 6:46 AM
DetailsStateUpdate ApprovedActive1/1/2025 12:01 AM
ContactsAuthorizing OfficialUpdateChange RequestPilgrim, Patti Chief Financial Officer MemorialCare Long beach medical Center/Miller children's & Women's Hospital 5629331905Kent, Blair Chief Executive Officer Long Beach Medical Center 562933111112/12/2024 1:37 PM
ContactsSigned ByInsertNew Registration Pilgrim, Patti Chief Financial Officer MemorialCare Long beach medical Center/Miller children's & Women's Hospital 562933190510/8/2024 7:58 AM
Details340B IDUpdateNew Registration DSH050485F10/8/2024 7:58 AM
DetailsEntity NameUpdateNew RegistrationMEMORIALCARE LONG BEACH MED CTRLong Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center10/8/2024 7:58 AM
DetailsEntity SubnameUpdateNew RegistrationPET ScanningPET Scanning - PET Scanning10/8/2024 7:58 AM
DatesParticipating Approval DateUpdateNew Registration 10/8/2024 7:58:59 AM10/8/2024 7:58 AM
DetailsStateUpdateNew RegistrationPendingApproved10/8/2024 7:58 AM
DatesSigned By DateUpdateNew Registration 10/7/2024 10:57:02 AM10/8/2024 7:58 AM
DatesStart DateUpdateNew Registration 1/1/2025 12:00:00 AM10/8/2024 7:58 AM
AddressesMain AddressInsertNew Registration  2888 Long Beach Blvd 110 Long Beach, CA 9080610/2/2024 4:52 PM
AddressesBilling AddressInsertNew Registration Long Beach Memorial Medical Center 17360 Brookhurst Street Fountain Valley, CA 9270810/2/2024 4:52 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/2/2024 4:52 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 024762510/2/2024 4:52 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA10/2/2024 4:52 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/2/2024 4:52 PM
Medicaid BillingMedicaid: NumberInsertNew Registration HSP40485G10/2/2024 4:52 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA10/2/2024 4:52 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/2/2024 4:52 PM
Medicaid BillingMedicaid: NumberInsertNew Registration HSC40485G10/2/2024 4:52 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA10/2/2024 4:52 PM
Medicaid BillingNPI: NumberInsertNew Registration 197251450310/2/2024 4:52 PM
Medicaid BillingNPI: StateInsertNew Registration CA10/2/2024 4:52 PM
Medicaid BillingNPI: NumberInsertNew Registration 189189015810/2/2024 4:52 PM
Medicaid BillingNPI: StateInsertNew Registration CA10/2/2024 4:52 PM
Medicaid BillingNPI: NumberInsertNew Registration 196244201210/2/2024 4:52 PM
Medicaid BillingNPI: StateInsertNew Registration CA10/2/2024 4:52 PM
Medicaid BillingNPI: NumberInsertNew Registration 105365378210/2/2024 4:52 PM
Medicaid BillingNPI: StateInsertNew Registration CA10/2/2024 4:52 PM
ContactsPrimary ContactInsertNew Registration Chang, Jennifer T Executive Director, Pharmacy Services Long Beach Medical Center & Millier Children's and Women's Hospital 562933028210/2/2024 4:52 PM
ContactsAuthorizing OfficialInsertNew Registration Pilgrim, Patti Chief Financial Officer MemorialCare Long beach medical Center/Miller children's & Women's Hospital 562933190510/2/2024 4:52 PM
DetailsAssistance Received From DateInsertNew Registration  10/2/2024 4:52 PM
DetailsAssistance Received To DateInsertNew Registration  10/2/2024 4:52 PM
DetailsLast Recertification DateInsertNew Registration  10/2/2024 4:52 PM
DetailsGrant NumberInsertNew Registration  10/2/2024 4:52 PM
Details340B IDInsertNew Registration  10/2/2024 4:52 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/2/2024 4:52 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/2/2024 4:52 PM
DetailsMedicare Provider NumberInsertNew Registration 05048510/2/2024 4:52 PM
DetailsEntity NameInsertNew Registration MEMORIALCARE LONG BEACH MED CTR10/2/2024 4:52 PM
DetailsNOFO NumberInsertNew Registration  10/2/2024 4:52 PM
DetailsProgram CodeInsertNew Registration DSH10/2/2024 4:52 PM
DetailsEntity SubnameInsertNew Registration PET Scanning10/2/2024 4:52 PM
DatesParticipating Approval DateInsertNew Registration  10/2/2024 4:52 PM
DetailsStateInsertNew Registration Pending10/2/2024 4:52 PM
DatesRegistration DateInsertNew Registration 10/2/2024 4:52:21 PM10/2/2024 4:52 PM
DatesSigned By DateInsertNew Registration  10/2/2024 4:52 PM
DatesStart DateInsertNew Registration  10/2/2024 4:52 PM
TerminationsTermination CommentsInsertNew Registration  10/2/2024 4:52 PM
TerminationsTermination DateInsertNew Registration  10/2/2024 4:52 PM
TerminationsTermination Effective DateInsertNew Registration  10/2/2024 4:52 PM
TerminationsTermination ReasonInsertNew Registration  10/2/2024 4:52 PM