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DSH050348CA UCI MEDICAL CENTER (Terminated)
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Main Details
Name
UCI MEDICAL CENTER
Subdivision Name
Radiology Implants 7148
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050348CA
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
Radiology Implants
Orange, CA 92868
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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