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SATELLITE MEDICATION DISPENSING
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
SATELLITE MEDICATION DISPENSING
Pharmacy Address
GLENDALE ADVENTIST MEDICAL CENTER
1509 WILSON TER
WEST TOWER RM 4B13
GLENDALE, CA 91206
Pharmacy Comments
Contract Details
Approval Date
6/12/2020
Contract Begin Date
6/12/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Blin Daniel Richards, CFO
(323) 307-8950
Contract Pharmacy Representative
Adventist Health-Glendale
Romic Martini Eskandarian, Director of Pharmacy
(818) 409-8437
Signed By Date
6/12/2020
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