340B Drug Pricing Program Database
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DSH050761B PROVIDENCE CEDARS SINAI TARZANA MEDICAL CENTER (Terminated)
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Main Details
Name
PROVIDENCE CEDARS SINAI TARZANA MEDICAL CENTER
Subdivision Name
PROVIDENCE TARZANA WOMEN'S CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050761B
Medicare Provider Number
050761
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/7/2016
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Providence Tarzana Medical Center
Nick Lymberopoulos, Chief Operating Officer
(818) 708-5151
Primary Contact
Providence Cedars-Sinai Tarzana Medical Center
Goorgen Boghossian, Director of Pharmacy
(818) 708-5413
Addresses
Street Address
18344 CLARK ST 110
TARZANA, CA 91356-3565
Billing Address
Providence Tarzana Medical Center
PO BOX 696430
San Antonio, TX 78269
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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