Covered Entity Details

PED363303-225 CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON (Approved) - information as of 5/8/2025 10:15:23 PM

Main Details

Name

CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON

Subdivision Name

Psych Wooster - Pediatric Psychiatry

Type

Children's Hospital

Rural

340B ID

PED363303-225

Medicare Provider Number

363303

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/9/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/5/2025

Last Recertification Date

Contacts

Authorizing Official

Children's Hospital Medical Center of Akron
Alicia Lamancusa, Vice President Finance
(330) 543-8171

Primary Contact

Akron Children's
Thomas Kyle Finnerty, Director of Pharmacy
(330) 543-8197

Addresses

Street Address

3807 Friendsville Road
Wooster, OH 44691

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?
Yes

State	Medicaid Number	NPI Number
OH	1473203	1861506560,1912055484,1649485848

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
PED363303-01	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S AT MAHONING VALLEY	6505 MARKET STREET	BOARDMAN	OH	Terminated
PED363303-02	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S BOSTON HEIGHTS HEALTH CENTER	328 East Hines HIll Road	HUDSON	OH	Terminated
PED363303-03	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S AT MONTROSE	4125 MEDINA ROAD	AKRON	OH	Active
PED363303-04	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS ASHLAND OFFICE	2212 MIFFLIN AVE.	ASHLAND	OH	Terminated
PED363303-05	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS BARBERTON OFFICE	62 CONSERVATORY DRIVE	BARBERTON	OH	Terminated
PED363303-06	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS EAST	891 EAST EXCHANGE STREET	AKRON	OH	Active
PED363303-07	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS ELLET OFFICE	1463 Canton Road	AKRON	OH	Active
PED363303-08	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS FAIRLAWN OFFICE	701 WHITE POND DRIVE	AKRON	OH	Active
PED363303-09	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS GREEN OFFICE	1622 E. TURKEYFOOT LAKE ROAD	AKRON	OH	Terminated
PED363303-10	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS HUDSON OFFICE	1365 CORPORATE DRIVE	HUDSON	OH	Active
PED363303-100	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Ophthalmology Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-101	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Gastroenterology North Canton - Pediatrics	6076 Whipple Ave NW	North Canton	OH	Active
PED363303-102	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MFM Aultman - Pediatrics	2600 Tuscarawas Street West	Canton	OH	Active
PED363303-103	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Ophthalmology North Canton - Pediatrics	6076 Whipple Avenue Northwest	North Canton	OH	Active
PED363303-104	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Ophthalmology MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-105	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center Norwalk - Pediatrics	282 Benedict Ave	Norwalk	OH	Active
PED363303-106	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Hematology/Oncology MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-107	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Hematology/Oncology Mansfield - Pediatrics	1029 S. Trimble Road	Mansfield	OH	Active
PED363303-108	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Hematology/Oncology Millersburg - Pediatrics	1261 Wooster Road	Millersburg	OH	Active
PED363303-109	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Urology Mansfield - Pediatrics	1029 South Trimble Road	Mansfield	OH	Active
PED363303-11	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS KENT OFFICE	1951 ROUTE 59	KENT	OH	Terminated
PED363303-110	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Rheumatology North Canton - Pediatrics	6076 Whipple Avenue NW	North Canton	OH	Active
PED363303-111	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Health Active Living MV - Pediatrics	6505 Market St	Boardman	OH	Active
PED363303-112	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Healthy Active Living Green - Pediatrics	1622 E. Turkeyfoot Lake Rd	Akron	OH	Terminated
PED363303-113	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Pulmonary North Canton - Pediatrics	6076 Whipple Avenue NW	North Canton	OH	Active
PED363303-114	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Pulmonary Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-115	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Pulmonary MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-116	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Neurology Warren - Pediatrics	5000 East Market Street	Warren	OH	Active
PED363303-117	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Neurology Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Terminated
PED363303-118	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Neurology MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-119	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Ravenna - Pediatrics	6847 North Chestnut Street	Ravenna	OH	Terminated
