Yes
CA | 0247625,HSP40485G,HSC40485G | 1972514503,1891890158,1962442012,1053653782 |
DSH050485A | Child | DSH | Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center | LBM Multi-Specialty Center - Adult specialty clinic | 2865 Atlantic Ave, Suite 104 | Long Beach | CA | Active |
DSH050485B | Child | DSH | Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center | CNC Ambulatory Infusion Program | 2810 Long Beach Blvd | Long Beach | CA | Active |
DSH050485C | Child | DSH | Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center | TCI Specialty Center (3rd Floor) | 2810 Long Beach Blvd | Long Beach | CA | Active |
DSH050485D | Child | DSH | Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center | LBMC Multi-Specialty Center - Cardiology | 2865 Atlantic Ave, Suite 210 | Long Beach | CA | Terminated |
DSH050485E | Child | DSH | Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center | TCI SPECIALTY CLINIC - 2ND FLOOR | 2810 Long Beach Blvd | Long Beach | CA | Active |
DSH050485F | Child | DSH | Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center | PET Scanning - PET Scanning | 2888 Long Beach Blvd | Long Beach | CA | Active |
Contacts | Primary Contact | Update | Change Request | Chang, Jennifer T
Executive Director, Pharmacy Services
Long Beach Medical Center & Millier Children's and Women's Hospital
5629330282 | French, Suzanne
Manager, 340B Program
MemorialCare
7144864693 | 6/10/2025 7:04 AM |
Contacts | Authorizing Official | Update | Change Request | Kent, Blair
Chief Executive Officer
Long Beach Medical Center
5629331111 | Beirne, Frank
Chief Executive Officer
MemorialCare Long Beach Medical Center
5629331111 | 5/9/2025 6:46 AM |
Details | State | Update | | Approved | Active | 1/1/2025 12:01 AM |
Contacts | Authorizing Official | Update | Change Request | Pilgrim, Patti
Chief Financial Officer
MemorialCare Long beach medical Center/Miller children's & Women's Hospital
5629331905 | Kent, Blair
Chief Executive Officer
Long Beach Medical Center
5629331111 | 12/12/2024 1:37 PM |
Contacts | Signed By | Insert | New Registration | | Pilgrim, Patti
Chief Financial Officer
MemorialCare Long beach medical Center/Miller children's & Women's Hospital
5629331905 | 10/8/2024 7:58 AM |
Details | 340B ID | Update | New Registration | | DSH050485F | 10/8/2024 7:58 AM |
Details | Entity Name | Update | New Registration | MEMORIALCARE LONG BEACH MED CTR | Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center | 10/8/2024 7:58 AM |
Details | Entity Subname | Update | New Registration | PET Scanning | PET Scanning - PET Scanning | 10/8/2024 7:58 AM |
Dates | Participating Approval Date | Update | New Registration | | 10/8/2024 7:58:59 AM | 10/8/2024 7:58 AM |
Details | State | Update | New Registration | Pending | Approved | 10/8/2024 7:58 AM |
Dates | Signed By Date | Update | New Registration | | 10/7/2024 10:57:02 AM | 10/8/2024 7:58 AM |
Dates | Start Date | Update | New Registration | | 1/1/2025 12:00:00 AM | 10/8/2024 7:58 AM |
Addresses | Main Address | Insert | New Registration | |
2888 Long Beach Blvd
110
Long Beach, CA 90806 | 10/2/2024 4:52 PM |
Addresses | Billing Address | Insert | New Registration | | Long Beach Memorial Medical Center
17360 Brookhurst Street
Fountain Valley, CA 92708 | 10/2/2024 4:52 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 10/2/2024 4:52 PM |
Medicaid Billing | Medicaid: Number | Insert | New Registration | | 0247625 | 10/2/2024 4:52 PM |
Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 10/2/2024 4:52 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 10/2/2024 4:52 PM |
Medicaid Billing | Medicaid: Number | Insert | New Registration | | HSP40485G | 10/2/2024 4:52 PM |
Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 10/2/2024 4:52 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 10/2/2024 4:52 PM |
Medicaid Billing | Medicaid: Number | Insert | New Registration | | HSC40485G | 10/2/2024 4:52 PM |
Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 10/2/2024 4:52 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1972514503 | 10/2/2024 4:52 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | CA | 10/2/2024 4:52 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1891890158 | 10/2/2024 4:52 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | CA | 10/2/2024 4:52 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1962442012 | 10/2/2024 4:52 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | CA | 10/2/2024 4:52 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1053653782 | 10/2/2024 4:52 PM |
Medicaid Billing | NPI: State | Insert | New Registration | | CA | 10/2/2024 4:52 PM |
Contacts | Primary Contact | Insert | New Registration | | Chang, Jennifer T
Executive Director, Pharmacy Services
Long Beach Medical Center & Millier Children's and Women's Hospital
5629330282 | 10/2/2024 4:52 PM |
Contacts | Authorizing Official | Insert | New Registration | | Pilgrim, Patti
Chief Financial Officer
MemorialCare Long beach medical Center/Miller children's & Women's Hospital
5629331905 | 10/2/2024 4:52 PM |
Details | Assistance Received From Date | Insert | New Registration | | | 10/2/2024 4:52 PM |
Details | Assistance Received To Date | Insert | New Registration | | | 10/2/2024 4:52 PM |
Details | Last Recertification Date | Insert | New Registration | | | 10/2/2024 4:52 PM |
Details | Grant Number | Insert | New Registration | | | 10/2/2024 4:52 PM |
Details | 340B ID | Insert | New Registration | | | 10/2/2024 4:52 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/2/2024 4:52 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/2/2024 4:52 PM |
Details | Medicare Provider Number | Insert | New Registration | | 050485 | 10/2/2024 4:52 PM |
Details | Entity Name | Insert | New Registration | | MEMORIALCARE LONG BEACH MED CTR | 10/2/2024 4:52 PM |
Details | NOFO Number | Insert | New Registration | | | 10/2/2024 4:52 PM |
Details | Program Code | Insert | New Registration | | DSH | 10/2/2024 4:52 PM |
Details | Entity Subname | Insert | New Registration | | PET Scanning | 10/2/2024 4:52 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 10/2/2024 4:52 PM |
Details | State | Insert | New Registration | | Pending | 10/2/2024 4:52 PM |
Dates | Registration Date | Insert | New Registration | | 10/2/2024 4:52:21 PM | 10/2/2024 4:52 PM |
Dates | Signed By Date | Insert | New Registration | | | 10/2/2024 4:52 PM |
Dates | Start Date | Insert | New Registration | | | 10/2/2024 4:52 PM |
Terminations | Termination Comments | Insert | New Registration | | | 10/2/2024 4:52 PM |
Terminations | Termination Date | Insert | New Registration | | | 10/2/2024 4:52 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 10/2/2024 4:52 PM |
Terminations | Termination Reason | Insert | New Registration | | | 10/2/2024 4:52 PM |