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LONG BEACH MEMORIAL MEDICAL CENTER
DSH050485 Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center
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Covered Entity Details
Entity Name
Long Beach Memorial Medical Center, Inc. dba MemorialCare Long Beach Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050485
Entity Address
2801 ATLANTIC AVENUE
LONG BEACH, CA 90806
Medicare Provider Number
050485
Participating Start Date
7/1/2004
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
LONG BEACH MEMORIAL MEDICAL CENTER
Pharmacy Address
OUTPATIENT PHARMACY
2801 ATLANTIC AVENUE
LONG BEACH, CA 90806-1701
Pharmacy Comments
Contract Details
Approval Date
1/6/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Bishop, Chief Executive Officer
(562) 933-1111
Contract Pharmacy Representative
Scott Preston, Director of Pharmacy
(562) 933-0328
Signed By Date
1/6/2015
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