Covered Entity Details

CAN050660-00 USC Norris Cancer Hospital (Active) - information as of 6/9/2025 11:00:07 PM

Main Details

Name

USC Norris Cancer Hospital

Subdivision Name

Type

Free Standing Cancer Hospital

Rural

340B ID

CAN050660-00

Medicare Provider Number

050660

Additional Details

Current Program Status

Active

Registration Date

10/14/2013

Participating Start Date

1/1/2014

Participating Approval Date

12/13/2013

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

1441 Eastlake Avenue
Los Angeles, CA 90033

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		1770728438,1417554528

Shipping Addresses

Shipping Address 1

USC Kenneth Norris Jr. Cancer Hospital
1441 Eastlake Avenue
Los Angeles, CA 90033

Shipping Address 2

Keck Hospital of USC-Arcadia Treatment Center
125 West Huntington Drive
Building A
A300 Rm 309
Arcadia, CA 91007

Shipping Address 3

USC Kenneth Norris Jr. Cancer Hospital
1441 Eastlake Avenue
Los Angeles, CA 90089

Shipping Address 4

USC Kenneth Norris JR Cancer Hospital
625 South Fair Oaks Avenue
Suite 365
Pasadena, CA 91105

Shipping Address 5

KECK MEDICINE OF USC-NEWPORT PHARMACY
330 OLD NEWPORT BLVD RM 170
NEWPORT BEACH, CA 92663-4121

Shipping Address 6

USC Norris Cancer Hospital - Santa Clarita Treatment Center
25751 MCBEAN PKWY
305
SANTA CLARITA, CA 91355

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/21/2014	01/01/2015		10/21/2014
Contract Detail	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	10/21/2014	01/01/2015	10/04/2017	10/19/2017
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/21/2014	01/01/2015		10/21/2014
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/24/2017	07/01/2017		04/24/2017
Contract Detail	ACCREDO HEALTH GROUP INC	2410 WARDLOW RD	STE 101	CORONA	CA	92878	10/15/2018	01/01/2019		01/01/2019
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/21/2014	01/01/2015		10/21/2014
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/21/2014	01/01/2015		10/21/2014
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/13/2022	10/01/2022		10/01/2022
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/11/2024	07/01/2024		07/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/17/2023	10/01/2023		10/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/17/2023	10/01/2023		10/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/17/2023	10/01/2023		10/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	10/14/2024	01/01/2025		01/01/2025
Contract Detail	BIOSCRIP INFUSION SERVICES, INC.	199 TECHNOLOGY DR	STE 140 & 150	IRVINE	CA	92618	04/13/2023	07/01/2023	03/24/2025	04/09/2025
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/17/2015	10/01/2015		07/17/2015
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/18/2017	07/01/2017		04/18/2017
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/18/2017	07/01/2017		04/18/2017
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/17/2015	10/01/2015		07/17/2015
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/17/2015	10/01/2015		07/17/2015
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/15/2021	01/01/2022		01/01/2022
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/17/2015	10/01/2015		07/17/2015
