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PED053309-18 Long Beach Memorial Medical Center, Inc., dba MemorialCare Miller Children's and Women's Hospital Long Beach (Active)
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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
OB/GYN Clinic - Obstetrics & Gynecology
Type
Children's Hospital
Rural
No
340B ID
PED053309-18
Medicare Provider Number
053309
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2021
Participating Start Date
4/1/2021
Participating Approval Date
2/1/2021
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Long Beach Medical Center
Blair Kent, Chief Executive Officer
(562) 933-1111
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
2888 Long Beach Blvd
340
Long Beach, CA 90806
Billing Address
Earl & Loraine Miller Children's Hospital
2801 Atlantic Avenue
Long Beach, CA 90806
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2018, terminated 10/1/2019. Reinstated 4/1/2021.
01/22/2021
April 2025
April 2025
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