340B Drug Pricing Program Database


DSH050262 RONALD REAGAN UCLA MEDICAL CENTER (Active) - information as of 6/24/2025 12:02:03 AM

Main Details
RONALD REAGAN UCLA MEDICAL CENTER
Disproportionate Share Hospital
No
DSH050262
050262


Additional Details
Active
9/11/2007
1/1/1998
9/11/2007
8/16/2024

Contacts

UCLA Health
Tammy Wallace, Chief Financial Officer Hospital System
(310) 794-8627

UCLA
Lana Balderrama, 340B Program Supervisor
(310) 267-1278

Addresses

757 WESTWOOD PLAZA
LOS ANGELES, CA 90095

Ronald Reagan UCLA Medical Center
757 Westwood Plaza,
Los Angeles, CA 90095


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
8/16/10 NPI ADDED - 6/11/09 UPDATED ENTITY NAME (WAS UCLA MEDICAL CENTER) AND ADDRESS (WAS 10833 LE CONTE AVENUE,ROOM A7-224); 12/2/08 SUBDIV NAME CHANGE (WAS DEPARTMENT OF PHARMACEUTICAL SERVICES) AND ROOM CHANGE (WAS ROOM 17-135 CHS)09/11/2007
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CAHSC30262W1902803315,1295913499,1275633224,1427156454,1710087762,1639898414,1245941848
Shipping Addresses

Ronald Reagan UCLA Outpatient Pharmacy
757 Westwood Plaza
Room B140B
Los Angeles, CA 90095

UCLA Med Ctr CHS Outpatient Pharmacy
300 Stein Plaza, Room 123
Los Angeles, CA 90095

RONALD REAGAN UCLA MEDICAL CENTER
662 GAYLEY AVENUE, ROOM B504A
LOS ANGELES, CA 90095

UCLA Medical Plaza Level IV Pharmacy
200 Medical Plaza
Suite 426
Los Angeles, CA 90095

UCLA Medical Plaza Level I Pharmacy
200 Medical Plaza
Suite 135
Los Angeles, CA 90095

