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DSH050262AE RONALD REAGAN UCLA MEDICAL CENTER (Active)
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Main Details
Name
RONALD REAGAN UCLA MEDICAL CENTER
Subdivision Name
Doris Stein Retina Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050262AE
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
8/16/2024
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
200 Stein Plaza, Room 1-533
Los Angeles, CA 90095
Billing Address
Ronald Reagan UCLA Medical Center
200 Stein Plaza
Room 1533
Los Angeles, CA 90095
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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