340B Drug Pricing Program Database
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DSH050696T Keck Hospital of USC (Terminated)
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Main Details
Name
Keck Hospital of USC
Subdivision Name
Beverly Hills Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050696T
Medicare Provider Number
050696
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/11/2014
Last Recertification Date
8/17/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Keck Medicine of USC
Rod Hanners, Chief Operating Officer
(323) 442-8677
Primary Contact
Keck Medicine of USC
Krist Azizian, Chief Pharmacy Officer
(323) 865-3588
Addresses
Street Address
9033 Wilshire Blvd
#360, #400
Beverly Hills, CA 90211
Billing Address
Keck Hospital of USC
1500 San Pablo St.
Los Angeles, CA 90033
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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