340B Drug Pricing Program Database
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DSH050696AF Keck Hospital of USC (Terminated)
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Main Details
Name
Keck Hospital of USC
Subdivision Name
Arcadia Treatment Center (Arcadia Infusion) - Arcadia Infusion
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050696AF
Medicare Provider Number
050696
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/17/2019
Last Recertification Date
8/25/2020
Termination Date
Termination Reason
1/1/2021
Business decision by the Covered Entity
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
125 West Huntington Drive
Building A
A300
Arcadia, CA 91007
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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