Bowyer Pharmacy
200 Medical Plaza, Room 130
Los Angeles, CA 90095
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACARIAHEALTH PHARMACY #11, INC1311 W SAM HOUSTON PKWY N STE 130
HOUSTONTX77043-401507/09/202010/01/2020 12/31/202401/09/2025
Contract DetailACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310207/09/202010/01/2020 12/31/202401/09/2025
Contract DetailACARIAHEALTH PHARMACY #14, INC.4151 E COMMERCE WAY # 1041
SACRAMENTOCA95834-967907/09/202010/01/2020 12/31/202401/09/2025
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/11/201810/01/2018  10/01/2018
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/11/201810/01/2018  10/01/2018
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/11/201810/01/2018  10/01/2018
Contract DetailACCREDO HEALTH GROUP INC2410 WARDLOW RD STE 101
CORONACA9287804/15/202007/01/2020  07/01/2020
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/11/201810/01/2018  10/01/2018
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/11/201810/01/2018  10/01/2018
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/11/201810/01/2018 06/30/202311/03/2023
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607504/13/202307/01/2023  07/01/2023
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280907/13/202010/01/2020  10/01/2020
Contract DetailAETNA SPECIALTY PHARMACY, LLC503 SUNPORT LN
ORLANDOFL32809-787410/08/201901/01/2020 02/18/202103/07/2024
Contract DetailBIOLOGICS, INC.BIOLOGICS BY MCKESSON 11800 WESTON PARKWAY
CARYNC2751301/10/202304/01/2023  04/01/2023
Contract DetailBIOPLUS SPECIALTY INFUSION AL LLC2511 ROSS CLARK CIR
DOTHANAL3630101/14/201904/01/2019  04/01/2019
Contract DetailBIOPLUS SPECIALTY INFUSION CA, LLC19110 VAN NESS AVE.
TORRANCECA9050101/14/201904/01/2019  04/01/2019
Contract DetailBIOPLUS SPECIALTY INFUSION TX, LLC1748 N GREENVILLE AVE
RICHARDSONTX7508101/14/201904/01/2019  04/01/2019
Contract DetailBIOPLUS SPECIALTY PHARMACY CA7373 LINCOLN WAY
GARDEN GROVECA9284101/14/201904/01/2019  04/01/2019
Contract DetailBIOPLUS SPECIALTY PHARMACY LA, LLC2731 MANHATTAN BLVD STE B17
HARVEYLA7005801/14/201904/01/2019  04/01/2019
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/13/202307/01/2023  07/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/13/202307/01/2023  07/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/13/202307/01/2023  07/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620307/11/202410/01/2024  10/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522607/11/202410/01/2024  10/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY, INC3200 LAKE EMMA RD UNIT 1000
LAKE MARYFL3274601/14/201904/01/2019  04/01/2019
Contract DetailBRIOVARX OF MAINE INCDBA BRIOVARX 53 DARLING AVE
SOUTH PORTLANDME0410607/09/201810/01/2018 10/08/201910/08/2019
Contract DetailBRIOVARX OF MASSACHUSETTS, LLCD/B/A BRIOVARX BLDG 2 - UNIT A
145 BODWELL STREET 		AVONMA0232207/09/201810/01/2018 10/24/201910/28/2019
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/09/201810/01/2018  10/01/2018
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/09/201810/01/2018  10/01/2018
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/09/201810/01/2018  10/01/2018
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/09/201810/01/2018 07/09/201807/09/2018
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/09/201810/01/2018  10/01/2018
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/09/201810/01/2018  10/01/2018
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/09/201810/01/2018  10/01/2018
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/09/201810/01/2018  10/01/2018
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/09/201810/01/2018  10/01/2018
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/09/201810/01/2018  10/01/2018
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/13/202207/01/2022  07/01/2022
Contract DetailCENTERWELL PHARMACY, INC.10737 MARKS WAY
MIRAMARFL3302507/08/202110/01/2021 03/03/202403/19/2024
Contract DetailCENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506907/08/202110/01/2021  10/01/2021
Contract DetailCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/08/202407/01/2024  07/01/2024
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/08/202110/01/2021  10/01/2021
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/08/202110/01/2021  10/01/2021
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/13/202007/01/2020  07/01/2020
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/11/201810/01/2018  10/01/2018
Contract DetailDIPLOMAT SPECIALTY PHARMACY15211 VANOWEN ST STE 301
VAN NUYSCA9140507/11/201810/01/2018 07/01/201907/10/2019
Contract DetailDIPLOMAT SPECIALTY PHARMACYG3320 BEECHER RD
FLINTMI48532-361407/11/201810/01/2018 10/08/201910/08/2019
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268310/09/201801/01/2019 04/13/202204/13/2022
Contract DetailDIPLOMAT SPECIALTY PHARMACY OF PHOENIX,DIPLOMAT SPECIALTY PHARMACY 485 N. JUNIPER DR
