Covered Entity Details

DSH050348BU UCI MEDICAL CENTER (Terminated) - information as of 6/9/2025 10:58:30 PM

Main Details

Name

UCI MEDICAL CENTER

Subdivision Name

Audiology 7215

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH050348BU

Medicare Provider Number

050348

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

5/14/2012

Participating Start Date

7/1/2012

Participating Approval Date

6/6/2012

Last Recertification Date

8/29/2016

Termination Date
Termination Reason

10/1/2016
Site closure

Contacts

Authorizing Official

UCI Health
Chad Thurman Lefteris, CEO
(714) 714-1423

Primary Contact

UCI Health
Melanie Joe, Chief Pharmacy Officer
(714) 456-5514

Addresses

Street Address

101 The City Dr S
Audiology 7215
Orange, CA 92868

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
CA	ZZT40348W
		1689608150

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH050348AA	Child	DSH	UCI MEDICAL CENTER	Breast Center	101 The City Dr S.	Orange	CA	Active
DSH050348AB	Child	DSH	UCI MEDICAL CENTER	Clinic Medical Specialty	101 The City Dr. S	Orange	CA	Active
DSH050348AC	Child	DSH	UCI MEDICAL CENTER	CDDC Clinic	101 The City Dr. S	Orange	CA	Active
DSH050348AD	Child	DSH	UCI MEDICAL CENTER	Emergency Department 7231	101 The City Dr. S.	Orange	CA	Terminated
DSH050348AE	Child	DSH	UCI MEDICAL CENTER	Operating room 7021	101 The City Dr South	Orange	CA	Terminated
DSH050348AF	Child	DSH	UCI MEDICAL CENTER	Recovery Room Surgery 7022	101 The City Dr. South	Orange	CA	Terminated
DSH050348AG	Child	DSH	UCI MEDICAL CENTER	Surgery Pre and Post Op 7023	101 The City Dr. S	Orange	CA	Terminated
DSH050348AH	Child	DSH	UCI MEDICAL CENTER	Ambulatory Surgery 7031	101 The City Dr. S	Orange	CA	Terminated
DSH050348AJ	Child	DSH	UCI MEDICAL CENTER	Beckman Surgery Laser Center 7033	1002 Health Sciences Road East	Irvine	CA	Terminated
DSH050348AK	Child	DSH	UCI MEDICAL CENTER	Clinic Aesthetic and Plastic Surgery	200 S. Manchester Ave	Orange	CA	Active
DSH050348AL	Child	DSH	UCI MEDICAL CENTER	Plastic Surgery Center	200 S. Manchester Ave	Orange	CA	Terminated
DSH050348AM	Child	DSH	UCI MEDICAL CENTER	Labor and Delivery 7011	101 The City Dr. S	Orange	CA	Terminated
DSH050348AN	Child	DSH	UCI MEDICAL CENTER	Anesthesiology 7040	101 The City Dr. S	Orange	CA	Terminated
DSH050348AP	Child	DSH	UCI MEDICAL CENTER	Anesthesia Pre-Op Clinic 7423	101 The City Dr. S	Orange	CA	Terminated
DSH050348AQ	Child	DSH	UCI MEDICAL CENTER	Radiology Diagnostic	101 The City Dr S	Orange	CA	Active
DSH050348AR	Child	DSH	UCI MEDICAL CENTER	Radiology Special	101 The City Dr. S	Orange	CA	Active
DSH050348AS	Child	DSH	UCI MEDICAL CENTER	Radiology Plaza	1 Medical Plaza Drive	Irvine	CA	Active
DSH050348AT	Child	DSH	UCI MEDICAL CENTER	Radiology Cancer Center	101 The City Dr S	Orange	CA	Terminated
DSH050348AU	Child	DSH	UCI MEDICAL CENTER	CT Scanner	101 The City Dr. S	Orange	CA	Active
DSH050348AV	Child	DSH	UCI MEDICAL CENTER	GHEI Orange Ophthalmology Clinic	101 The City Dr S	Orange	CA	Active
DSH050348AW	Child	DSH	UCI MEDICAL CENTER	Clinics Neurology	101 The City Dr	Orange	CA	Active
