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DSH050262AC RONALD REAGAN UCLA MEDICAL CENTER (Active)
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Main Details
Name
RONALD REAGAN UCLA MEDICAL CENTER
Subdivision Name
Dermatology Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050262AC
Medicare Provider Number
050262
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/12/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/26/2012
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
UCLA Health
Tammy Wallace, Chief Financial Officer Hospital System
(310) 794-8627
Primary Contact
Ronald Reagan UCLA Medical Center
Kerry MenMuir, Director of Pharmacy
(310) 267-8509
Addresses
Street Address
200 Medical Plaza Suite 450
Los Angeles, CA 90095
Billing Address
Ronald Reagan Medical Center
200 Medical Plaza
Suite 450
Los Angeles, CA 90095
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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