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DSH050696X Keck Hospital of USC (Active)
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Main Details
Name
Keck Hospital of USC
Subdivision Name
Keck Pasadena Clinic - Main / Endocrinology, Cardiology, Dermatology, Rheumatology, Cardio-Thoracic Diagnostics, Family Medicine, Hepatobiliary & Pancreatic Surgery, Nutrition Medicine & Counseling, Vascular
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050696X
Medicare Provider Number
050696
Outpatient Facility Provider Number
050696
Additional Details
Current Program Status
Active
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/16/2014
Last Recertification Date
8/22/2024
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
625 S. Fair Oaks
Rooms 4202 & 4302
400
Pasadena, CA 91105
Billing Address
Keck Hospital of USC
1500 San Pablo Street
Los Angeles, CA 90033
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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