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DSH050761A TARZANA MEDICAL CENTER LLC DBA PROVIDENCE CEDARS SINAI TARZANA MEDICAL CENTER (Active)
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Main Details
Name
TARZANA MEDICAL CENTER LLC DBA PROVIDENCE CEDARS SINAI TARZANA MEDICAL CENTER
Subdivision Name
PROVIDENCE TARZANA WOUND CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050761A
Medicare Provider Number
050761
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/13/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/7/2016
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Providence Cedars Tarzana Medical Center
Jessica Marie Trimble, Chief Financial Officer
(818) 401-4195
Primary Contact
Providence Cedars Sinai Tarzana Medical Center
Goorgen Boghossian, Director of Pharmacy
(818) 708-5413
Addresses
Street Address
5411 Etiwanda Ave., Suite 100
TARZANA, CA 91356-3547
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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