CHANDLERAZ8522607/10/201910/01/2019 03/01/202104/08/2021
Contract DetailDIPLOMAT SPECIALTY PHARMACY OF SOUTHERNDIPLOMAT SPECIALTY PHARMACY 1809 EXCISE AVENUE
SUITE 204-208 		ONTARIOCA9176110/09/201801/01/2019 07/31/201907/31/2019
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/11/201810/01/2018  10/01/2018
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313410/07/202001/01/2021  01/01/2021
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/11/201810/01/2018  10/01/2018
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/11/201810/01/2018  10/01/2018
Contract DetailFOUNDATION CARE LLC111 CHESTERFIELD INDUSTRIAL BLVD STE 115
CHESTERFIELDMO6300507/09/202010/01/2020 12/31/202401/09/2025
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09493 12315 VENICE BOULEVARD
MAR VISTACA9006607/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09608 2505 SANTA MONICA BOULEVARD
SANTA MONICACA9040407/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09707 14735 VENTURA BLVD.
SHERMAN OAKSCA9140307/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08886 8601 SOUTH SEPULVEDA BOULEVARD
LOS ANGELESCA9004507/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09775 864 SWARTHMORE AVENUE
PACIFIC PALISADESCA9027207/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09576 10889 WELLWORTH AVENUE
LOS ANGELESCA9002407/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10146 12746 W. JEFFERSON BLVD., SUITE 3160
PLAYA VISTACA9009407/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09496 2900 N. SEPULVEDA BLVD.
MANHATTAN BEACHCA9026607/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08871 13171 MINDANAO WAY
MARINA DEL REYCA9029207/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09726 1411 LINCOLN BOULEVARD
SANTA MONICACA9040107/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08847 3010 SOUTH SEPULVEDA BOULEVARD
LOS ANGELESCA9003407/09/201810/01/2018  10/01/2018
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08879 8985 VENICE BOULEVARD
LOS ANGELESCA9003410/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09766 12015 WILSHIRE BOULEVARD
LOS ANGELESCA9002510/11/201801/01/2019 04/25/202210/14/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05828 1001 WESTWOOD BLVD.
LOS ANGELESCA9002410/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09582 3741 CRENSHAW BOULEVARD
LOS ANGELESCA9001610/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09669 2530 GLENDALE BOULEVARD
LOS ANGELESCA9003910/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09661 6360 WEST THIRD STREET
LOS ANGELESCA9003610/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09697 23841 MALIBU ROAD
MALIBUCA9026510/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09613 23357 MULHOLLAND DRIVE
WOODLAND HILLSCA9136410/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04792 15232 SHERMAN WAY
VAN NUYSCA9140510/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09652 8491 SANTA MONICA BLVD
WEST HOLLYWOODCA9006910/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08829 119 S. LINCOLN BLVD
VENICECA9029110/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09677 17320 VENTURA BLVD.
ENCINOCA9131610/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09767 9045 WILSHIRE BOULEVARD
BEVERLY HILLSCA9021110/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09477 5399 WEST CENTINELA AVENUE
LOS ANGELESCA9004510/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09580 5101 OBAMA BLVD
LOS ANGELESCA9001610/11/201801/01/2019 03/05/202503/11/2025
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09682 22968 VICTORY BLVD
WOODLAND HILLSCA9136710/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09627 22050 VENTURA BLVD.
WOODLAND HILLSCA9136410/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16048 10820 JEFFERSON BLVD
CULVER CITYCA9023010/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09573 6299 SOUTH BRISTOL PARKWAY
CULVER CITYCA9023010/11/201801/01/2019 03/29/202203/07/2024
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09751 5623 KANAN RD.
AGOURA HILLSCA9130110/11/201801/01/2019  01/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09618 4105 W AVENUE L
LANCASTERCA9353610/07/202001/01/2021  01/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08837 222 N. MARKET ST.
INGLEWOODCA9030110/07/202001/01/2021  01/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09668 727 S. ARROYO PARKWAY
PASADENACA9110510/07/202001/01/2021  01/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05809 4775 W. ROSECRANS AVE.
HAWTHORNECA9025010/07/202001/01/2021  01/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09778 12101 CENTRAL AVE.
CHINOCA9171010/07/202001/01/2021  01/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09615 19353 VICTORY BLVD.
RESEDACA9133510/07/202001/01/2021  01/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09531 4501 WEST SLAUSON AVENUE
LOS ANGELESCA9004310/07/202001/01/2021  01/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09617 2103 SOUTH ATLANTIC BOULEVARD
