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DSH050373 LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES - Los Angeles General Medical Center (Active)
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Main Details
Name
LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES - Los Angeles General Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050373
Medicare Provider Number
050373
Additional Details
Current Program Status
Active
Registration Date
10/16/2007
Participating Start Date
1/1/1998
Participating Approval Date
10/16/2007
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Los Angeles General Medical Center
Brad Spellberg, CMO
(323) 409-2130
Primary Contact
LAC+USC Medical Center
Beatrisa Bannister, Pharmacy Service Chief
(323) 409-4280
Addresses
Street Address
2051 Marengo St
B2A100
LOS ANGELES, CA 90033
Billing Address
LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES - Los Angeles General Medical Center
1200 N. STATE ST, RM A1C109
LOS ANGELES, CA 90033
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/23/10 PHYSICALS ADDR CHANGE/SHIP TO ADDED/ NPI REVISED (WAS 1200 N. STATE ST/PHB173660)01/31/11 UPDATED ADDR(WAS 1100 N. STATE ST.)
10/16/2007
June 2025
June 2025
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