DSH050348AX	Child	DSH	UCI MEDICAL CENTER	Anesthesiology Regional 7041	101 The City Dr	Orange	CA	Terminated
DSH050348AY	Child	DSH	UCI MEDICAL CENTER	Ambulatory PACU 7032	101 The City Dr. S	Orange	CA	Terminated
DSH050348AZ	Child	DSH	UCI MEDICAL CENTER	PET Scan	101 The City Dr. S	Orange	CA	Active
DSH050348BA	Child	DSH	UCI MEDICAL CENTER	Pavillion Imaging	101 The City Dr. S	Orange	CA	Active
DSH050348BB	Child	DSH	UCI MEDICAL CENTER	Magnetic Resonance Imaging	101 The City Dr. S	Orange	CA	Active
DSH050348BC	Child	DSH	UCI MEDICAL CENTER	Radiation Oncology	101 The City Dr. South	Orange	CA	Active
DSH050348BD	Child	DSH	UCI MEDICAL CENTER	Molecular Imaging	101 The City Dr S	Orange	CA	Active
DSH050348BE	Child	DSH	UCI MEDICAL CENTER	Hematology/Coagulation	101 The City Dr S	Orange	CA	Terminated
DSH050348BF	Child	DSH	UCI MEDICAL CENTER	Microbiology 7062	101 The City Dr S	Orange	CA	Terminated
DSH050348BG	Child	DSH	UCI MEDICAL CENTER	Chemistry 7063	101 The City Dr. S	Orange	CA	Terminated
DSH050348BH	Child	DSH	UCI MEDICAL CENTER	Outside Lab	101 The City Dr. S	Orange	CA	Terminated
DSH050348BJ	Child	DSH	UCI MEDICAL CENTER	Lab Support Services	101 The City Dr S	Orange	CA	Terminated
DSH050348BK	Child	DSH	UCI MEDICAL CENTER	Lab POCT	101 The City Dr. S	Orange	CA	Active
DSH050348BL	Child	DSH	UCI MEDICAL CENTER	Blood Bank	101 The City Dr. S	Orange	CA	Active
DSH050348BM	Child	DSH	UCI MEDICAL CENTER	Surgical Pathology 7072	101 The City Dr S	Orange	CA	Terminated
DSH050348BN	Child	DSH	UCI MEDICAL CENTER	Molecular Pathology 7074	101 The City Dr S	Orange	CA	Terminated
DSH050348BP	Child	DSH	UCI MEDICAL CENTER	Cytology 7073	101 The City Dr. S	Orange	CA	Terminated
DSH050348BQ	Child	DSH	UCI MEDICAL CENTER	Respiratory Therapy 7180	101 The City Dr. S	Orange	CA	Terminated
DSH050348BR	Child	DSH	UCI MEDICAL CENTER	Pulmonary Services 7185	101 The City Dr	Orange	CA	Terminated
DSH050348BS	Child	DSH	UCI MEDICAL CENTER	Physical Therapy	200 S. Manchester Ave	Orange	CA	Terminated
DSH050348BT	Child	DSH	UCI MEDICAL CENTER	Occupational Therapy	200 S. Manchester Ave	Orange	CA	Active
DSH050348BU	Child	DSH	UCI MEDICAL CENTER	Audiology 7215	101 The City Dr S	Orange	CA	Terminated
DSH050348BV	Child	DSH	UCI MEDICAL CENTER	Psych Adolescent Partial Hospitalization	3800 W. Chapman Ave.	Orange	CA	Terminated
DSH050348BW	Child	DSH	UCI MEDICAL CENTER	Cardiology Lab	101 The City Dr S	Orange	CA	Active
DSH050348BX	Child	DSH	UCI MEDICAL CENTER	Cardiac Cath Lab 7440	101 The City Dr.	Orange	CA	Terminated
DSH050348BY	Child	DSH	UCI MEDICAL CENTER	Neuro Diagnostics	101 The City Dr S	Orange	CA	Active
DSH050348BZ	Child	DSH	UCI MEDICAL CENTER	Operating Room Implants 7021	101 The City Dr. S	Orange	CA	Terminated
DSH050348C	Child	DSH	UCI MEDICAL CENTER	CDDC Lab	101 The City Dr. S	Orange	CA	Active
DSH050348CA	Child	DSH	UCI MEDICAL CENTER	Radiology Implants 7148	101 The City Dr S	Orange	CA	Terminated
DSH050348CB	Child	DSH	UCI MEDICAL CENTER	UCI GOTTSCHALK MEDICAL PLAZA	1 MEDICAL PLAZA DRIVE	IRVINE	CA	Terminated
DSH050348CC	Child	DSH	UCI MEDICAL CENTER	Plaza Multi-Specialty	1 MEDICAL PLAZA DRIVE	IRVINE	CA	Active