MONTEREY PARKCA9175410/07/202001/01/2021  01/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09730 2141 SOUTH HACIENDA BOULEVARD
HACIENDA HEIGHTSCA9174510/07/202001/01/2021  01/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16649 3535 S LA CIENEGA BLVD
LOS ANGELESCA9001610/12/202201/01/2023  01/01/2023
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS/PHARMACY # 2958 16461 VENTURA BLVD.
ENCINOCA9143610/12/202201/01/2023  01/01/2023
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09734 2500 W. VICTORY BLVD
BURBANKCA9150510/12/202201/01/2023  01/01/2023
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 01778 3883 E. FOOTHILL BLVD (NWC)
PASADENACA9110710/12/202201/01/2023  01/01/2023
Contract DetailGENOA HEALTHCARE LLC701 SHADOW LN STE 110
LAS VEGASNV8910601/06/202201/12/2022  01/13/2022
Contract DetailKROGER SPECIALTY PHARMACY CA 26240 WILSHIRE BLVD.
LOS ANGELESCA9004801/14/201904/01/2019 06/30/202007/06/2020
Contract DetailKROGER SPECIALTY PHARMACY FL 26435 HAZELTINE NATIONAL DR STE 140
ORLANDOFL32822-515601/14/201904/01/2019 05/16/202207/13/2022
Contract DetailKROGER SPECIALTY PHARMACY INCKROGER SPECIALTY PHARMACY CA 3 1821 KAISER AVE
IRVINECA92614-570701/14/201904/01/2019 02/28/202204/13/2022
Contract DetailKROGER SPECIALTY PHARMACY TX4280 KELLWAY CIR
ADDISONTX75001-420001/14/201904/01/2019 10/30/202012/14/2020
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09563 3458 S SEPULVEDA BLVD
LOS ANGELESCA9003407/09/201810/01/2018  10/01/2018
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09325 11941 SAN VICENTE BLVD
LOS ANGELESCA9004907/09/201810/01/2018  10/01/2018
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09527 12100 VENTURA BLVD
STUDIO CITYCA9160410/07/202001/01/2021  01/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09985 8900 SEPULVEDA WESTWAY
LOS ANGELESCA9004510/07/202001/01/2021  01/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09670 18441 VENTURA BLVD
TARZANACA9135610/12/202201/01/2023  01/01/2023
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191307/09/201810/01/2018 10/23/202012/14/2020
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191301/08/202404/01/2024  04/01/2024
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260101/08/202404/01/2024  04/01/2024
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502901/06/202104/01/2021  04/01/2021
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/06/202201/12/2022  01/13/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520401/08/202404/01/2024  04/01/2024
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/09/201810/01/2018  10/01/2018
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824901/06/202104/01/2021  04/01/2021
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/09/201810/01/2018  10/01/2018
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110107/09/201810/01/2018 04/10/202004/13/2020
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140104/13/202007/01/2020  07/01/2020
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508504/08/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 803, INC.701 SHADOW LN #110
LAS VEGASNV89106-413201/06/202104/01/2021 04/13/202204/13/2022
Contract DetailOPTUM PHARMACY 806, INC.2288 AUBURN BLVD STE. 102
SACRAMENTOCA95821-161804/13/202007/01/2020 06/18/202110/04/2021
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983810/07/202001/01/2021  01/01/2021
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660810/07/202001/01/2021 05/31/202207/13/2022
Contract DetailOWL SPECIALTY PHARMACY1010 E. ARROW HWY
COVINACA91724-102007/11/201810/01/2018 11/21/202301/11/2024
Contract DetailPANTHERX SPECIALTY LLC1120 STEVENSON MILL RD. SUITE 400
CORAOPOLISPA1510810/03/202401/01/2025  01/01/2025
Contract DetailPANTHERX SPECIALTY PHARMACY24 SUMMIT PARK DR STE 101
PITTSBURGHPA15275-110401/10/202304/01/2023  04/01/2023
Contract DetailPOLARIS SPECIALTY RX1010 E ARROW HWY
COVINACA9172401/11/202404/01/2024  04/01/2024
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/11/201810/01/2018 07/01/202208/17/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/09/201810/01/2018  10/01/2018
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 8607 SANTA MONICA BOULEVARD
WEST HOLLYWOODCA9006907/09/201810/01/2018  10/01/2018
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/13/202207/01/2022  07/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/13/202207/01/2022  07/01/2022
Contract DetailRALPH'S GROCERY CODBA RALPH'S #729 583 N. VENTU PARK RD
NEWBURY PARKCA9132001/14/201904/01/2019 10/09/201910/09/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #645 500 N SEPULVEDA BLVD
EL SEGUNDOCA9024501/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #702 14440 BURBANK BLVD
SHERMAN OAKSCA9140101/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #111 2201 W REDONDO BEACH BLVD
GARDENACA9024701/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #604 12470 SEAL BEACH BLVD
SEAL BEACHCA9074001/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #127 19781 RINALDI STREET
