340B Drug Pricing Program Database
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DSH050262AW RONALD REAGAN UCLA MEDICAL CENTER (Active)
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Main Details
Name
RONALD REAGAN UCLA MEDICAL CENTER
Subdivision Name
Connie Frank Kidney Transplant Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050262AW
Medicare Provider Number
050262
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/6/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/26/2017
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
UCLA Health
Tammy Wallace, Chief Financial Officer Hospital System
(310) 794-8627
Primary Contact
UCLA
Lana Balderrama, 340B Program Supervisor
(310) 267-1278
Addresses
Street Address
200 Medical Plaza, Room 565
Los Angeles, CA 90095-8358
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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