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/17/2015	10/01/2015		07/17/2015
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/17/2015	10/01/2015		07/17/2015
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/15/2021	01/01/2022		01/01/2022
Contract Detail	CRESCENT HEALTHCARE, INC.	CRESCENT HEALTHCARE	11980 TELEGRAPH RD STE 102	SANTA FE SPRINGS	CA	90670-6087	04/13/2023	07/01/2023		07/01/2023
Contract Detail	CRESCENT HEALTHCARE, INC.	CRESCENT HEALTHCARE	2010 IOWA AVE STE 110	RIVERSIDE	CA	92507-7433	04/13/2023	07/01/2023		07/01/2023
Contract Detail	CRESCENT HEALTHCARE, INC.	CRESCENT HEALTHCARE	11980 TELEGRAPH RD STE 100	SANTA FE SPRINGS	CA	90670-6089	04/13/2023	07/01/2023		07/01/2023
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/15/2021	01/01/2022		01/01/2022
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	10/12/2020	01/01/2021	07/11/2022	07/13/2022
Contract Detail	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	07/17/2023	10/01/2023		10/01/2023
Contract Detail	KECK HOSPITAL OF USC - ARCADIA TREATMENT	125 W HUNTINGTON DR BLDG A	STE A300 RM 309	ARCADIA	CA	91006	07/15/2019	10/01/2019	04/14/2021	07/13/2021
Contract Detail	KECK MEDICINE OF USC SPECIALTY PHARMACY	1000 S FREMONT AVE STE 10150		ALHAMBRA	CA	91803-8800	10/13/2015	01/01/2016		10/13/2015
Contract Detail	OPTION CARE	OPTION CARE HOME CARE, INC.	9401 CHIVERS AVE.	SUN VALLEY	CA	91352-2655	04/13/2023	07/01/2023		07/01/2023
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	04/13/2023	07/01/2023		07/01/2023
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	01/14/2020	04/01/2020	03/16/2021	04/15/2021
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/14/2022	04/15/2022		04/21/2022
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/14/2020	04/01/2020		04/01/2020
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/13/2023	07/01/2023		07/01/2023
Contract Detail	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/14/2020	04/01/2020		04/01/2020
Contract Detail	OPTUM PHARMACY 806, INC.	2288 AUBURN BLVD	STE. 102	SACRAMENTO	CA	95821-1618	10/12/2020	01/01/2021	12/10/2021	01/13/2022
Contract Detail	PREMIER INFUSION AND HEALTHCARE SERVICES	19500 NORMANDIE AVE		TORRANCE	CA	90502	10/14/2024	01/01/2025		01/01/2025
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/21/2014	01/01/2015		10/21/2014
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/15/2021	01/01/2022		01/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/15/2021	01/01/2022		01/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/15/2021	01/01/2022		01/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY	8607 SANTA MONICA BOULEVARD	WEST HOLLYWOOD	CA	90069	01/13/2022	04/01/2022		04/01/2022
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/17/2023	10/01/2023		10/01/2023
Contract Detail	UNIV OF SOUTH CALIF PHARMACY	3601 TROUSDALE PKWY		LOS ANGELES	CA	90089	01/17/2014	04/01/2014	05/22/2023	07/17/2023
Contract Detail	USC MEDICAL PLAZA PHARMACY	1510 SAN PABLO ST STE 144		LOS ANGELES	CA	90033-5394	01/17/2014	04/01/2014		01/17/2014
Contract Detail	USC PHARMACY	1025 W 34TH ST STE 105		LOS ANGELES	CA	90089	01/17/2014	04/01/2014	09/17/2021	10/15/2021