PED363303-12	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS MEDINA OFFICE	3443 Medina Road	MEDINA	OH	Terminated
PED363303-120	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Portage - Pediatrics	2497 State Route 59	Ravenna	OH	Active
PED363303-121	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Quick Care Portage - Pediatrics	2497 State Route 59	Ravenna	OH	Active
PED363303-122	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Endocrinology Mansfield - Pediatrics	1029 South Trimble Road	Mansfield	OH	Active
PED363303-123	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Endocrinology Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-124	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Endocrinology North Canton - Pediatrics	6076 Whipple Ave NW	North Canton	OH	Active
PED363303-125	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Allergy MV - Pediatrics	6505 market Street	Boardman	OH	Active
PED363303-126	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Childrens Ortho Boston Heights - Pediatric Orthopedics	328 East Hines Hill Rd	Hudson	OH	Active
PED363303-127	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MV OR - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-128	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Urgent Care Warren - Pediatrics	5000 East Market Street	Warren	OH	Active
PED363303-129	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Urgent Care Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-13	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS NEW PHILADELPHIA OFFICE	1045 WEST HIGH STREET	NEW PHILADELPHIA	OH	Active
PED363303-130	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Sports Medicine Warren - Pediatrics	5000 East Market Street	Warren	OH	Active
PED363303-131	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Sports Med North Canton - Pediatrics	6076 Whipple Ave NW	North Canton	OH	Active
PED363303-132	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center Mansfield - Pediatrics	1029 South Trimble Road	Mansfield	OH	Active
PED363303-133	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Palliative Care MV - Pediatrics	6505 Market Street.	Boardman	OH	Active
PED363303-134	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Quick Care Boardman - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-135	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center Beachwood - Pediatrics	3733 Park East Drive Building 1	Beachwood	OH	Active
PED363303-136	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Gastroenterology Mansfield - Pediatrics	1029 South Trimble Road	Mansfield	OH	Active
PED363303-137	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Gastroenterology Marietta - Pediatrics	320 East 8th Street	Marietta	OH	Active
PED363303-138	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Nephrology Mansfield - Pediatrics	1029 South Trimble Road	Mansfield	OH	Active
PED363303-139	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP North Canton - Pediatrics	6076 Whipple Ave NW	North Canton	OH	Active
PED363303-14	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS SOLON OFFICE	34125 SOLON ROAD	SOLON	OH	Terminated
PED363303-140	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Dermatology North Canton - Pediatrics	6076 Whipple Avenue NW	North Canton	OH	Active
PED363303-141	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Wooster Practice - Pediatrics	3807 Friendsville Road	Wooster	OH	Active
PED363303-142	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MFM Wooster - Pediatrics	546 Winter Street	Wooster	OH	Active
PED363303-143	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MFM Summa - Pediatrics	75 Arch Street	Akron	OH	Active
PED363303-144	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Child Advocacy Center - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-145	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Adolescent Medicine MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-146	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Pediatrics of Akron Cuyahoga Falls - Pediatrics	1100 Portage Trail	Cuyahoga Falls	OH	Active
PED363303-147	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Warren - Pediatrics	5000 East Market Street	Warren	OH	Active
PED363303-148	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Ontario - Pediatrics	371 Cline Avenue	Mansfield	OH	Terminated
PED363303-149	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Urology Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-15	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS TALLMADGE OFFICE	143 NORTHWEST AVENUE	TALLMADGE	OH	Active
PED363303-150	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Psych MV - Pediatrics	6614 Southern Blvd	Boardman	OH	Active
PED363303-151	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center New Philadelphia - Pediatrics	1045 West High Ave	New Philadelphia	OH	Active
PED363303-152	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Urology Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-153	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Wadsworth PSA - Pediatrics	1225 High Street	Wadsworth	OH	Active
