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DSH050112 SANTA MONICA UCLAMC AND ORTHOPAEDIC HOSPITAL (Active)
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Main Details
Name
SANTA MONICA UCLAMC AND ORTHOPAEDIC HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050112
Medicare Provider Number
050112
Additional Details
Current Program Status
Active
Registration Date
6/9/2009
Participating Start Date
7/1/2009
Participating Approval Date
6/14/2009
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
1250 16TH STREET
SANTA MONICA, CA 90404-1249
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/4/2009 DOC RECD TO CONFIRM ELIG DSH ADJ %
06/14/2009
May 2025
May 2025
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