340B Drug Pricing Program Database


DSH050696 Keck Hospital of USC (Active) - information as of 6/6/2025 4:25:56 AM

Main Details
Keck Hospital of USC
Disproportionate Share Hospital
Yes
DSH050696
050696


Additional Details
Active
3/9/2010
4/1/2010
3/15/2010
8/22/2024

Contacts

Keck Medicine of USC
Rod Hanners, Chief Operating Officer
(323) 442-8677

Keck Medicine of USC
Krist Azizian, Chief Pharmacy Officer
(323) 865-3588

Addresses

1500 SAN PABLO STREET
LOS ANGELES, CA 90033

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
1/5/12 add NPI JH03/09/2010
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CAHSC30696G1952546616,1013514199
Shipping Addresses

Keck Medicine of USC - Newport Pharmacy
330 Old Newport Blvd.
RM 170
Newport Beach, CA 92663

Keck Hospital of USC Pharmacy
1500 San Pablo Street
Los Angeles, CA 90033

Safecor Health
317 New Boston St
Suite 100
Woburn, MA 01801

Safecor Health
4060 Business Park Drive
Suite B
Columbus, OH 43204

Keck Hospital of USC-Arcadia Treatment
125 W Huntington Drive Building A
A300 Room 309
Arcadia, CA 91007