NORTHRIDGECA9132601/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #701 12842 VENTURA BLVD
STUDIO CITYCA9160401/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #120 1413 HAWTHORNE BLVD.
REDONDO BEACHCA9027801/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #84 29675 THE OLD ROAD NORTH
CASTAICCA9138401/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA: RALPHS #721 22333 SHERMAN WAY
CANOGA PARKCA9130301/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA: RALPHS STORE #741 674 LAS POSAS
CAMARILLOCA9301001/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS STORE #88 5035 PACIFIC COAST HIGHWAY
TORRANCECA9050501/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #280 4311 LINCOLN BLVD
MARINA DEL REYCA9029201/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #219 16325 VENTURA BLVD
ENCINOCA9143601/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #292 1644 CLOVERFIELD AVE
SANTA MONICACA9040401/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #39 260 S LA BREA AVE
LOS ANGELESCA9003601/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #147 27760 N. MCBEAN PKWY
VALENCIACA9135401/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #704 16940 DEVONSHIRE ST
GRANADA HILLSCA9134401/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #132 1770 CARSON ST
TORRANCECA9050101/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #720 30019 HAWTHORNE BLVD
RANCHO PALOS VERDESCA9027501/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #210 11727 OLYMPIC BLVD
LOS ANGELESCA9006401/14/201904/01/2019  04/01/2019
Contract DetailRALPHS GROCERY CODBA RALPHS PHARMACY #213 22915 VICTORY BLVD
WEST HILLSCA9130701/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #293 1233 N. LA BREA AVE
WEST HOLLYWOODCA9003801/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #712 1100 N SAN FERNANDO BLVD
BURBANKCA9150401/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPH #100 7257 W. SUNSET BLVD
LOS ANGLESCA9004601/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #64 14919 WHITTIER BLVD
WHITTIERCA9060501/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #757 24975 PICO CANYON RD
STEVENSON RANCHCA9138101/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS STORE #87 1050 N WESTERN AVENUE
SAN PEDROCA9073201/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS #289 5601 WILSHIRE BLVD
LOS ANGELESCA9003601/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CODBA RALPHS STORE #759 10861 WEYBURN AVE STE 201
LOS ANGELESCA9002401/15/201904/01/2019  04/01/2019
Contract DetailRALPHS GROCERY CO.DBA: RALPHS #110 3455 SEPULVEDA BLVD.
TORRANCECA9050501/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CO.DBA: RALPHS #284 10772 JEFFERSON BLVD
CULVER CITYCA9023001/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CO.DBA: RALPHS #279 4700 ADMIRALTY WAY
MARINA DEL REYCA9029201/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS GROCERY CO.DBA: RALPHS #022 645 W. 9TH ST.
LOS ANGELESCA9001501/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRALPHS PHARMACY #22214049 VENTURA BLVD
SHERMAN OAKSCA9140301/14/201904/01/2019 10/08/201910/08/2019
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/13/202307/01/2023  07/01/2023
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301307/11/202410/01/2024  10/01/2024
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022310/03/202401/01/2025  01/01/2025
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104210/03/202401/01/2025  01/01/2025
Contract DetailSINA DRUG, LLC D/B/A ONCO36015990 N GREENWAY HAYDEN LOOP STE D-100
SCOTTSDALEAZ8526010/03/202401/01/2025  01/01/2025
Contract DetailWALGREEN CODBA: WALGREENS #01813 18568 VENTURA BLVD
TARZANACA9135607/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CODBA: WALGREENS #9882 331 N PACIFIC COAST HWY
EL SEGUNDOCA90245-444407/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16382 2323 16TH ST STE 100
BAKERSFIELDCA9330107/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06445 8770 W PICO BLVD
LOS ANGELESCA9003507/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #12419 11795 W OLYMPIC BLVD
LOS ANGELESCA9006407/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15294 8490 SANTA MONICA BLVD STE 1
WEST HOLLYWOODCA9006907/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16368 3745 S LA BREA AVE STE C & D
LOS ANGELESCA9001607/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #09029 6416 TAMPA AVE
TARZANACA9133507/11/201810/01/2018 12/11/201912/11/2019
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15293 4940 VAN NUYS BLVD STE 104
SHERMAN OAKSCA9140307/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 05526 1932 WILSHIRE BLVD
SANTA MONICACA9040307/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #09685 2400 N SEPULVEDA BLVD
MANHATTAN BEACHCA9026607/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #12720 1911 LINCOLN BLVD
SANTA MONICACA9040507/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15190 1399 ROXBURY DR