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAN050660-01	Child	CAN	USC Norris Cancer Hospital	Clinics	625 South Fair Oaks Avenue	Pasadena	CA	Active
CAN050660-02	Child	CAN	USC Norris Cancer Hospital	Urology - NCH Urology	1516 SAN PABLO STREET	Los Angeles	CA	Active
CAN050660-03	Child	CAN	USC Norris Cancer Hospital	Women's Specialty Care and Breast Center	1516 San Pablo Street	Los Angeles	CA	Active
CAN050660-04	Child	CAN	USC Norris Cancer Hospital	USC Cancer Center LA - Oncology/Infusion	500 S. Virgil Ave Suite 502	Los Angeles	CA	Active
CAN050660-05	Child	CAN	USC Norris Cancer Hospital	Buena Park - Buena Park Infusion	5832 Beach Blvd Suite 201	Buena Park	CA	Active
CAN050660-06	Child	CAN	USC Norris Cancer Hospital	Keck Medicine of USC - Arcadia Clinic - Hematology/Oncology - Hematology, Oncology, Sarcoma, Dermatology, Rheumatology, Hepatobiliary, Otolaryngology	125 W. Huntington Dr	Arcadia	CA	Active
CAN050660-07	Child	CAN	USC Norris Cancer Hospital	Keck Medicine of USC - Arcadia Radiation Oncology - Radiation Oncology	125 W. Huntington Drive	Arcadia	CA	Active
CAN050660-08	Child	CAN	USC Norris Cancer Hospital	Keck Medicine of USC - Arcadia Treatment Center - Arcadia Infusion Center - Hematology, Oncology,	125 W. Huntington Drive	Arcadia	CA	Active
CAN050660-09	Child	CAN	USC Norris Cancer Hospital	Keck Medicine of USC - Huntington Beach Healthcare Center - Hematology, Oncology, Neurology	19582 Beach Blvd.	Huntington Beach	CA	Terminated
CAN050660-10	Child	CAN	USC Norris Cancer Hospital	Keck Medicine of USC - USC Norris Oncology/Hematology Newport Beach - Oncology, Hematology, Cancer Therapy, Blood Disorders	330 Old Newport Blvd	Newport Beach	CA	Active
CAN050660-11	Child	CAN	USC Norris Cancer Hospital	Keck Medicine of USC Norris Treatment Center Newport Beach - Infusion Center - Chemotherapy, Oncology, Hematology, Infusion Therapy	330 Old Newport Blvd.	Newport Beach	CA	Active
CAN050660-12	Child	CAN	USC Norris Cancer Hospital	Keck Medicine of USC - Huntington Beach Treatment Center - Infusion Center - Hematology, Oncology, Neurology	19582 Beach Blvd.	Huntington Beach	CA	Terminated
CAN050660-13	Child	CAN	USC Norris Cancer Hospital	USC KENNETH NORRIS JR CANCER HOSPIT - Radiation Oncology	25751 MCBEAN PKWY	SANTA CLARITA	CA	Active
CAN050660-14	Child	CAN	USC Norris Cancer Hospital	Keck Medicine of USC - Santa Clarita Treatment Center and Infusion Center - Multi-Specialty	25751 McBean Pkwy	Santa Clarita	CA	Active
CAN050660-15	Child	CAN	USC Norris Cancer Hospital	Buena Park Radiation Oncology - Radiation Oncology and Urology	5832 Beach Blvd	Buena Park	CA	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 4:57:49 PM	8/22/2024 12:29:30 PM	8/22/2024 12:29 PM
Addresses	Shipping Address	Insert	Change Request		USC Norris Cancer Hospital - Santa Clarita Treatment Center 25751 MCBEAN PKWY 305 SANTA CLARITA, CA 91355	6/4/2024 1:56 PM
Addresses	Shipping Address	Delete	Change Request	Keck Hospital of USC-Huntington Beach Treatment Center 19582 Beach Blvd. Suite 115L Huntington Beach, CA 92648		10/16/2023 2:12 PM
Addresses	Shipping Address	Delete	Change Request	Keck Medicine of USC - Huntington Beach Healthcare Center - Hematology/Oncology 19582 Beach Boulevard 206 Huntington Beach, CA 92648		10/16/2023 2:12 PM
Addresses	Shipping Address	Delete	Change Request	Keck Medicine of USC - Huntington Beach Treatment Center - Infusion 19582 Beach Boulevard 115 Huntington Beach, CA 92648		10/16/2023 2:12 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 11:57:57 AM	8/17/2023 4:57:49 PM	8/17/2023 4:57 PM
Addresses	Shipping Address	Update	Change Request	Keck Hospital of USC-Arcadia Treatment Center 125 West Huntington Drive Building A A300 Arcadia, CA 91007	Keck Hospital of USC-Arcadia Treatment Center 125 West Huntington Drive Building A A300 Rm 309 Arcadia, CA 91007	1/19/2023 7:13 AM