PED363303-154	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Medina Plastic Surgery Clinic - Plastic Surgery	3778 Medina Road	Medina	OH	Active
PED363303-155	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Amherst Plastic Surgery Clinic - Plastic Surgery	47185 Cooper Foster Park Road	Amherst	OH	Active
PED363303-156	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Amherst General Surgery - General Surgery Clinic	47185 Cooper Foster Park Road	Amherst	OH	Active
PED363303-157	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Perioperative Surgical Home MV - Pediatric Surgery Clinic	6505 Market Street	Boardman	OH	Active
PED363303-158	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Akron Children's Hospital Pediatrics Millersburg - Pediatrics	1261 Wooster Road	Millersburg	OH	Active
PED363303-159	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Dev Behavior Peds FCLC - Developmental Pediatrics	143 Northwest Ave	Tallmadge	OH	Terminated
PED363303-16	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS TWINSBURG OFFICE	8054 DARROW ROAD	TWINSBURG	OH	Active
PED363303-160	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Akron Children's Hospital Pediatrics Oberlin - Pediatrics	224 West Lorain Street	Oberlin	OH	Active
PED363303-161	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Akron Children's Hospital Pediatrics Sandusky - Pediatrics	2800 Hayes Ave	Sandusky	OH	Active
PED363303-162	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Norwalk Gastroenterology Clinic - gastroenterology	282 Benedict Avenue	Norwalk	OH	Terminated
PED363303-163	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Akron Children's Hospital Pediatrics Stow - Pediatrics	3019 Graham Road	Stow	OH	Active
PED363303-164	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Boston Heights Physiatry - Physiatry	328 East Hines Hill Road	Hudson	OH	Active
PED363303-165	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Akron Children's Hospital Pediatrics Beachwood - Pediatrics	3733 Park East Drive	Beachwood	OH	Active
PED363303-166	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Beachwood Gastroenterology - Gastroenterology	3733 Park East Drive	Beachwood	OH	Active
PED363303-167	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Wooster Gastroenterology - Gastroenterology	3807 Friendsville Road	Wooster	OH	Active
PED363303-168	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Wooster Heart Center - Cardiology	3807 Friendsville Road	Wooster	OH	Active
PED363303-169	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Wooster Allergy Clinic - Allergy	3807 Friendsville Road	Wooster	OH	Active
PED363303-17	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS WADSWORTH OFFICE	323 High Street	Wadsworth	OH	Active
PED363303-170	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Marietta Nephrology - Nephrology	320 East 8th St.	Marietta	OH	Active
PED363303-171	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Amherst Radiology - Amherst Radiology	47185 Cooper Foster Park Road	Amherst	OH	Active
PED363303-172	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Amherst Heart Center - Cardiology	47185 Cooper Foster Park Road	Amherst	OH	Active
PED363303-173	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Amherst Neurology - Amherst Neurology	47185 Cooper Foster Park Road	Amherst	OH	Active
PED363303-174	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Amherst Nephrology - Nephrology	47185 Cooper Foster Park Road	Amherst	OH	Active
PED363303-175	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Amherst Gastroenterology - Gastroenterology	47185 Cooper Foster Park Road	Amherst	OH	Active
PED363303-176	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	North Canton Neurology - Neurology	6076 Whipple Ave. NW	North Canton	OH	Active
PED363303-177	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MV Immunization Clinic - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-178	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MV Infusion Center - Infusion Clinic	6505 market Street Building A	Boardman	OH	Active
PED363303-179	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Boardman Psychiatry - Psychiatry	6505 Market Street, Building A	Boardman	OH	Active
PED363303-18	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS WOOSTER OFFICE	128 EAST MILTOWN ROAD	WOOSTER	OH	Terminated
PED363303-180	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MV Sedation Services - Sedation Services	6506 Market Street	Boardman	OH	Active
PED363303-181	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MV Perianesthesia - Perianesthesia	6506 Market Street	Boardman	OH	Active
PED363303-182	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Pediatric Surgery Clinic New Philadelphia - Pediatric Surgery Clinic	1045 West High Avenue	New Philadelphia	OH	Terminated
PED363303-183	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Warren Pediatric Surgery Clinic - Pediatric Surgery	5000 East Market Street	Warren	OH	Active
