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LAC WILMINGTON HLTH CTR PHMCY
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
LAC WILMINGTON HLTH CTR PHMCY
Pharmacy Address
1325 BROAD AVE
WILMINGTON, CA 90744
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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