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PED053309-13 Long Beach Memorial Medical Center, Inc., dba MemorialCare Miller Children's and Women's Hospital Long Beach (Terminated)
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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
Surgical Specialties
Type
Children's Hospital
Rural
No
340B ID
PED053309-13
Medicare Provider Number
053309
Outpatient Facility Provider Number
Additional Details
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
Contacts
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
Addresses
Street Address
2701 Atlantic Avenue
Long Beach, CA 90806-1428
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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