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DSH050373N LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES - Los Angeles General Medical Center (Active)
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Main Details
Name
LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES - Los Angeles General Medical Center
Subdivision Name
LA General Medical Center / Asthma Mobile Unit
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050373N
Medicare Provider Number
050373
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/19/2015
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Los Angeles General Medical Center
Brad Spellberg, CMO
(323) 409-2130
Primary Contact
LAC+USC Medical Center
Beatrisa Bannister, Pharmacy Service Chief
(323) 409-4280
Addresses
Street Address
1200N STATE ST
LOS ANGELES, CA 90033-1029
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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