Addresses	Shipping Address	Delete	Change Request	Keck Hospital of USC Orange County Pharmacy 300 Old Newport Blvd. Newport Beach, CA 92663		1/19/2023 7:13 AM
Addresses	Shipping Address	Delete	Change Request	USC Oncology Hematology 520 Superior Ave. Suite 300 Newport Beach, CA 92663		1/19/2023 7:13 AM
Addresses	Shipping Address	Delete	Change Request	USC Oncology Hematology Infusion 300 Old Newport Blvd Newport Beach, CA 92663		1/19/2023 7:13 AM
Addresses	Shipping Address	Delete	Change Request	USC Kenneth Norris Jr. Cancer Hospital 1441 Eastlake Avenue Room 3341, 3rd Floor Los Angeles, CA 90033		1/19/2023 7:13 AM
Addresses	Shipping Address	Update	Change Request	USC Kenneth Norris Jr. Cancer Hospital 1441 Eastlake Avenue Room 1355, First Floor Los Angeles, CA 90033	USC Kenneth Norris Jr. Cancer Hospital 1441 Eastlake Avenue Los Angeles, CA 90033	1/19/2023 7:13 AM
Addresses	Shipping Address	Insert	Change Request		KECK MEDICINE OF USC-NEWPORT PHARMACY 330 OLD NEWPORT BLVD RM 170 NEWPORT BEACH, CA 92663-4121	9/28/2022 6:15 AM
Details	Last Recertification Date	Update	Recertification	9/14/2021 8:04:44 AM	8/29/2022 11:57:57 AM	8/29/2022 11:57 AM
Details	Last Recertification Date	Update	Recertification	8/25/2020 1:16:52 PM	9/14/2021 8:04:44 AM	9/14/2021 8:04 AM
Addresses	Shipping Address	Delete	Change Request	Keck Hospital of USC-Huntington Beach Treatment Center 19582 Beach Blvd. Suite 115 Huntington Beach, CA 92648		4/19/2021 2:00 PM
Addresses	Shipping Address	Insert	Change Request		Keck Hospital of USC-Huntington Beach Treatment Center 19582 Beach Blvd. Suite 115L Huntington Beach, CA 92648	4/19/2021 2:00 PM
Addresses	Shipping Address	Insert	Change Request		USC Kenneth Norris Jr. Cancer Hospital 1441 Eastlake Avenue Los Angeles, CA 90089	4/19/2021 2:00 PM
Addresses	Shipping Address	Insert	Change Request		Keck Medicine of USC - Huntington Beach Healthcare Center - Hematology/Oncology 19582 Beach Boulevard 206 Huntington Beach, CA 92648	4/19/2021 2:00 PM
Addresses	Shipping Address	Insert	Change Request		USC Oncology Hematology 520 Superior Ave. Suite 300 Newport Beach, CA 92663	4/19/2021 2:00 PM
Addresses	Shipping Address	Insert	Change Request		USC Kenneth Norris JR Cancer Hospital 625 South Fair Oaks Avenue Suite 365 Pasadena, CA 91105	4/19/2021 2:00 PM
Addresses	Shipping Address	Insert	Change Request		USC Oncology Hematology Infusion 300 Old Newport Blvd Newport Beach, CA 92663	4/19/2021 2:00 PM
Addresses	Shipping Address	Insert	Change Request		Keck Medicine of USC - Huntington Beach Treatment Center - Infusion 19582 Beach Boulevard 115 Huntington Beach, CA 92648	4/19/2021 2:00 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1417554528	1/11/2021 6:02 PM
Medicaid Billing	NPI: State	Insert	Change Request		CA	1/11/2021 6:02 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/25/2020 1:16 PM
Details	Last Recertification Date	Update	Recertification	9/17/2019 1:24:15 PM	8/25/2020 1:16:52 PM	8/25/2020 1:16 PM
Addresses	Shipping Address	Insert	Change Request		Keck Hospital of USC-Huntington Beach Treatment Center 19582 Beach Blvd. Suite 115 Huntington Beach, CA 92648	7/15/2020 8:41 AM
Addresses	Shipping Address	Insert	Change Request		Keck Hospital of USC-Arcadia Treatment Center 125 West Huntington Drive Building A A300 Arcadia, CA 91007	7/15/2020 8:41 AM
Addresses	Shipping Address	Insert	Change Request		Keck Hospital of USC Orange County Pharmacy 300 Old Newport Blvd. Newport Beach, CA 92663	7/15/2020 8:41 AM
Details	Last Recertification Date	Update	Recertification	9/5/2018 12:09:58 PM	9/17/2019 1:24:15 PM	9/17/2019 1:24 PM
Addresses	Shipping Address	Delete	Change Request	USC Kenneth Norris Jr Cancer Hospital 625 S Fair Oaks Ave Suite 400 Pasadena, CA 91105		7/17/2019 7:28 AM
