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PED363305-41 NATIONWIDE CHILDREN'S HOSPITAL (Active)
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Main Details
Name
NATIONWIDE CHILDREN'S HOSPITAL
Subdivision Name
Allergy Clinic - ALLERGY CLINIC LEWIS CENTER
Type
Children's Hospital
Rural
No
340B ID
PED363305-41
Medicare Provider Number
363305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/13/2024
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Nationwide Childrens Hospital
Luke Brown, Vice President of Finance and Treasury
(614) 355-3117
Primary Contact
Nationwide Children's Hospital
Jonathan Labuhn, Director, Pharmacy Finance & Supply Chain
(614) 722-0412
Addresses
Street Address
7853 Pacer Drive
Delaware, OH 43015
Billing Address
Nationwide Children's Hospital
PO Box 31772
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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