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DSH050678D ORANGE COAST MEMORIAL MEDICAL CENTER (Active)
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Main Details
Name
ORANGE COAST MEMORIAL MEDICAL CENTER
Subdivision Name
OP SERVICES - NUCLEAR MEDICINE - Nuclear Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050678D
Medicare Provider Number
050678
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/8/2020
Participating Start Date
7/1/2020
Participating Approval Date
5/1/2020
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Orange Coast Memorial Medical Center
Emily Marcus Randle, COO
(714) 378-7538
Primary Contact
Orange Coast Memorial Medical Center
Stanley Hill, DIRECTOR OF PHARMACY
(714) 378-7012
Addresses
Street Address
18111 Brookhurst St.
2200
Fountain Valley, CA 92708
Billing Address
Orange Coast Memorial Medical Center
9920 Talbert Ave
Fountain Valley, CA 92708
Comments
Medicaid Billing
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