LOS ANGELESCA9003507/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #11735 16100 VENTURA BLVD
ENCINOCA9143607/11/201810/01/2018 01/27/202502/10/2025
Contract DetailWALGREEN CO.DBA: WALGREENS # 07016 3724 CRENSHAW BLVD
LOS ANGELESCA9001607/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06124 9750 WOODMAN AVENUE
ARLETACA9133107/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06413 230 N LABREA AVE
INGLEWOODCA9030107/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 07070 4009 LINCOLN BLVD
MARINA DEL REYCA90292-561307/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06931 10407 SANTA MONICA BLVD
LOS ANGELESCA9002507/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06516 5467 WILSHIRE BLVD
LOS ANGELESCA9003607/11/201810/01/2018  10/01/2018
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21141 217 ALMA ST STE 200
PALO ALTOCA9430107/11/201810/01/2018  10/01/2018
Contract DetailWALGREENS MAIL SERVICE, LLCWALGREENS MAIL SERVICE #03397 8350 S RIVER PARKWAY
TEMPEAZ8528407/11/201810/01/2018  10/01/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/11/201810/01/2018  10/01/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/11/201810/01/2018  10/01/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700807/11/201810/01/2018 06/30/202110/04/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/11/201810/01/2018  10/01/2018
Contract DetailWALGREENS.COM, INC.DBA: WALGREENS 2225 S. PRICE ROAD
CHANDLERAZ8528607/11/201810/01/2018  10/01/2018
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050262AAChildDSHRONALD REAGAN UCLA MEDICAL CENTERRadiology CT - Outpatient200 Medical Plaza, Suite B165-50Los AngelesCAActive
DSH050262ABChildDSHRONALD REAGAN UCLA MEDICAL CENTERClinical & Translational Research Center10833 Le Conte Ave, Suite BE-144Los AngelesCATerminated
DSH050262ACChildDSHRONALD REAGAN UCLA MEDICAL CENTERDermatology Clinic200 Medical Plaza Suite 450Los AngelesCAActive
DSH050262ADChildDSHRONALD REAGAN UCLA MEDICAL CENTERDermatology Surgery200 Medical Plaza, Suite 465Los AngelesCAActive
DSH050262AEChildDSHRONALD REAGAN UCLA MEDICAL CENTERDoris Stein Retina Clinic200 Stein Plaza, Room 1-533Los AngelesCAActive
DSH050262AFChildDSHRONALD REAGAN UCLA MEDICAL CENTERFamily Medicine Clinic200 Medical Plaza, Suite 440Los AngelesCAActive
DSH050262AGChildDSHRONALD REAGAN UCLA MEDICAL CENTERGonda Diabetes Center200 Medical Plaza, Suite 530Los AngelesCAActive
DSH050262AHChildDSHRONALD REAGAN UCLA MEDICAL CENTERHemapheresis Unit200 Medical Plaza, Suite 670Los AngelesCAActive
DSH050262AJChildDSHRONALD REAGAN UCLA MEDICAL CENTERHyperbaric Center200 Medical Plaza, Suite B270Los AngelesCAActive
DSH050262AKChildDSHRONALD REAGAN UCLA MEDICAL CENTERInternal Medicine Clinic200 Medical Plaza, Suite 420Los AngelesCAActive
DSH050262ALChildDSHRONALD REAGAN UCLA MEDICAL CENTERMedical Specialties Suite200 Medical Plaza, Suite 365Los AngelesCAActive
DSH050262AMChildDSHRONALD REAGAN UCLA MEDICAL CENTERPediatric Heart Center200 Medical Plaza, Suite 330Los AngelesCAActive
DSH050262ANChildDSHRONALD REAGAN UCLA MEDICAL CENTERMedical Procedures Unit200 Medical Plaza, Suite 320Los AngelesCAActive
DSH050262APChildDSHRONALD REAGAN UCLA MEDICAL CENTERRadiology MRI- Outpatient100 Medical Plaza, Suite 100Los AngelesCAActive
DSH050262AQChildDSHRONALD REAGAN UCLA MEDICAL CENTERRadiology MRI - Outpatient200 Medical Plaza, Suite B165Los AngelesCAActive
DSH050262ARChildDSHRONALD REAGAN UCLA MEDICAL CENTERNeurophysiology - EEG300 Medical Plaza, Suite 2100Los AngelesCAActive
DSH050262ASChildDSHRONALD REAGAN UCLA MEDICAL CENTERNuclear Medicine Clinic200 Medical Plaza, Suite B-114Los AngelesCAActive
DSH050262ATChildDSHRONALD REAGAN UCLA MEDICAL CENTERSleep Disorder Clinic10833 Le Conte AveLos AngelesCAActive
DSH050262AUChildDSHRONALD REAGAN UCLA MEDICAL CENTERWound Care Center200 Medical Plaza, Suite 528Los AngelesCAActive
DSH050262AVChildDSHRONALD REAGAN UCLA MEDICAL CENTERPediatrics Infusion Center200 Medical Plaza, Suite 265Los AngelesCAActive
DSH050262AWChildDSHRONALD REAGAN UCLA MEDICAL CENTERConnie Frank Kidney Transplant Center200 Medical Plaza, Room 565Los AngelesCAActive
DSH050262AXChildDSHRONALD REAGAN UCLA MEDICAL CENTERThoracic Surgery, Surgical Oncology200 Medical Plaza, Suite B265Los AngelesCAActive
DSH050262AYChildDSHRONALD REAGAN UCLA MEDICAL CENTERRonald Reagn UCLA Medical Center - CTRC - Research and Sleep Disorder10833 Le Conte Avenue Suite BE-144Los AngelesCAActive
DSH050262AZChildDSHRONALD REAGAN UCLA MEDICAL CENTERSanta Clarita Radiation Oncology - Radiation Oncology27235 Tourney RdSanta ClaritaCAActive
DSH050262EChildDSHRONALD REAGAN UCLA MEDICAL CENTERPulmonary Function Lab200 Medical Plaza, Suite 302Los AngelesCAActive
DSH050262EAChildDSHRONALD REAGAN UCLA MEDICAL CENTERNuclear Medicine - Theranostics100 Medical Plaza Suite 700Los AngelesCAActive
DSH050262EBChildDSHRONALD REAGAN UCLA MEDICAL CENTERInternal Medicine - Immediate Care200 Medical PlazaLos AngelesCAActive
