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DSH050112C SANTA MONICA UCLAMC AND ORTHOPAEDIC HOSPITAL (Active)
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Main Details
Name
SANTA MONICA UCLAMC AND ORTHOPAEDIC HOSPITAL
Subdivision Name
Outpatient Radiology MRI
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050112C
Medicare Provider Number
050112
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/10/2013
Participating Start Date
10/1/2013
Participating Approval Date
8/30/2013
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
1245 16th Street, Suite 105
Santa Monica, CA 90404-1249
Billing Address
Santa Monica UCLA Medical Center
1250 16th Street
Santa Monica, CA 90404-1249
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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