DSH050348CD	Child	DSH	UCI MEDICAL CENTER	Plaza Infusion Center	1 MEDICAL PLAZA DRIVE	IRVINE	CA	Active
DSH050348CE	Child	DSH	UCI MEDICAL CENTER	UCI GOTTSCHALK MEDICAL PLAZA	1 MEDICAL PLAZA DRIVE	IRVINE	CA	Terminated
DSH050348CF	Child	DSH	UCI MEDICAL CENTER	Cancer Center Gyn/Onc	101 CITY DR S	ORANGE	CA	Active
DSH050348CG	Child	DSH	UCI MEDICAL CENTER	Pacific Infusion Center	1640 NEWPORT BL STE 400	COSTA MESA	CA	Active
DSH050348CH	Child	DSH	UCI MEDICAL CENTER	Same Day Access Clinic - Orange	101 The City Drive, Pav III	Orange	CA	Active
DSH050348CJ	Child	DSH	UCI MEDICAL CENTER	Same Day Access Clinic - Irvine	1 MEDICAL PLAZA DRIVE	IRVINE	CA	Active
DSH050348CK	Child	DSH	UCI MEDICAL CENTER	Plaza Neurology	1 MEDICAL PLAZA DRIVE	IRVINE	CA	Active
DSH050348CL	Child	DSH	UCI MEDICAL CENTER	After Hours Clinic - Orange	101 The City Drive	Orange	CA	Terminated
DSH050348CM	Child	DSH	UCI MEDICAL CENTER	Beckman Surgery Laser Center	1002 Health Sciences Road	Irvine	CA	Active
DSH050348CN	Child	DSH	UCI MEDICAL CENTER	Yorba Linda Infusion Center	18635 Yorba Linda Bl.	Yorba Linda	CA	Active
DSH050348CP	Child	DSH	UCI MEDICAL CENTER	Laguna Hills Infusion	23961 CALLE DE LA MAGDALENA	LAGUNA HILLS	CA	Active
DSH050348CQ	Child	DSH	UCI MEDICAL CENTER	Irvine CAC - Urgent Care - CAC - Urgent Care	19200 Jamboree Rd.	Irvine	CA	Active
DSH050348CR	Child	DSH	UCI MEDICAL CENTER	Irvine CAC - Primary Care - CAC - Primary Care	19200 Jamboree Rd.	Irvine	CA	Active
DSH050348CS	Child	DSH	UCI MEDICAL CENTER	Irvine CAC - Pain Management - CAC - Pain Management	19200 Jamboree Rd.	Irvine	CA	Active
DSH050348CT	Child	DSH	UCI MEDICAL CENTER	Irvine CAC - Ortho-Spine - CAC - Ortho-Spine	19200 Jamboree Rd.	Irvine	CA	Active
DSH050348CU	Child	DSH	UCI MEDICAL CENTER	Irvine CAC - Neuroscience - CAC - Neuroscience	19200 Jamboree Rd.	Irvine	CA	Active
DSH050348CV	Child	DSH	UCI MEDICAL CENTER	Irvine CAC - Multispecialty - CAC - Multispecialty	19200 Jamboree Rd.	Irvine	CA	Active
DSH050348CW	Child	DSH	UCI MEDICAL CENTER	Irvine CAC - Imaging - CAC - Imaging	19200 Jamboree Rd.	Irvine	CA	Active
DSH050348CX	Child	DSH	UCI MEDICAL CENTER	Irvine CAC - Digestive Health Institute - CAC - Digestive Health Institute	19200 Jamboree Rd.	Irvine	CA	Active
DSH050348CY	Child	DSH	UCI MEDICAL CENTER	Irvine CAC - Center for Autism and Neurodevelopmental Disorders - CAC-Center for Autism and Neurodevelopmental Disorders	19200 Jamboree Rd.	Irvine	CA	Active
DSH050348CZ	Child	DSH	UCI MEDICAL CENTER	Irvine ACC - Phlebotomy - ACC - Phlebotomy	19208 Jamboree Rd.	Irvine	CA	Active
DSH050348D	Child	DSH	UCI MEDICAL CENTER	Cardiac Cath Lab Implants 7445	101 The City Dr S	Orange	CA	Terminated
DSH050348DA	Child	DSH	UCI MEDICAL CENTER	Irvine ACC - Infusion Center - ACC - Infusion Center	19208 Jamboree Rd.	Irvine	CA	Active
DSH050348E	Child	DSH	UCI MEDICAL CENTER	CDDC Lab Implants 7415	101 The City Dr S	Orange	CA	Terminated
DSH050348F	Child	DSH	UCI MEDICAL CENTER	Inpatient Dialysis 7190	101 The City Dr. S	Orange	CA	Terminated
DSH050348G	Child	DSH	UCI MEDICAL CENTER	Clinic Urology	101 The City Dr S	Orange	CA	Active