Keck Hospital of USC - Norris Healthcare Center
1516 San Pablo ST
Los Angeles, CA 90033
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/13/201401/01/2015  10/13/2014
Contract DetailACCREDO HEALTH GROUP INC201 GREAT CIRCLE ROAD
NASHVILLETN3722810/13/201401/01/2015 10/04/201710/19/2017
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750210/13/201401/01/2015  10/13/2014
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/24/201707/01/2017  04/24/2017
Contract DetailACCREDO HEALTH GROUP INC2410 WARDLOW RD STE 101
CORONACA9287810/15/201801/01/2019  01/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624110/13/201401/01/2015  10/13/2014
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282210/13/201401/01/2015  10/13/2014
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/13/202210/01/2022  10/01/2022
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280904/11/202407/01/2024  07/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526107/17/202310/01/2023  10/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771307/17/202310/01/2023  10/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267007/17/202310/01/2023  10/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522610/14/202401/01/2025  01/01/2025
Contract DetailBIOSCRIP INFUSION SERVICES, INC.320 S FLOWER ST
BURBANKCA91502-210310/14/201910/15/2019 05/20/202005/22/2020
Contract DetailBIOSCRIPINFUSIONSERVICESINC320 S. FLOWER STREET
BURBANKCA9150201/13/201704/01/2017 10/14/201910/14/2019
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/17/201510/01/2015  07/17/2015
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/18/201707/01/2017  04/18/2017
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/18/201707/01/2017  04/18/2017
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/17/201510/01/2015  07/17/2015
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/17/201510/01/2015  07/17/2015
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/15/202101/01/2022  01/01/2022
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/17/201510/01/2015  07/17/2015
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/17/201510/01/2015  07/17/2015
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/17/201510/01/2015  07/17/2015
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/15/202101/01/2022  01/01/2022
Contract DetailCORAM HEALTHCARE CORP OF SOUTHERN CALIFODBA CORAM CVS/SPECIALTY INFUSION SERVICE 2710 MEDIA CENTER DRIVE, BLDG. #6,
SUITE 150 		LOS ANGELESCA9006501/13/202204/01/2022 12/01/202301/11/2024
Contract DetailCRESCENT HEALTHCARE INC11980 TELEGRAPH RD SUITE 102
SANTA FE SPRINGSCA90670-608910/17/201601/01/2017 10/14/201910/14/2019
Contract DetailCRESCENT HEALTHCARE, INC.2010 IOWA AVE. SUITE 110
RIVERSIDECA92507-743310/28/201601/01/2017 10/14/201910/14/2019
Contract DetailCRESCENT HEALTHCARE, INC.  11980 TELEGRAPH RD
STE 100 		SANTA FE SPRINGSCA9067010/28/201601/01/2017 10/14/201910/14/2019
Contract DetailCRESCENT HEALTHCARE, INC.11980 TELEGRAPH RD. SUITE 100
SANTA FE SPRINGSCA90670-608910/17/201601/01/2017 12/19/201612/19/2016
Contract DetailCRESCENT HEALTHCARE, INC.CRESCENT HEALTHCARE 11980 TELEGRAPH RD STE 100
SANTA FE SPRINGSCA90670-608910/14/201910/15/2019  10/15/2019
Contract DetailCRESCENT HEALTHCARE, INC.CRESCENT HEALTHCARE 2010 IOWA AVE STE 110
RIVERSIDECA92507-743310/14/201910/15/2019  10/15/2019
Contract DetailCRESCENT HEALTHCARE, INC.CRESCENT HEALTHCARE 11980 TELEGRAPH RD STE 102
SANTA FE SPRINGSCA90670-608710/14/201910/15/2019  10/15/2019
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/15/202101/01/2022  01/01/2022
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268310/12/202001/01/2021 07/11/202207/13/2022
Contract DetailDOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K 		GREENVILLESC29607-654007/17/202310/01/2023  10/01/2023
Contract DetailKECK MEDICINE OF USC SPECIALTY PHARMACY1000 S FREMONT AVE STE 10150
ALHAMBRACA91803-880010/13/201501/01/2016  10/13/2015
Contract DetailOPTION CAREOPTION CARE HOME CARE, INC. 9401 CHIVERS AVE.
SUN VALLEYCA91352-265510/14/201910/15/2019  10/15/2019
Contract DetailOPTION CAREOPTION CARE ENTERPRISES, INC. 5800 DISTRICT BLVD UNIT 200
