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DSH050696 Keck Hospital of USC (Active)
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Main Details
Name
Keck Hospital of USC
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050696
Medicare Provider Number
050696
Additional Details
Current Program Status
Active
Registration Date
3/9/2010
Participating Start Date
4/1/2010
Participating Approval Date
3/15/2010
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
1500 SAN PABLO STREET
LOS ANGELES, CA 90033
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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1/5/12 add NPI JH
03/09/2010
April 2025
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