DSH050348H	Child	DSH	UCI MEDICAL CENTER	Clinic Surgery ENT	101 The City Dr. S	Orange	CA	Active
DSH050348J	Child	DSH	UCI MEDICAL CENTER	Clinic Surgery Ortho	101 The City Dr. S	Orange	CA	Active
DSH050348K	Child	DSH	UCI MEDICAL CENTER	Clinic Cardiovascular	101 The City Dr. S	Orange	CA	Active
DSH050348L	Child	DSH	UCI MEDICAL CENTER	Clinic Senior Center	101 The City Dr. S	Orange	CA	Active
DSH050348M	Child	DSH	UCI MEDICAL CENTER	Clinic Internal Medicine	101 The City Dr S	Orange	CA	Active
DSH050348N	Child	DSH	UCI MEDICAL CENTER	Clinic Surgical Specialty	101 The City Dr. S	Orange	CA	Active
DSH050348P	Child	DSH	UCI MEDICAL CENTER	Clinic Neurosurgery	101 The City Dr S.	Orange	CA	Active
DSH050348Q	Child	DSH	UCI MEDICAL CENTER	Clinic Occupational Health	101 The City Dr S	Orange	CA	Active
DSH050348R	Child	DSH	UCI MEDICAL CENTER	Clinic Burn	101 The City Dr S	Orange	CA	Active
DSH050348S	Child	DSH	UCI MEDICAL CENTER	Infusion Center	101 The City Dr S	Orange	CA	Active
DSH050348T	Child	DSH	UCI MEDICAL CENTER	Plaza Multi Specialty	1 Medical Plaza	Irvine	CA	Terminated
DSH050348U	Child	DSH	UCI MEDICAL CENTER	GHEI Irvine Ophthalmology Clinic	850 Health Sciences Road	Irvine	CA	Active
DSH050348V	Child	DSH	UCI MEDICAL CENTER	GHEI Ambulatory PACU	850 Health Sciences Road	Irvine	CA	Active
DSH050348W	Child	DSH	UCI MEDICAL CENTER	Plaza Primary Care	1 Medical Plaza Dr.	Irvine	CA	Active
DSH050348X	Child	DSH	UCI MEDICAL CENTER	Plaza Pain Management	1 Medical Plaza Dr.	Irvine	CA	Active
DSH050348Y	Child	DSH	UCI MEDICAL CENTER	Cancer Center Medicine	101 The City Dr S	Orange	CA	Active
DSH050348Z	Child	DSH	UCI MEDICAL CENTER	Cancer Center Surgery	101 The City Dr S	Orange	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Lefteris, Chad Thurman COO UCI Health 7147141423	Lefteris, Chad Thurman CEO UCI Health 7147141423	1/8/2021 12:17 PM
Contacts	Authorizing Official	Update	AO Change Request	Gannotta, Richard Chief Executive Officer UCI Health 7144567830	Lefteris, Chad Thurman COO UCI Health 7147141423	8/30/2019 1:15 PM
Contacts	Authorizing Official	Update	Profile Change Request	Gannotta, Richard Interim Chief Executive Officer UCI Health 7144567830	Gannotta, Richard Chief Executive Officer UCI Health 7144567830	8/21/2018 1:15 PM
Contacts	Authorizing Official	Update	Change Request	Federoff, Howard CEO & Vice Chancellor, Health Affairs University of California Irvine Medical Center 9498245926	Gannotta, Richard Interim Chief Executive Officer UCI Health 7144567830	2/13/2018 7:57 AM
Contacts	Authorizing Official	Update		Federoff, Howard CEO & Vice Chancellor, Health Affairs 9498245926	Federoff, Howard CEO & Vice Chancellor, Health Affairs University of California Irvine Medical Center 9498245926	9/29/2017 11:56 AM
Contacts	Primary Contact	Update		Joe, Melanie Chief Pharmacy Officer 7144565514	Joe, Melanie Chief Pharmacy Officer UCI Health 7144565514	9/26/2017 10:56 AM
Contacts	Authorizing Official	Insert			Federoff, Howard CEO & Vice Chancellor, Health Affairs 9498245926	8/9/2017 1:53 PM
Contacts	Primary Contact	Update		Ho, Sam Interim Pharmacy Director 7144565514	Joe, Melanie Chief Pharmacy Officer 7144565514	5/18/2017 3:16 PM