PED363303-184	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Dermatology Mansfield - Pediatric Dermatology	1029 South Trimble Rd.	Mansfield	OH	Active
PED363303-185	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Plastics Boston Heights - Pediatric Plastics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-186	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center Sharon - Pediatric Heart Center	740 E. State St.	Sharon	OH	Terminated
PED363303-187	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	PT Portage - Pediatric PT	2497 State Route 59	Ravenna	OH	Active
PED363303-188	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	PT North Canton - Pediatric PT	6076 Whipple Ave. NW	North Canton	OH	Active
PED363303-189	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Neonatology North Canton - Pediatric Neonatology	6076 Whipple Ave. NW	North Canton	OH	Active
PED363303-19	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDREN'S HOSPITAL PEDIATRICS BRECKSVILLE OFFICE	7001 S. EDGERTON ROAD	BRECKSVILLE	OH	Active
PED363303-190	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ENT Amherst - Pediatric ENT	47185 Cooper Foster Park Rd.	Amherst	OH	Active
PED363303-191	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Quick Care Austintown - Pediatrics	5480 Norquest Blvd	Austintown	OH	Active
PED363303-192	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Genetics MV - Pediatric Genetics	6505 Market St, Bldg A	Boardman	OH	Active
PED363303-193	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MV Speech Pathology - Pediatric Speech Pathology	6505 Market St., Bldg C	Boardman	OH	Active
PED363303-194	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Radiology Warren - Pediatric Radiology	5000 East Market Street	Warren	OH	Active
PED363303-195	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center Sandusky - Pediatric Heart Center	2800 Hayes Ave, Building G	Sandusky	OH	Active
PED363303-196	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MFM Mansfield - Pediatric MFM	1029 S Trimble Rd.	Mansfield	OH	Active
PED363303-197	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ENT Portage - Pediatric ENT	2497 State Route 59	Ravenna	OH	Active
PED363303-198	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Sleep Medicine North Canton - Pediatric Sleep Medicine	6076 Whipple Ave NW	North Canton	OH	Active
PED363303-199	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MV EEG - Pediatric EEG	6505 Market Street, Bldg A, 2nd Floor	Boardman	OH	Active
PED363303-20	Child	PED	CHILDRENS HOSPITAL MEDICAL CENTER	Mahoning Valley Pediatrics Specialties	8423 Market Street	Boardman	OH	Terminated
PED363303-200	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Adolescent Medicine North Canton - Pediatric adolescent medicine	6076 Whipple Ave. NW	North Canton	OH	Active
PED363303-201	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Akron Children's Rheumatology Mansfield - Pediatric rheumatology	1029 S Trimble Rd.	Mansfield	OH	Active
PED363303-202	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Psych PIRC Akron - Pediatric Psychiatry	177 W Exchange Street	Akron	OH	Active
PED363303-203	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Psych Mansfield - Pediatric psychology	1029 South Trimble Rd.	Mansfield	OH	Active
PED363303-204	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MV Audiology - Pediatric audiology	6505 Market Street Building C	Boardman	OH	Active
PED363303-205	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP - BELPRE - ACHP Belpre - Pediatrics	807 Farson St.	Belpre	OH	Active
PED363303-206	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP - CAMPBELL - ACHP Campbell - Pediatrics	434 Struthers-Coitsville Rd.	Lowellville	OH	Active
PED363303-207	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP - MARIETTA - ACHP Marietta - Pediatrics	310 E. 8th St.	Marietta	OH	Active
PED363303-208	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	CHILDRENS ORTHO UNIV OF AKRON - Pediatric Ortho University of Akron	254 Spicer St.	Akron	OH	Active
PED363303-209	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	LAB BOSTON HEIGHTS - Pediatric Laboratory Boston Heights	328 East Hines Hill Rd	Hudson	OH	Active
PED363303-21	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Urgent Care Mansfield - Pediatrics	1029 South Trimble Road	Mansfield	OH	Active
PED363303-210	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	LAB NORTH CANTON - Pediatric Laboratory North Canton	6076 Whipple Ave. NW	North Canton	OH	Active
PED363303-211	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	OPHTHALMOLOGY AMHERST - Pediatric Ophthalmology Amherst	47185 Cooper Foster Park Rd.	Amherst	OH	Active
PED363303-212	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	PEDIATRIC SURGERY MARIETTA - Pediatric Surgery Marietta	320 E. 8th Street	Marietta	OH	Active
PED363303-213	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	PSYCH BH CANTON - Pediatric Psych Behavioral Health Canton	626 30th St. NW	Canton	OH	Active
PED363303-214	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	PSYCH BH MANSFIELD - Pediatric psych behavior health Mansfield	1027 South Trimble Rd.	Mansfield	OH	Active
