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RWI90059 Los Angeles County, Department of Health Services (Terminated)
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Main Details
Name
Los Angeles County, Department of Health Services
Subdivision Name
Martin Luther King, Jr. Outpatient Center
Type
Ryan White Part A
340B ID
RWI90059
Grant Number
H89HA90059
Additional Details
Current Program Status
Terminated
Registration Date
9/7/2011
Participating Start Date
1/1/2012
Participating Approval Date
12/21/2011
Last Recertification Date
2/22/2022
Time Period the Assistance was Received
3/1/2020 - 2/28/2022
Termination Date
Termination Reason
4/1/2023
Failure to recertify
Contacts
Authorizing Official
Los Angeles County DHS
Quentin O'Brien, CEO, Ambulatory Care Network
(213) 288-9000
Primary Contact
Martin Luther King JR- Outpatient Center (OPC), LA County DHS
Russell Y Kim, Martin Luther King JR - OPC Pharmacy Chief
(424) 338-1930
Addresses
Street Address
1670 East 120th Street
Los Angeles, CA 90059
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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2/13/12-Added room number.
02/13/2012
June 2025
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