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DSH050373CD LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES - Los Angeles General Medical Center (Terminated)
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Main Details
Name
LOS ANGELES COUNTY DEPARTMENT OF HEALTH SERVICES - Los Angeles General Medical Center
Subdivision Name
OBSTETRICS ONCOLOGY - OBSTETRICS ONCOLOGY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050373CD
Medicare Provider Number
050373
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/23/2018
Last Recertification Date
8/26/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Los Angeles General Medical Center
Brad Spellberg, CMO
(323) 409-2130
Primary Contact
LAC+USC Medical Center
Beatrisa Bannister, Pharmacy Service Chief
(323) 409-4280
Addresses
Street Address
2010 Zonal Ave
Los Angeles, CA 90033
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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