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DSH050353 PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE (Active)
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Main Details
Name
PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050353
Medicare Provider Number
050353
Additional Details
Current Program Status
Active
Registration Date
2/22/2007
Participating Start Date
4/1/2007
Participating Approval Date
2/23/2007
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Providence Health & Services Little Company of Mary Medical Centers San Pedro and Torrance
John Fleming Goeders, Chief Financial Officer
(310) 829-8411
Primary Contact
Providence Little Company of Mary Medical Center
Muno Bholat, Director of Pharmacy
(310) 303-5722
Addresses
Street Address
4101 TORRANCE BLVD.
TORRANCE, CA 90503
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/19/2009- UPDATED ENTITY NAME (WAS LITTLE COMPANY OF MARY HOSPITAL) AND CONTACT PERSON INFO.; 8/7/08-DOC SUBMITTED TO CONFIRM ELIG DSH ADJ PERCENTAGE
06/19/2009
April 2025
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