Contacts	Primary Contact	Update	Change Request	Gray, John Patrick Director, Enterprise 340B Operations Keck Medical Center of USC 3234428438	Azizian, Krist Chief Pharmacy Officer Keck Medicine of USC 3238653588	2/11/2019 4:52 PM
Contacts	Primary Contact	Update	Recertification	WING, EVELYN 340B MANAGER Keck Medicine of USC 3238653611	Gray, John Patrick Director, Enterprise 340B Operations Keck Medical Center of USC 3234428438	9/5/2018 12:09 PM
Details	Last Recertification Date	Update	Recertification	10/18/2017 11:08:54 AM	9/5/2018 12:09:58 PM	9/5/2018 12:09 PM
Addresses	Main Address	Update	Change Request	1441 Eastlake Avenue Room 1355, First Floor Los Angeles, CA 90033	1441 Eastlake Avenue Los Angeles, CA 90033	2/8/2018 1:57 PM
Details	Last Recertification Date	Update	Recertification	9/2/2016 12:00:00 AM	10/18/2017 11:08:54 AM	10/18/2017 11:08 AM
Contacts	Authorizing Official	Insert	Change Request		Hanners, Rod Chief Operating Officer Keck Medicine of USC 3234428677	9/25/2017 8:56 AM
Contacts	Primary Contact	Update		WING, EVELYN 340B MANAGER 3238653611	WING, EVELYN 340B MANAGER Keck Medicine of USC 3238653611	9/18/2017 5:49 PM
Contacts	Primary Contact	Update		KILDOO, CARL DIRECTOR OF PHARMACY 6263018833	WING, EVELYN 340B MANAGER 3238653611	9/5/2016 9:10 AM
Addresses	Main Address	Insert			1441 Eastlake Avenue Room 1355, First Floor Los Angeles, CA 90033	9/2/2016 5:10 PM
Contacts	Signed By	Insert			Evans, Scott Chief Executive Officer 3234428677	9/2/2016 5:10 PM
Details	Last Recertification Date	Update		9/1/2015 12:00:00 AM	9/2/2016 12:00:00 AM	9/2/2016 5:10 PM
Details	Last Recertification Date	Update		9/8/2014 12:00:00 AM	9/1/2015 12:00:00 AM	9/3/2015 11:12 AM
Addresses	Shipping Address	Insert			USC Kenneth Norris Jr. Cancer Hospital 1441 Eastlake Avenue Room 3341, 3rd Floor Los Angeles, CA 90033	5/27/2015 3:20 PM
Addresses	Shipping Address	Insert			USC Kenneth Norris Jr Cancer Hospital 625 S Fair Oaks Ave Suite 400 Pasadena, CA 91105	5/27/2015 3:20 PM
Addresses	Shipping Address	Insert			USC Kenneth Norris Jr. Cancer Hospital 1441 Eastlake Avenue Room 1355, First Floor Los Angeles, CA 90033	5/27/2015 3:20 PM
Medicaid Billing	NPI: Number	Update		1184655417	1770728438	5/27/2015 3:20 PM
Details	Last Recertification Date	Update			9/8/2014 12:00:00 AM	9/8/2014 2:40 PM
Contacts	Primary Contact	Insert			KILDOO, CARL DIRECTOR OF PHARMACY 6263018833	7/30/2014 10:30 PM
Dates	Participating Approval Date	Update			12/13/2013 12:00:00 AM	12/13/2013 12:42 PM
Details	State	Update		Pending	Active	12/13/2013 12:42 PM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	12/13/2013 12:42 PM
Details	340B ID	Update		ONLINE_REG	CAN050660-00	12/11/2013 7:52 AM
Medicaid Billing	NPI: Number	Insert			1184655417	10/14/2013 7:16 PM
Details	Last Recertification Date	Insert				10/14/2013 7:16 PM
Details	Grant Number	Insert				10/14/2013 7:16 PM
Details	340B ID	Insert			ONLINE_REG	10/14/2013 7:16 PM
Details	Is Authorizing Official EHB Data	Insert				10/14/2013 7:16 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/14/2013 7:16 PM
Details	Medicare Provider Number	Insert			050660	10/14/2013 7:16 PM
Details	Entity Name	Insert			USC Norris Cancer Hospital	10/14/2013 7:16 PM
Details	Program Code	Insert			CAN	10/14/2013 7:16 PM
Details	Entity Subname	Insert				10/14/2013 7:16 PM
Dates	Participating Approval Date	Insert				10/14/2013 7:16 PM
Details	State	Insert			Pending	10/14/2013 7:16 PM
Dates	Registration Date	Insert			10/14/2013 12:00:00 AM	10/14/2013 7:16 PM
Dates	Signed By Date	Insert			10/14/2013 12:00:00 AM	10/14/2013 7:16 PM
Dates	Start Date	Insert				10/14/2013 7:16 PM
Terminations	Termination Comments	Insert				10/14/2013 7:16 PM
Terminations	Termination Date	Insert				10/14/2013 7:16 PM
Terminations	Termination Effective Date	Insert				10/14/2013 7:16 PM
Terminations	Termination Reason	Insert				10/14/2013 7:16 PM