BAKERSFIELDCA93313-214810/14/201910/15/2019  10/15/2019
Contract DetailOPTION CARE ENTERPRISES, INC.D/B/A OPTION CARE 11403 BLUEGRASS PARKWAY
SUITE 400 		LOUISVILLEKY40299-239810/28/201601/01/2017  10/28/2016
Contract DetailOPTION CARE ENTERPRISES, INC.OPTION CARE 5800 DISTRICT BLVD.
SUITE 200 		BAKERSFIELDCA93313-214610/28/201601/01/2017 10/14/201910/14/2019
Contract DetailOPTION CARE HOME CARE, INC.OPTION CARE 9401 CHIVERS AVE.
SUN VALLEYCA91352-265510/28/201601/01/2017 10/14/201910/14/2019
Contract DetailOPTION CARE HOME CARE, INC.OPTION CARE 4867 COLT ST.
VENTURACA93003-773110/28/201601/01/2017 07/19/201907/19/2019
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191301/14/202004/01/2020 03/16/202104/15/2021
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191310/16/202301/01/2024  01/01/2024
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260110/16/202301/01/2024  01/01/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/15/202107/01/2021  07/01/2021
Contract DetailOPTUM INFUSION SERVICES 401, LLC4610 NORTHGATE BLVD. STE. 130
SACRAMENTOCA95834-115404/15/202107/01/2021  07/01/2021
Contract DetailOPTUM INFUSION SERVICES 402, LLC2300 MAIN ST STE 150
IRVINECA92614-622304/15/202107/01/2021 10/28/202404/09/2025
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502904/15/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/14/202204/15/2022  04/21/2022
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713001/14/202004/01/2020  04/01/2020
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824904/15/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/15/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140101/14/202004/01/2020  04/01/2020
Contract DetailOPTUM PHARMACY 806, INC.2288 AUBURN BLVD STE. 102
SACRAMENTOCA95821-161801/14/202004/01/2020 12/10/202101/13/2022
Contract DetailPREMIER INFUSION AND HEALTHCARE SERVICES19500 NORMANDIE AVE
TORRANCECA9050210/14/202401/01/2025  01/01/2025
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/13/201401/01/2015  10/13/2014
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/15/202101/01/2022  01/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/15/202101/01/2022  01/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681310/15/202101/01/2022  01/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 8607 SANTA MONICA BOULEVARD
WEST HOLLYWOODCA9006901/13/202204/01/2022  04/01/2022
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255007/17/202310/01/2023  10/01/2023
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500207/17/202310/01/2023  10/01/2023
Contract DetailUNIV OF SOUTH CALIF PHARMACY3601 TROUSDALE PKWY
LOS ANGELESCA9008908/30/201009/01/2010 05/22/202307/17/2023
Contract DetailUSC I.D.S. PHARMACY1441 EASTLAKE AVE SUITE 2407
LOS ANGELESCA90089-011210/07/201010/07/2010 04/24/201904/26/2019
Contract DetailUSC MEDICAL PLAZA PHARMACY1510 SAN PABLO ST STE 144
LOS ANGELESCA90033-539408/30/201009/01/2010  03/28/2013
Contract DetailUSC PHARMACY1025 W 34TH ST STE 105
LOS ANGELESCA9008903/15/201304/01/2013 09/17/202110/15/2021
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050696AChildDSHKeck Hospital of USCOrtho1520 SAN PABLO STREETLOS ANGELESCAActive
DSH050696AAChildDSHKeck Hospital of USCTreatment Center (Infusion)1516 San Pablo StreetLos AngelesCAActive
DSH050696ABChildDSHKeck Hospital of USCKeck Medicine of USC - USC Roski Eye Institute - Ophthalmology1450 San Pablo St.Los AngelesCAActive
DSH050696ACChildDSHKeck Hospital of USCOP Surgery Center - HC3 - Ambulatory Surgery1516 San Pablo St.Los AngelesCAActive
DSH050696ADChildDSHKeck Hospital of USCKeck Medicine of USC - Huntington Beach Treatment Center - Infusion19582 Beach BoulevardHuntington BeachCATerminated
DSH050696AEChildDSHKeck Hospital of USCKeck Medicine of USC - Huntington Beach Healthcare Center - Hematology/Oncology19582 Beach BoulevardHuntington BeachCATerminated
DSH050696AFChildDSHKeck Hospital of USCArcadia Treatment Center (Arcadia Infusion) - Arcadia Infusion125 West Huntington DriveArcadiaCATerminated
DSH050696AGChildDSHKeck Hospital of USCGI Liver Clinic - Gastroenterology1510 San Pablo StLos AngelesCAActive
DSH050696BChildDSHKeck Hospital of USCTransplant Clinic1516 SAN PABLO STREETLOS ANGELESCAActive
