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PANTHERX SPECIALTY LLC
DSH050262 RONALD REAGAN UCLA MEDICAL CENTER
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Covered Entity Details
Entity Name
RONALD REAGAN UCLA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050262
Entity Address
757 WESTWOOD PLAZA
LOS ANGELES, CA 90095
Medicare Provider Number
050262
Participating Start Date
1/1/1998
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
PANTHERX SPECIALTY LLC
Pharmacy Address
1120 STEVENSON MILL RD.
SUITE 400
CORAOPOLIS, PA 15108
Pharmacy Comments
Contract Details
Approval Date
10/3/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tammy Wallace, Chief Financial Officer Hospital System
(310) 794-8627
Contract Pharmacy Representative
PantheRX
Richard Faris, Chief Strategy and Growth Officer
(855) 726-8479
Signed By Date
10/3/2024
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