340B Drug Pricing Program Database

Name

Long Beach Memorial Medical Center, Inc., dba MemorialCare Miller Children's and Women's Hospital Long Beach

Subdivision Name

Peds Renal/Urology

Type

Children's Hospital

Rural

No

340B ID

PED053309-16

Medicare Provider Number

053309

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

4/11/2016

Participating Start Date

7/1/2016

Participating Approval Date

5/4/2016

Last Recertification Date

8/20/2021

Termination Date
Termination Reason

1/1/2022
Other

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

Street Address

2701 Atlantic Av
Long Beach, CA 90806

Billing Address

Earl & Loraine Miller Children's Hospital
2801 Atlantic Avenue
Long Beach, CA 90806