DSH050262ECChildDSHRONALD REAGAN UCLA MEDICAL CENTERCardiovascular - Cardiology100 Medical Plaza, Ste 700Los AngelesCAActive
DSH050262FChildDSHRONALD REAGAN UCLA MEDICAL CENTEREye and Laser OR at Stein Eye Institute with Laser Clinic300 Stein PlazaLos AngelesCAActive
DSH050262GChildDSHRONALD REAGAN UCLA MEDICAL CENTERAudiology Clinic200 Medical Plaza, Suite 540Los AngelesCAActive
DSH050262HChildDSHRONALD REAGAN UCLA MEDICAL CENTERBowyer Oncology Clinic200 Medical Plaza, Suite 120Los AngelesCAActive
DSH050262JChildDSHRONALD REAGAN UCLA MEDICAL CENTERRadiation Oncology200 Medical Plaza, Suite B265Los AngelesCAActive
DSH050262KChildDSHRONALD REAGAN UCLA MEDICAL CENTERRadiology Outpatient General Diagnostic200 Medical Plaza, Suite 165Los AngelesCAActive
DSH050262LChildDSHRONALD REAGAN UCLA MEDICAL CENTERRehabilitation - PT/OT1000 Veteran Ave, Rm A-744Los AngelesCAActive
DSH050262MChildDSHRONALD REAGAN UCLA MEDICAL CENTERSpeech Pathology Clinic200 Medical Plaza, Suite 540Los AngelesCAActive
DSH050262NChildDSHRONALD REAGAN UCLA MEDICAL CENTERSurgery Center200 Medical Plaza, Suite 660Los AngelesCAActive
DSH050262PChildDSHRONALD REAGAN UCLA MEDICAL CENTERPfleger Liver Clinic100 Medical Plaza, Suite 700Los AngelesCAActive
DSH050262QChildDSHRONALD REAGAN UCLA MEDICAL CENTERRadiology - Ultrasound100 Medical Plaza, Suite 100Los AngelesCAActive
DSH050262RChildDSHRONALD REAGAN UCLA MEDICAL CENTERRadiology Ultrasound Pediatric200 Medical Plaza, Suite 165Los AngelesCAActive
DSH050262SChildDSHRONALD REAGAN UCLA MEDICAL CENTERWest Medical OB/GYN Clinic1010 Veteran Ave, Level ILos AngelesCAActive
DSH050262TChildDSHRONALD REAGAN UCLA MEDICAL CENTERBreast Imaging Clinic200 Medical Plaza, Suite B170Los AngelesCAActive
DSH050262UChildDSHRONALD REAGAN UCLA MEDICAL CENTERWomen's Health Center100 Medical Plaza, Suite 250Los AngelesCAActive
DSH050262VChildDSHRONALD REAGAN UCLA MEDICAL CENTERBrachytherapy Clinic200 Medical Plaza, Suite B265-40Los AngelesCAActive
DSH050262WChildDSHRONALD REAGAN UCLA MEDICAL CENTERCardiopulmonary Rehabilitation100 Medical Plaza, Suite 440Los AngelesCAActive
DSH050262XChildDSHRONALD REAGAN UCLA MEDICAL CENTERCardiomyopathy Clinic200 Medical Plaza, Suite 224Los AngelesCATerminated
DSH050262YChildDSHRONALD REAGAN UCLA MEDICAL CENTERRadiology CT - Outpatient100 Medical Plaza, Suite 100Los AngelesCAActive
DSH050262ZChildDSHRONALD REAGAN UCLA MEDICAL CENTERCardiovascular Cardiomyopathy Center100 Medical Plaza, Suite 630Los AngelesCAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/16/2023 11:21:43 AM8/16/2024 12:00:02 PM8/16/2024 12:00 PM
AddressesShipping AddressInsertChange Request Bowyer Pharmacy 200 Medical Plaza, Room 130 Los Angeles, CA 900957/18/2024 12:39 PM
AddressesShipping AddressUpdateChange RequestRONALD REAGAN UCLA MEDICAL CENTER 662 GAYLEY AVENUE, ROOM 504A LOS ANGELES, CA 90095RONALD REAGAN UCLA MEDICAL CENTER 662 GAYLEY AVENUE, ROOM B504A LOS ANGELES, CA 9009511/6/2023 7:00 AM
DetailsLast Recertification DateUpdateRecertification9/9/2022 10:12:51 AM8/16/2023 11:21:43 AM8/16/2023 11:21 AM
ContactsPrimary ContactUpdateGroup Change RequestMenMuir, Kerry Director of Inpatient Pharmacy Ronald Reagan UCLA Medical Center 3102678509Balderrama, Lana 340B Program Supervisor UCLA 31026712785/16/2023 4:30 PM
Medicaid BillingNPI: NumberInsertChange Request 124594184812/9/2022 2:21 PM
Medicaid BillingNPI: StateInsertChange Request CA12/9/2022 2:21 PM
AddressesShipping AddressUpdateChange RequestRonald Reagan UCLA Outpatient Pharmacy 662 Gayley Ave Room B140B Los Angeles, CA 90095Ronald Reagan UCLA Outpatient Pharmacy 757 Westwood Plaza Room B140B Los Angeles, CA 9009511/16/2022 2:17 PM
Medicaid BillingNPI: NumberInsertChange Request 163989841410/12/2022 2:33 PM
Medicaid BillingNPI: StateInsertChange Request CA10/12/2022 2:33 PM
DetailsLast Recertification DateUpdateRecertification8/27/2021 12:16:07 PM9/9/2022 10:12:51 AM9/9/2022 10:12 AM
ContactsAuthorizing OfficialUpdateAO Change RequestStaton, Paul CFO UCLA Medical Center 3102679308Wallace, Tammy Chief Financial Officer Hospital System UCLA Health 31079486276/21/2022 6:27 AM
DetailsLast Recertification DateUpdateRecertification8/18/2020 1:06:31 PM8/27/2021 12:16:07 PM8/27/2021 12:16 PM
Medicaid BillingNPI: StateUpdateRecertification CA8/18/2020 1:06 PM
Medicaid BillingNPI: StateUpdateRecertification CA8/18/2020 1:06 PM
Medicaid BillingNPI: StateUpdateRecertification CA8/18/2020 1:06 PM
Medicaid BillingNPI: StateUpdateRecertification CA8/18/2020 1:06 PM
Medicaid BillingNPI: StateUpdateRecertification CA8/18/2020 1:06 PM
DetailsLast Recertification DateUpdateRecertification8/21/2019 8:26:34 PM8/18/2020 1:06:31 PM8/18/2020 1:06 PM
ContactsPrimary ContactUpdateProfile Change RequestMen Muir, Kerry Director of Inpatient Pharmacy Ronald Reagan UCLA Medical Center 3102678509MenMuir, Kerry Director of Inpatient Pharmacy Ronald Reagan UCLA Medical Center 310267850912/5/2019 4:45 PM