DSH050696CChildDSHKeck Hospital of USCCystic Fibrosis1510 San Pablo StreetLOS ANGELESCAActive
DSH050696DChildDSHKeck Hospital of USCCT Surgery Clinic1520 SAN PABLO STREET, 4th FLLOS ANGELESCAActive
DSH050696FChildDSHKeck Hospital of USCESOPHAGEAL LAB1500 SAN PABLO STREETLOS ANGELESCAActive
DSH050696HChildDSHKeck Hospital of USCSleep Disorders1500 San Pablo Street, 3rd FLLos AngelesCAActive
DSH050696KChildDSHKeck Hospital of USCCVTI1520 San Pablo StreetLos AngelesCAActive
DSH050696LChildDSHKeck Hospital of USCInternal Medicine1520 San Pablo Street, Suite 1000Los Angeles,CAActive
DSH050696MChildDSHKeck Hospital of USCNeurosciences Clinic1520 San Pablo Street, 3rd FloorLos AngelesCAActive
DSH050696NChildDSHKeck Hospital of USCAmbulatory Surgery Center1537 Norfolk StreetLos AngelesCAActive
DSH050696PChildDSHKeck Hospital of USCSurgery Clinic1510 San Pablo Street, 5th FloorLos AngelesCATerminated
DSH050696QChildDSHKeck Hospital of USCKeck Pasadena Clinic - Ophthalmology625 South Fair Oaks AvenuePasadenaCAActive
DSH050696RChildDSHKeck Hospital of USCPET Imaging Center1510 San Pablo StreetLos AngelesCAActive
DSH050696SChildDSHKeck Hospital of USCImaging Center1520 San Pablo StreetLos AngelesCAActive
DSH050696TChildDSHKeck Hospital of USCBeverly Hills Clinic 9033 Wilshire BlvdBeverly HillsCATerminated
DSH050696UChildDSHKeck Hospital of USCDowntown Clinic830 South Flower St.LOS ANGELESCAActive
DSH050696VChildDSHKeck Hospital of USCENT Clinic1450 San PabloLos AngelesCAActive
DSH050696WChildDSHKeck Hospital of USCPain Management1520 San Pablo St.Los AngelesCATerminated
DSH050696XChildDSHKeck Hospital of USCKeck Pasadena Clinic - Main / Endocrinology, Cardiology, Dermatology, Rheumatology, Cardio-Thoracic Diagnostics, Family Medicine, Hepatobiliary & Pancreatic Surgery, Nutrition Medicine & Counseling, Vascular625 S. Fair OaksPasadenaCAActive
DSH050696YChildDSHKeck Hospital of USCUSC Oncology Hematology520 Superior Ave.Newport BeachCATerminated
DSH050696ZChildDSHKeck Hospital of USCUSC Oncology Hematology Infusion300 Old Newport BlvdNewport BeachCATerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/21/2023 3:00:56 PM8/22/2024 12:29:05 PM8/22/2024 12:29 PM
AddressesShipping AddressDeleteChange RequestKeck Hospital of USC - Huntington Beach Treatment Center 19582 Beach Blvd. Suite 115L Huntington Beach, CA 92648 10/16/2023 1:32 PM
DetailsLast Recertification DateUpdateRecertification8/30/2022 8:16:48 AM8/21/2023 3:00:56 PM8/21/2023 3:00 PM
AddressesShipping AddressUpdateChange RequestKeck Hospital of USC-Arcadia Treatment 125 W Huntington Drive Building A A300 Room 309 Arcadia, CA 91006Keck Hospital of USC-Arcadia Treatment 125 W Huntington Drive Building A A300 Room 309 Arcadia, CA 910071/19/2023 12:36 PM
AddressesShipping AddressUpdateChange RequestKeck Hospital of USC Orange County Pharmacy 300 Old Newport Blvd. Newport Beach, CA 92663Keck Medicine of USC - Newport Pharmacy 330 Old Newport Blvd. RM 170 Newport Beach, CA 926631/19/2023 12:36 PM
DetailsLast Recertification DateUpdateRecertification8/20/2021 11:53:01 AM8/30/2022 8:16:48 AM8/30/2022 8:16 AM
DetailsLast Recertification DateUpdateRecertification8/25/2020 1:16:31 PM8/20/2021 11:53:01 AM8/20/2021 11:53 AM
AddressesShipping AddressDeleteChange RequestKeck Hospital of USC - Huntington Beach Treatment Center 19582 Beach Blvd. Suite 115 Huntington Beach, CA 92648 4/15/2021 2:04 PM
AddressesShipping AddressInsertChange Request Keck Hospital of USC - Huntington Beach Treatment Center 19582 Beach Blvd. Suite 115L Huntington Beach, CA 926484/15/2021 2:04 PM
Medicaid BillingNPI: NumberInsertChange Request 10135141991/11/2021 6:06 PM
Medicaid BillingNPI: StateInsertChange Request CA1/11/2021 6:06 PM
Medicaid BillingNPI: StateUpdateRecertification CA8/25/2020 1:16 PM
DetailsLast Recertification DateUpdateRecertification9/10/2019 5:59:39 PM8/25/2020 1:16:31 PM8/25/2020 1:16 PM
DetailsLast Recertification DateUpdateRecertification9/5/2018 12:08:20 PM9/10/2019 5:59:39 PM9/10/2019 5:59 PM
AddressesShipping AddressInsertChange Request Keck Hospital of USC - Norris Healthcare Center 1516 San Pablo ST Los Angeles, CA 900337/22/2019 8:54 AM