PED363303-215	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	PSYCH INTENSIVE OP BH CANTON - Pediatric Psych Intensive OP Behavior Health Canton	626 30th St. NW	Canton	OH	Active
PED363303-216	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	PSYCH INTENSIVE OP BH MANSFIELD - Pediatric psych intensive OP behavior health Mansfield	1027 South Trimble Rd.	Mansfield	OH	Active
PED363303-217	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	SLEEP LAB MV - Pediatric Sleep Lab MV	6505 Market St., Building D	Boardman	OH	Active
PED363303-218	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	SPORTS MEDICINE UNIV OF AKRON - Pediatric Sports Medicine University of Akron	254 Spicer St.	Akron	OH	Active
PED363303-219	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP - WADSWORTH NORTH - ACHP Wadsworth North - Pediatrics	1225 High St.	Wadsworth	OH	Active
PED363303-22	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	AKRON CHILDRENS HOSPITAL AT HATTIEH - Physiatry	9772 DIAGONAL ROAD	MANTUA	OH	Active
PED363303-220	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Psych Healthy Active Living MV - Pediatric Psych Healthy Active Living MV	6505 Market St.	Boardman	OH	Active
PED363303-221	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Radiology Boston Heights - Pediatric Radiology Boston Heights	328 East Hines Hill Rd.	Hudson	OH	Active
PED363303-222	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Speech Therapy New Philadelphia - Pediatric Speech Therapy	1045 West High Ave.	New Philadelphia	OH	Approved
PED363303-223	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	PT Massillon - Pediatric Physical Therapy	1149 Lincoln Way East	Massillon	OH	Approved
PED363303-224	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Psych Boston Heights - Pediatric Psychiatry	328 East Hines Hill Rd.	Hudson	OH	Approved
PED363303-225	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Psych Wooster - Pediatric Psychiatry	3807 Friendsville Road	Wooster	OH	Approved
PED363303-24	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-25	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Allergy Immuno Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-26	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Childrens Ortho Medina - Pediatric Orthopedics	3778 Medina Road	Medina	OH	Active
PED363303-27	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Dermatology Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-28	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Endocrinology Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-29	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ENT Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-30	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Gastroenterology Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-31	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-32	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Neurology Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-33	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Ophthalmology Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-34	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Physiatry Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-35	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Rheumatology Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-36	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Sports Medicine Medina - Pediatrics	3778 Medina Road	Medina	OH	Active
PED363303-37	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Alliance - Pediatrics	1826 S. Arch Ave	Alliance	OH	Active
PED363303-38	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Amherst - Pediatrics	47185 Cooper Foster Park Rd	Amherst	OH	Active
PED363303-39	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Ashland Practice - Pediatrics	1120 George Road	Ashland	OH	Active
PED363303-40	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Austintown - Pediatrics	5480 Norquest Blvd	Austintown	OH	Active
PED363303-41	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Barberton Practice - Pediatrics	566 Robinson Avenue	Barberton	OH	Active
PED363303-42	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Boardman - Pediatrics	6505 Market St	Boardman	OH	Active
PED363303-43	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Boston Heights - Pediatrics	328 East Hines Hill Rd	Hudson	OH	Active
PED363303-44	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP East Liverpool - Pediatrics	15655 State Route 170	East Liverpool	OH	Active
PED363303-45	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Green Practice - Pediatrics	1622 E. Turkeyfoot Lake Road	Akron	OH	Active
PED363303-46	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Liberty - Pediatrics	3530 Belmont Ave	Youngstown	OH	Active
PED363303-47	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP LIsbon - Pediatric	400 North Market Street	Lisbon	OH	Active
PED363303-48	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center Lisbon - Pediatrics	400 North Market Street	Lisbon	OH	Active
