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COUNTY OF LOS ANGELES
DSH050376 LOS ANGELES COUNTY (LAC)
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Covered Entity Details
Entity Name
LOS ANGELES COUNTY (LAC)
Subdivision Name
HARBOR-UCLA MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH050376
Entity Address
1000 WEST CARSON ST.
TORRANCE, CA 90502
Medicare Provider Number
050376
Participating Start Date
7/1/1997
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
COUNTY OF LOS ANGELES
Pharmacy Address
MARTIN LUTHER KING JR. MACC
OUTPATIENT PHARMACY
12021 S. WILMINGTON AV, RM 1086
LOS ANGELES, CA 90059
Pharmacy Comments
Contract Details
Approval Date
2/20/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Delvecchio Finley, Chief Executive Officer
(310) 222-2101
Contract Pharmacy Representative
Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059
Signed By Date
1/9/2013
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