Covered Entity Details

PED103304-13 NEMOURS CHILDRENS HOSPITAL (Active) - information as of 4/26/2025 11:43:43 PM

Main Details

Name

NEMOURS CHILDRENS HOSPITAL

Subdivision Name

NCH, WINTER GARDEN - Cardiology

Type

Children's Hospital

Rural

340B ID

PED103304-13

Medicare Provider Number

103304

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/11/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/27/2024

Last Recertification Date

Contacts

Authorizing Official

Nemours
Hal Williams, Operational Vice President Central Florida Finance
(407) 650-7456

Primary Contact

Nemours Children's Hospital, Florida
Sylinda Fulse, Pharmacy Business Manager
(863) 860-3517

Addresses

Street Address

2020 DANIELS RD
STE B
WINTER GARDEN, FL 34787-4975

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
PED103304-01	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Cardiology	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-02	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Endocrinology	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-03	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Gastroenterology	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-04	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Genetics	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-05	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Medical Imaging	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-06	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Nephrology	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-07	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Nutrition	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-08	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Orthopedics	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-09	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Otolaryngology	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-10	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Physical Medicine and Rehabilitation	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-11	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Pulmonology	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-12	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Audiology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-13	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Cardiology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-14	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Endocrinology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-15	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Gastroenterology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-16	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Interventional Radiology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-17	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Medical Imaging	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-18	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Nephrology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-19	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Neurology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-20	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Neurotology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-21	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Orthopedics	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-22	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Otolaryngology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-23	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Plastic Surgery	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-24	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Pulmonology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-25	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Sports Medicine	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-26	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Urology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-27	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Neurosurgery	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-28	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Neurosurgery	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-29	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Optometry	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-30	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Ophthalmology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-31	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Audiology	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active
PED103304-32	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, WINTER GARDEN - Immunology	2020 DANIELS RD	WINTER GARDEN	FL	Active
PED103304-33	Child	PED	NEMOURS CHILDRENS HOSPITAL	NCH, LAKE MARY - Interventional Radiology	3300 W LAKE MARY BLVD	LAKE MARY	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Williams, Hal Operational Vice President Central Florida Finance Nemours 4076507456	8/27/2024 6:45 AM
Details	340B ID	Update	New Registration		PED103304-13	8/27/2024 6:45 AM
Details	Entity Subname	Update	New Registration	NCH, WINTER GARDEN	NCH, WINTER GARDEN - Cardiology	8/27/2024 6:45 AM
Dates	Participating Approval Date	Update	New Registration		8/27/2024 6:45:25 AM	8/27/2024 6:45 AM
Details	State	Update	New Registration	Pending	Approved	8/27/2024 6:45 AM
Dates	Signed By Date	Update	New Registration		8/13/2024 1:11:01 PM	8/27/2024 6:45 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/27/2024 6:45 AM
Addresses	Main Address	Insert	New Registration		2020 DANIELS RD STE B WINTER GARDEN, FL 34787-4975	7/11/2024 4:21 PM
Contacts	Authorizing Official	Insert	New Registration		Williams, Hal Operational Vice President Central Florida Finance Nemours 4076507456	7/11/2024 4:21 PM
Contacts	Primary Contact	Insert	New Registration		Fulse, Sylinda Pharmacy Business Manager Nemours Children's Hospital, Florida 8638603517	7/11/2024 4:21 PM
Details	Assistance Received From Date	Insert	New Registration			7/11/2024 4:21 PM
Details	Assistance Received To Date	Insert	New Registration			7/11/2024 4:21 PM
Details	Last Recertification Date	Insert	New Registration			7/11/2024 4:21 PM
Details	Grant Number	Insert	New Registration			7/11/2024 4:21 PM
Details	340B ID	Insert	New Registration			7/11/2024 4:21 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/11/2024 4:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/11/2024 4:21 PM
Details	Medicare Provider Number	Insert	New Registration		103304	7/11/2024 4:21 PM
Details	Entity Name	Insert	New Registration		NEMOURS CHILDRENS HOSPITAL	7/11/2024 4:21 PM
Details	NOFO Number	Insert	New Registration			7/11/2024 4:21 PM
Details	Program Code	Insert	New Registration		PED	7/11/2024 4:21 PM
Details	Entity Subname	Insert	New Registration		NCH, WINTER GARDEN	7/11/2024 4:21 PM
Dates	Participating Approval Date	Insert	New Registration			7/11/2024 4:21 PM
Details	State	Insert	New Registration		Pending	7/11/2024 4:21 PM
Dates	Registration Date	Insert	New Registration		7/11/2024 4:21:45 PM	7/11/2024 4:21 PM
Dates	Signed By Date	Insert	New Registration			7/11/2024 4:21 PM
Dates	Start Date	Insert	New Registration			7/11/2024 4:21 PM
Terminations	Termination Comments	Insert	New Registration			7/11/2024 4:21 PM
Terminations	Termination Date	Insert	New Registration			7/11/2024 4:21 PM
Terminations	Termination Effective Date	Insert	New Registration			7/11/2024 4:21 PM
Terminations	Termination Reason	Insert	New Registration			7/11/2024 4:21 PM