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DSH050262AB RONALD REAGAN UCLA MEDICAL CENTER (Terminated)
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Main Details
Name
RONALD REAGAN UCLA MEDICAL CENTER
Subdivision Name
Clinical & Translational Research Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050262AB
Medicare Provider Number
050262
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/12/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/26/2012
Last Recertification Date
9/1/2015
Termination Date
Termination Reason
7/1/2016
For-Profit conversion
Contacts
Authorizing Official
UCLA Medical Center
Paul Staton, CFO
(310) 267-9308
Primary Contact
Ronald Reagan UCLA Medical Center
Kerry Menmuir, Interim Chief Pharmacy Officer
(310) 267-8509
Addresses
Street Address
10833 Le Conte Ave, Suite BE-144
Los Angeles, CA 90095
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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March 2025
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