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PED053309-04 Earl & Lorraine Miller Children's Hospital of Long Beach (Terminated)
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Main Details
Name
Earl & Lorraine Miller Children's Hospital of Long Beach
Subdivision Name
Craniofacial CCS Center
Type
Children's Hospital
Rural
No
340B ID
PED053309-04
Medicare Provider Number
053309
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/10/2014
Last Recertification Date
8/17/2018
Termination Date
Termination Reason
4/1/2019
Other
Contacts
Authorizing Official
Long Beach Medical Center
John Bishop, Chief Executive Officer
(562) 933-1111
Primary Contact
Memorialcare Long Beach Medical Center
Jane Hodding, Executive Director of Pharmacy
(562) 933-0282
Addresses
Street Address
2650 Elm Avenue Suite 301
Long Beach, CA 90806
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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