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DSH050262 RONALD REAGAN UCLA MEDICAL CENTER (Active)
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Main Details
Name
RONALD REAGAN UCLA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050262
Medicare Provider Number
050262
Additional Details
Current Program Status
Active
Registration Date
9/11/2007
Participating Start Date
1/1/1998
Participating Approval Date
9/11/2007
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
UCLA Health
Tammy Wallace, Chief Financial Officer Hospital System
(310) 794-8627
Primary Contact
UCLA
Lana Balderrama, 340B Program Supervisor
(310) 267-1278
Addresses
Street Address
757 WESTWOOD PLAZA
LOS ANGELES, CA 90095
Billing Address
Ronald Reagan UCLA Medical Center
757 Westwood Plaza,
Los Angeles, CA 90095
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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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
May 2025
May 2025
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