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DSH050112B SANTA MONICA UCLAMC AND ORTHOPAEDIC HOSPITAL (Active)
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Main Details
Name
SANTA MONICA UCLAMC AND ORTHOPAEDIC HOSPITAL
Subdivision Name
Rehabilitation - Outpatient
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050112B
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
1260 15th Street, Suite 900
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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