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PED053309-19 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
Stramski Behavioral & Developmental Center
Type
Children's Hospital
Rural
No
340B ID
PED053309-19
Medicare Provider Number
053309
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/11/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/27/2018
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
2651 Elm Ave Suite 205
Long Beach, CA 90806
Billing Address
Earl & Lorraine Miller Children's Hospital
2801 Atlantic Avenue
Long Beach, CA 90806
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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