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WHITE MEM MED PLAZA PHARMACY
DSH050103 WHITE MEMORIAL MEDICAL CENTER, DBA Adventist Health White Memorial
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Covered Entity Details
Entity Name
WHITE MEMORIAL MEDICAL CENTER, DBA Adventist Health White Memorial
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050103
Entity Address
1720 EAST CESAR E CHAVEZ AVENUE
LOS ANGELES, CA 90033
Medicare Provider Number
050103
Participating Start Date
7/1/2005
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WHITE MEM MED PLAZA PHARMACY
Pharmacy Address
1701 CESAR CHAVEZ AVE SUITE 109
LOS ANGELES, CA 90033
Pharmacy Comments
Contract Details
Approval Date
10/17/2018
Contract Begin Date
10/17/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Blin Daniel Richards, CFO
(323) 307-8950
Contract Pharmacy Representative
Adventist Health White memorial
Paresh Patel, Owner
(323) 224-6304
Signed By Date
10/17/2018
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