Addresses	Main Address	Insert			101 The City Dr S Audiology 7215 Orange, CA 92868	9/21/2016 1:40 PM
Contacts	Signed By	Insert			Belmont, Terry CEO 7144566240	9/21/2016 1:40 PM
Dates	Last Date That 340B Drugs Purchased	Update			9/5/2016 12:00:00 AM	9/21/2016 1:40 PM
Details	State	Update		Active	Terminated	9/21/2016 1:40 PM
Terminations	Termination Comments	Update			Site no longer owned by UC Irvine Medical Center. Location is now owned by private physician.	9/21/2016 1:40 PM
Terminations	Termination Date	Update			10/1/2016 12:00:00 AM	9/21/2016 1:40 PM
Terminations	Termination Effective Date	Update			9/6/2016 12:00:00 AM	9/21/2016 1:40 PM
Terminations	Termination Reason	Update			Site closure	9/21/2016 1:40 PM
Details	Last Recertification Date	Update		8/7/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 5:51 PM
Details	Last Recertification Date	Update		8/20/2014 12:00:00 AM	8/7/2015 12:00:00 AM	8/7/2015 7:02 PM
Details	Last Recertification Date	Update		8/20/2013 12:00:00 AM	8/20/2014 12:00:00 AM	8/20/2014 1:36 PM
Contacts	Primary Contact	Insert			Ho, Sam Interim Pharmacy Director 7144565514	7/23/2014 3:02 PM
Details	Last Recertification Date	Update		8/20/2013 8:45:20 PM	8/20/2013 12:00:00 AM	11/21/2013 8:47 AM
Details	Last Recertification Date	Update			8/20/2013 8:45:20 PM	8/20/2013 8:45 PM
Details	340B ID	Update		IS-DSH050348BU	DSH050348BU	6/6/2012 6:19 PM
Dates	Participating Approval Date	Update			6/6/2012 12:00:00 AM	6/6/2012 6:19 PM
Details	State	Update		Pending	Active	6/6/2012 6:19 PM
Dates	Start Date	Update			7/1/2012 12:00:00 AM	6/6/2012 6:19 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-DSH050348BU	5/31/2012 5:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/14/2012 4:06 PM
Medicaid Billing	Medicaid: Number	Insert			ZZT40348W	5/14/2012 4:06 PM
Medicaid Billing	Medicaid: State	Insert			CA	5/14/2012 4:06 PM
Medicaid Billing	NPI: Number	Insert			1689608150	5/14/2012 4:06 PM
Details	Last Recertification Date	Insert				5/14/2012 4:06 PM
Details	Grant Number	Insert				5/14/2012 4:06 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	5/14/2012 4:06 PM
Details	Is Authorizing Official EHB Data	Insert				5/14/2012 4:06 PM
Dates	Last Date That 340B Drugs Purchased	Insert				5/14/2012 4:06 PM
Details	Medicare Provider Number	Insert			050348	5/14/2012 4:06 PM
Details	Entity Name	Insert			UCI MEDICAL CENTER	5/14/2012 4:06 PM
Details	Program Code	Insert			DSH	5/14/2012 4:06 PM
Details	Entity Subname	Insert			Audiology 7215	5/14/2012 4:06 PM
Dates	Participating Approval Date	Insert				5/14/2012 4:06 PM
Details	State	Insert			Pending	5/14/2012 4:06 PM
Dates	Registration Date	Insert			5/14/2012 12:00:00 AM	5/14/2012 4:06 PM
Dates	Signed By Date	Insert			5/14/2012 12:00:00 AM	5/14/2012 4:06 PM
Dates	Start Date	Insert				5/14/2012 4:06 PM
Terminations	Termination Comments	Insert				5/14/2012 4:06 PM
Terminations	Termination Date	Insert				5/14/2012 4:06 PM
Terminations	Termination Effective Date	Insert				5/14/2012 4:06 PM
Terminations	Termination Reason	Insert				5/14/2012 4:06 PM