PED363303-49	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Lorain - Pediatrics	47185 Cooper Foster Park Road	Amherst	OH	Active
PED363303-50	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Mansfield - Pediatrics	1029 South Trimble Road	Mansfield	OH	Active
PED363303-51	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Massilon - Pediatrics	1149 Lincoln Way East	Massilon	OH	Active
PED363303-52	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Magnetic Resonance MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-53	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Childrens Ortho Mansfield - Pediatric Orthopedics	1029 South Trimble Road	Mansfield	OH	Active
PED363303-54	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Childrens Ortho North Canton - Pediatric Orthopedics	6076 Whipple Ave NW	North Canton	OH	Active
PED363303-55	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Neurology Norwalk - Pediatrics	282 Benedict Avenue	Norwalk	OH	Active
PED363303-56	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Urology MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-57	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Urology Norwalk - Pediatrics	282 Benedict Avenue	Norwalk	OH	Active
PED363303-58	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Physiatry North Canton - Pediatrics	6076 Whipple Avenue NW	North Canton	OH	Active
PED363303-59	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Urology North Canton - Pediatrics	6076 Whipple Ave NW	North Canton	OH	Active
PED363303-60	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Childrens Ortho MV - Pediatric Orthopedics	6505 Market Street	Boardman	OH	Active
PED363303-61	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Allergy Boston Heights - Pediatrics	328 East Hines Hill Rd	Hudson	OH	Active
PED363303-62	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Dev Behavioral Peds MV - Pediatrics	6505 Market Street,	Boardman	OH	Active
PED363303-63	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Urology Warren - Pediatrics	5000 East Market Street	Warren	OH	Active
PED363303-64	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ENT Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-65	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center Marietta - Pediatrics	320 East 8th Street	Marietta	OH	Active
PED363303-66	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Neonatology MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-67	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Gastroenterology Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-68	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-69	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Psych Intensive OP MV - Pediatrics	6614 Southern Blvd	Boardman	OH	Active
PED363303-70	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	MV Rheumatology - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-71	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Pulmonary Norwalk - Pediatrics	282 Benedict Avenue	Norwalk	OH	Active
PED363303-72	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Dermatology Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-73	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Sleep Medicine MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-74	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Gastroenterology MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-75	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Pulmonary Warren - Pediatrics	5000 East Market Street	Warren	OH	Active
PED363303-76	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Allergy North Canton - Pediatrics	6076 Whipple Avenue NW	North Canton	OH	Active
PED363303-77	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center Warren - Pediatrics	5000 E Market Street	Warren	OH	Active
PED363303-78	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Sports Medicine Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-79	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Warren Downtown - Pediatrics	661 Mahoning Avenue	Warren	OH	Active
PED363303-80	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Stark Count Advocacy Center - Pediatrics	213 Market Avenue North	Canton	OH	Active
PED363303-81	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Streetsboro - Pediatrics	9150 Market Square	Streetsboro	OH	Active
PED363303-82	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Childrens Ortho Warren - Pediatric Orthopedics	5000 East Market Street	Warren	OH	Active
PED363303-83	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Plastics MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-84	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ACHP Perry - Pediatrics	125 Whipple Ave SW	Canton	OH	Active
PED363303-85	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	ENT Mansfield - Pediatrics	1029 South Trimble Road	Mansfield	OH	Active
PED363303-86	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center North Canton - Pediatrics	6076 Whipple Ave NW	North Canton	OH	Active
