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DSH050348AP UCI MEDICAL CENTER (Terminated)
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Main Details
Name
UCI MEDICAL CENTER
Subdivision Name
Anesthesia Pre-Op Clinic 7423
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050348AP
Medicare Provider Number
050348
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/14/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/6/2012
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
10/1/2024
Other
Contacts
Authorizing Official
UCI Health
Chad Thurman Lefteris, CEO
(714) 714-1423
Primary Contact
UCI Health
Melanie Joe, Chief Pharmacy Officer
(714) 456-5514
Addresses
Street Address
101 The City Dr. S
Anesthesia Pre-Op Clinic 7423
Orange, CA 92868
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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