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KECK MEDICINE OF USC SPECIALTY PHARMACY
CAN050660-00 USC Norris Cancer Hospital
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Covered Entity Details
Entity Name
USC Norris Cancer Hospital
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN050660-00
Entity Address
1441 Eastlake Avenue
Los Angeles, CA 90033
Medicare Provider Number
050660
Participating Start Date
1/1/2014
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
KECK MEDICINE OF USC SPECIALTY PHARMACY
Pharmacy Address
1000 S FREMONT AVE STE 10150
ALHAMBRA, CA 91803-8800
Pharmacy Comments
Contract Details
Approval Date
10/13/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rod Hanners, Chief Operating Officer
(323) 442-8677
Contract Pharmacy Representative
Raffi Svadjian, Executive Director Retail Pharmacy Services
(323) 442-6121
Signed By Date
10/13/2015
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