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PED053309-07 Long Beach Memorial Medical Center, Inc., dba MemorialCare Miller Children's and Women's Hospital Long Beach (Terminated)
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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
Hematology/Oncology Center
Type
Children's Hospital
Rural
No
340B ID
PED053309-07
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
8/26/2020
Termination Date
Termination Reason
4/1/2021
Other
Contacts
Authorizing Official
MemorialCare-Long Beach Medical Center, Miller Children's & Women's Hospital
Ikenna (Ike) Mmeje, Chief Operating Officer
(562) 933-1123
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
2653 Elm Avenue
Suite 200
Long Beach, CA 90806
Billing Address
Earl & Lorraine Miller Children's Hospital
2801 Atlantic Avenue
Long Beach, CA 90806
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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