ContactsPrimary ContactUpdateProfile Change RequestMen Muir, Kerry Interim Chief of Pharmacy Ronald Reagan UCLA Medical Center 3102678509Men Muir, Kerry Director of Inpatient Pharmacy Ronald Reagan UCLA Medical Center 310267850912/4/2019 2:31 PM
AddressesShipping AddressDeleteChange RequestSafecor 4060 Business Park Dr, Suite B Columbus, OH 43204 11/7/2019 1:33 PM
AddressesShipping AddressDeleteChange RequestSafecor 317 New Boston St, Suite 100 Woburn, MA 01801 11/7/2019 1:33 PM
DetailsLast Recertification DateUpdateRecertification8/22/2018 8:42:19 AM8/21/2019 8:26:34 PM8/21/2019 8:26 PM
DetailsLast Recertification DateUpdateRecertification11/13/2017 10:17:39 AM8/22/2018 8:42:19 AM8/22/2018 8:42 AM
Medicaid BillingNPI: NumberInsertChange Request 12959134994/17/2018 1:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12756332244/17/2018 1:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14271564544/17/2018 1:45 PM
Medicaid BillingNPI: NumberInsertChange Request 17100877624/17/2018 1:45 PM
AddressesShipping AddressInsertChange Request Safecor 4060 Business Park Dr, Suite B Columbus, OH 432041/17/2018 3:15 PM
AddressesShipping AddressInsertChange Request Safecor 317 New Boston St, Suite 100 Woburn, MA 018011/17/2018 3:15 PM
AddressesBilling AddressUpdateChange RequestRONALD REAGAN MEDICAL CENTER File 2009 LOS ANGELES, CA 90074Ronald Reagan UCLA Medical Center 757 Westwood Plaza, Los Angeles, CA 9009512/15/2017 11:20 AM
DetailsLast Recertification DateUpdateRecertification10/25/2017 11:25:42 AM11/13/2017 10:17:39 AM11/13/2017 10:17 AM
DetailsLast Recertification DateUpdateRecertification8/29/2016 12:00:00 AM10/25/2017 11:25:42 AM10/25/2017 11:25 AM
ContactsPrimary ContactInsertChange Request Men Muir, Kerry Interim Chief of Pharmacy Ronald Reagan UCLA Medical Center 310267850910/16/2017 12:09 PM
ContactsAuthorizing OfficialUpdate Staton, Paul CFO 3102679308Staton, Paul CFO UCLA Medical Center 310267930810/10/2017 5:41 PM
ContactsAuthorizing OfficialUpdate RUBIN, AMIR COO 3102679302Staton, Paul CFO 31026793084/26/2017 10:13 AM
AddressesMain AddressInsert   757 WESTWOOD PLAZA LOS ANGELES, CA 900954/26/2017 10:12 AM
AddressesBilling AddressInsert  RONALD REAGAN MEDICAL CENTER File 2009 LOS ANGELES, CA 900744/26/2017 10:12 AM
AddressesShipping AddressInsert  RONALD REAGAN UCLA MEDICAL CENTER 662 GAYLEY AVENUE, ROOM 504A LOS ANGELES, CA 900954/26/2017 10:12 AM
AddressesShipping AddressInsert  Ronald Reagan UCLA Outpatient Pharmacy 662 Gayley Ave Room B140B Los Angeles, CA 900954/26/2017 10:12 AM
AddressesShipping AddressInsert  UCLA Medical Plaza Level I Pharmacy 200 Medical Plaza Suite 135 Los Angeles, CA 900954/26/2017 10:12 AM
AddressesShipping AddressInsert  UCLA Medical Plaza Level IV Pharmacy 200 Medical Plaza Suite 426 Los Angeles, CA 900954/26/2017 10:12 AM
AddressesShipping AddressInsert  UCLA Med Ctr CHS Outpatient Pharmacy 300 Stein Plaza, Room 123 Los Angeles, CA 900954/26/2017 10:12 AM
DetailsLast Recertification DateUpdate 8/31/2015 12:00:00 AM8/29/2016 12:00:00 AM8/31/2016 12:55 PM
DetailsLast Recertification DateUpdate 8/28/2014 12:00:00 AM8/31/2015 12:00:00 AM9/1/2015 11:59 AM
DetailsLast Recertification DateUpdate 9/10/2013 12:00:00 AM8/28/2014 12:00:00 AM8/28/2014 3:55 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/10/2013 12:00:00 AM9/10/2013 8:18 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False5/14/2012 8:20 AM
Medicaid BillingMedicaid: NumberInsert  HSC30262W5/14/2012 8:20 AM
Medicaid BillingMedicaid: StateInsert  CA5/14/2012 8:20 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/14/2012 8:20 AM
ContactsAuthorizing OfficialInsert  RUBIN, AMIR COO 31026793028/16/2010 12:59 PM
Medicaid BillingNPI: NumberInsert  19028033159/11/2007 7:29 AM
DetailsLast Recertification DateInsert   9/11/2007 7:29 AM
DetailsGrant NumberInsert   9/11/2007 7:29 AM
Details340B IDInsert  DSH0502629/11/2007 7:29 AM
DetailsIs Authorizing Official EHB DataInsert   9/11/2007 7:29 AM
DatesLast Date That 340B Drugs PurchasedInsert   9/11/2007 7:29 AM
DetailsMedicare Provider NumberInsert  0502629/11/2007 7:29 AM
DetailsEntity NameInsert  RONALD REAGAN UCLA MEDICAL CENTER9/11/2007 7:29 AM
DetailsProgram CodeInsert  DSH9/11/2007 7:29 AM
DetailsEntity SubnameInsert   9/11/2007 7:29 AM
DatesParticipating Approval DateInsert  9/11/2007 12:00:00 AM9/11/2007 7:29 AM
DetailsStateInsert  Active9/11/2007 7:29 AM
DatesRegistration DateInsert  9/11/2007 12:00:00 AM9/11/2007 7:29 AM
DatesSigned By DateInsert   9/11/2007 7:29 AM
DatesStart DateInsert  1/1/1998 12:00:00 AM9/11/2007 7:29 AM
TerminationsTermination CommentsInsert   9/11/2007 7:29 AM
TerminationsTermination DateInsert   9/11/2007 7:29 AM
TerminationsTermination Effective DateInsert   9/11/2007 7:29 AM
TerminationsTermination ReasonInsert   9/11/2007 7:29 AM
DetailsComments PublicInsert  8/16/10 NPI ADDED - 6/11/09 UPDATED ENTITY NAME (WAS UCLA MEDICAL CENTER) AND ADDRESS (WAS 10833 LE CONTE AVENUE,ROOM A7-224); 12/2/08 SUBDIV NAME CHANGE (WAS DEPARTMENT OF PHARMACEUTICAL SERVICES) AND ROOM CHANGE (WAS ROOM 17-135 CHS)9/11/2007 7:29 AM