340B Drug Pricing Program Database
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PED053309-10 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
OC Peds MultiSpecialty Center
Type
Children's Hospital
Rural
No
340B ID
PED053309-10
Medicare Provider Number
053309
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/10/2014
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Long Beach Medical Center
Blair Kent, Chief Executive Officer
(562) 933-1111
Primary Contact
MemorialCare
Suzanne French, Manager, 340B Program
(714) 486-4693
Addresses
Street Address
9940 Talbert Suite 200
Fountain Valley, CA 92708
Billing Address
Earl & Loraine Miller Children's Hospital
2801 Atlantic Avenue
Long Beach, CA 90806
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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