PED363303-87	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Nephrology MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-88	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Gastroenterology Warren - Pediatrics	5000 E Market St	Warren	OH	Active
PED363303-89	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Emergency MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-90	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Rheumatology Boston Heights - Pediatrics	328 East Hines Hill Road	Hudson	OH	Active
PED363303-91	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Allergy Immuno Mansfield - Pediatrics	1029 South Trimble Road	Mansfield	OH	Active
PED363303-92	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Pediatric Surgery MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-93	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Physiatry MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-94	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Care Center Akron - Pediatrics	300 Locust Street	Akron	OH	Terminated
PED363303-95	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Sports Medicine MV - Pediatrics	6505 Market Street	Boardman	OH	Active
PED363303-96	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Endocrinology Warren - Pediatrics	5000 East Market Street	Warren	OH	Active
PED363303-97	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Allergy Beachwood - Pediatrics	3733 Park East Drive	Beachwood	OH	Terminated
PED363303-98	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Heart Center Boston Heights - Pediatrics	328 East Hines Hill Rd	Hudson	OH	Active
PED363303-99	Child	PED	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	Endocrinology MV - Pediatrics	6505 Market Street	Boardman	OH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Lamancusa, Alicia Vice President Finance Children's Hospital Medical Center of Akron 3305438171	5/5/2025 12:36 PM
Details	340B ID	Update	New Registration		PED363303-225	5/5/2025 12:36 PM
Details	Entity Name	Update	New Registration	CHILDRENS HOSPITAL MEDICAL CENTER	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON	5/5/2025 12:36 PM
Details	Entity Subname	Update	New Registration	Psych Wooster	Psych Wooster - Pediatric Psychiatry	5/5/2025 12:36 PM
Dates	Participating Approval Date	Update	New Registration		5/5/2025 12:36:01 PM	5/5/2025 12:36 PM
Details	State	Update	New Registration	Pending	Approved	5/5/2025 12:36 PM
Dates	Signed By Date	Update	New Registration		4/24/2025 9:04:26 AM	5/5/2025 12:36 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/5/2025 12:36 PM
Addresses	Main Address	Insert	New Registration		3807 Friendsville Road Wooster, OH 44691	4/9/2025 1:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/9/2025 1:48 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1473203	4/9/2025 1:48 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	4/9/2025 1:48 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1861506560	4/9/2025 1:48 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	4/9/2025 1:48 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1912055484	4/9/2025 1:48 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	4/9/2025 1:48 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1649485848	4/9/2025 1:48 PM
Medicaid Billing	NPI: State	Insert	New Registration		OH	4/9/2025 1:48 PM
Contacts	Authorizing Official	Insert	New Registration		Lamancusa, Alicia Vice President Finance Children's Hospital Medical Center of Akron 3305438171	4/9/2025 1:48 PM
Contacts	Primary Contact	Insert	New Registration		Finnerty, Thomas Kyle Director of Pharmacy Akron Children's 3305438197	4/9/2025 1:48 PM
Details	Assistance Received From Date	Insert	New Registration			4/9/2025 1:48 PM
Details	Assistance Received To Date	Insert	New Registration			4/9/2025 1:48 PM
Details	Last Recertification Date	Insert	New Registration			4/9/2025 1:48 PM
Details	Grant Number	Insert	New Registration			4/9/2025 1:48 PM
Details	340B ID	Insert	New Registration			4/9/2025 1:48 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/9/2025 1:48 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/9/2025 1:48 PM
Details	Medicare Provider Number	Insert	New Registration		363303	4/9/2025 1:48 PM
Details	Entity Name	Insert	New Registration		CHILDRENS HOSPITAL MEDICAL CENTER	4/9/2025 1:48 PM
Details	NOFO Number	Insert	New Registration			4/9/2025 1:48 PM
Details	Program Code	Insert	New Registration		PED	4/9/2025 1:48 PM
Details	Entity Subname	Insert	New Registration		Psych Wooster	4/9/2025 1:48 PM
Dates	Participating Approval Date	Insert	New Registration			4/9/2025 1:48 PM
Details	State	Insert	New Registration		Pending	4/9/2025 1:48 PM
Dates	Registration Date	Insert	New Registration		4/9/2025 1:48:41 PM	4/9/2025 1:48 PM
Dates	Signed By Date	Insert	New Registration			4/9/2025 1:48 PM
Dates	Start Date	Insert	New Registration			4/9/2025 1:48 PM
Terminations	Termination Comments	Insert	New Registration			4/9/2025 1:48 PM
Terminations	Termination Date	Insert	New Registration			4/9/2025 1:48 PM
Terminations	Termination Effective Date	Insert	New Registration			4/9/2025 1:48 PM
Terminations	Termination Reason	Insert	New Registration			4/9/2025 1:48 PM