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DSH050485D Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center (Terminated)
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Main Details
Name
Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center
Subdivision Name
LBMC Multi-Specialty Center - Cardiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050485D
Medicare Provider Number
050485
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/8/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/4/2021
Last Recertification Date
8/17/2023
Termination Date
Termination Reason
7/1/2024
Other
Contacts
Authorizing Official
MemorialCare Long beach medical Center/Miller children's & Women's Hospital
Patti Pilgrim, Chief Financial Officer
(562) 933-1905
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
2865 Atlantic Ave, Suite 210
Long Beach, CA 90806
Billing Address
Long Beach Memorial Medical Center
2801 Atlantic Av
Long Beach, CA 90806
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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