AddressesShipping AddressInsertChange Request Keck Hospital of USC - Huntington Beach Treatment Center 19582 Beach Blvd. Suite 115 Huntington Beach, CA 926487/22/2019 8:54 AM
AddressesShipping AddressInsertChange Request Keck Hospital of USC-Arcadia Treatment 125 W Huntington Drive Building A A300 Room 309 Arcadia, CA 910067/17/2019 10:39 AM
ContactsPrimary ContactUpdateChange RequestGray, John Patrick Director, Enterprise 340B Operations Keck Medical Center of USC 3234428438Azizian, Krist Chief Pharmacy Officer Keck Medicine of USC 32386535882/11/2019 4:51 PM
ContactsPrimary ContactUpdateRecertificationWING, EVELYN 340B MANAGER Keck Medicine of USC 3238653611Gray, John Patrick Director, Enterprise 340B Operations Keck Medical Center of USC 32344284389/5/2018 12:08 PM
DetailsLast Recertification DateUpdateRecertification11/15/2017 3:41:16 PM9/5/2018 12:08:20 PM9/5/2018 12:08 PM
DetailsLast Recertification DateUpdateRecertification9/2/2016 12:00:00 AM11/15/2017 3:41:16 PM11/15/2017 3:41 PM
ContactsAuthorizing OfficialInsertChange Request Hanners, Rod Chief Operating Officer Keck Medicine of USC 32344286779/25/2017 1:05 PM
ContactsPrimary ContactUpdate WING, EVELYN 340B MANAGER 3238653611WING, EVELYN 340B MANAGER Keck Medicine of USC 32386536119/18/2017 5:49 PM
ContactsPrimary ContactUpdate Chellamy, Caroline Director of Ambulatory Pharmacy 3238653545WING, EVELYN 340B MANAGER 32386536119/5/2016 9:10 AM
AddressesMain AddressInsert   1500 SAN PABLO STREET LOS ANGELES, CA 900339/2/2016 4:30 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse9/2/2016 4:30 PM
DetailsLast Recertification DateUpdate 9/4/2015 12:00:00 AM9/2/2016 12:00:00 AM9/2/2016 4:30 PM
AddressesShipping AddressInsert  Keck Hospital of USC Pharmacy 1500 San Pablo Street Los Angeles, CA 9003312/2/2015 7:58 AM
AddressesShipping AddressInsert  Keck Hospital of USC Orange County Pharmacy 300 Old Newport Blvd. Newport Beach, CA 9266312/2/2015 7:58 AM
AddressesShipping AddressInsert  Safecor Health 4060 Business Park Drive Suite B Columbus, OH 4320412/2/2015 7:58 AM
AddressesShipping AddressInsert  Safecor Health 317 New Boston St Suite 100 Woburn, MA 0180112/2/2015 7:58 AM
DetailsLast Recertification DateUpdate 9/10/2014 12:00:00 AM9/4/2015 12:00:00 AM9/4/2015 7:45 AM
ContactsPrimary ContactInsert  Chellamy, Caroline Director of Ambulatory Pharmacy 32386535453/9/2015 10:53 AM
Medicaid BillingNPI: NumberInsert  19525466169/10/2014 6:55 AM
DetailsLast Recertification DateUpdate 9/12/2013 12:00:00 AM9/10/2014 12:00:00 AM9/10/2014 6:55 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/12/2013 12:00:00 AM9/12/2013 9:06 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/14/2012 9:41 AM
DetailsEntity NameUpdate USC UNIVERSITY HOSPITALKeck Hospital of USC5/14/2012 9:41 AM
DetailsEntity NameUpdate Keck Hospital of USCUSC UNIVERSITY HOSPITAL3/15/2010 12:49 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True3/9/2010 9:05 PM
Medicaid BillingMedicaid: NumberInsert  HSC30696G3/9/2010 9:05 PM
Medicaid BillingMedicaid: StateInsert  CA3/9/2010 9:05 PM
DetailsLast Recertification DateInsert   3/9/2010 9:05 PM
DetailsGrant NumberInsert   3/9/2010 9:05 PM
Details340B IDInsert  DSH0506963/9/2010 9:05 PM
DetailsIs Authorizing Official EHB DataInsert   3/9/2010 9:05 PM
DatesLast Date That 340B Drugs PurchasedInsert   3/9/2010 9:05 PM
DetailsMedicare Provider NumberInsert  0506963/9/2010 9:05 PM
DetailsEntity NameInsert  Keck Hospital of USC3/9/2010 9:05 PM
DetailsProgram CodeInsert  DSH3/9/2010 9:05 PM
DetailsEntity SubnameInsert   3/9/2010 9:05 PM
DatesParticipating Approval DateInsert  3/15/2010 12:00:00 AM3/9/2010 9:05 PM
DetailsStateInsert  Active3/9/2010 9:05 PM
DatesRegistration DateInsert  3/9/2010 12:00:00 AM3/9/2010 9:05 PM
DatesSigned By DateInsert  2/28/2010 12:00:00 AM3/9/2010 9:05 PM
DatesStart DateInsert  4/1/2010 12:00:00 AM3/9/2010 9:05 PM
TerminationsTermination CommentsInsert   3/9/2010 9:05 PM
TerminationsTermination DateInsert   3/9/2010 9:05 PM
TerminationsTermination Effective DateInsert   3/9/2010 9:05 PM
TerminationsTermination ReasonInsert   3/9/2010 9:05 PM
DetailsComments PublicInsert  1/5/12 add NPI JH3/9/2010 9:05 PM