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DSH050696AA Keck Hospital of USC (Active)
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Main Details
Name
Keck Hospital of USC
Subdivision Name
Treatment Center (Infusion)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050696AA
Medicare Provider Number
050696
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/20/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/24/2017
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Keck Medicine of USC
Rod Hanners, Chief Operating Officer
(323) 442-8677
Primary Contact
Keck Medicine of USC
Krist Azizian, Chief Pharmacy Officer
(323) 865-3588
Addresses
Street Address
1516 San Pablo Street
4th Floor
Los Angeles, CA 90033
Billing Address
Keck Hospital of USC-Norris Healthcare Center
1516 San Pablo Street
Los Angeles, CA 90033
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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