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PED053309-00 Long Beach Memorial Medical Center, Inc., dba MemorialCare Miller Children's and Women's Hospital Long Beach (Active)
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Main Details
Name
Long Beach Memorial Medical Center, Inc., dba MemorialCare Miller Children's and Women's Hospital Long Beach
Subdivision Name
Type
Children's Hospital
Rural
No
340B ID
PED053309-00
Medicare Provider Number
053309
Additional Details
Current Program Status
Active
Registration Date
1/14/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/11/2013
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
MemorialCare Long Beach Medical Center
Frank Beirne, Chief Executive Officer
(562) 933-1111
Primary Contact
Long Beach Medical Center & Millier Children's and Women's Hospital
Jennifer T Chang, Executive Director, Pharmacy Services
(562) 933-0282
Addresses
Street Address
2801 Atlantic Avenue 1st FL B1A3020
Long Beach, CA 90806-1428
Billing Address
Long Beach Memorial Medical Center, Inc., dba MemorialCare Miller Children's and Women's Hospital LB
PO Box 20892
Fountain Valley, CA 92728
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Entity name cannot be a pharmacy.
05/27/2014
May 2025
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