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PREMIER INFUSION AND HEALTHCARE SERVICES
DSH050696 Keck Hospital of USC
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Covered Entity Details
Entity Name
Keck Hospital of USC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050696
Entity Address
1500 SAN PABLO STREET
LOS ANGELES, CA 90033
Medicare Provider Number
050696
Participating Start Date
4/1/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
PREMIER INFUSION AND HEALTHCARE SERVICES
Pharmacy Address
19500 NORMANDIE AVE
TORRANCE, CA 90502
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rod Hanners, Chief Operating Officer
(323) 442-8677
Contract Pharmacy Representative
Premier Infusion Care
Sina M. Refua, Director of Pharmacy/CFO
(866) 365-2525 Ext: 240
Signed By Date
10/14/2024
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