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PED053301-108 CHILDRENS HOSP & RES CNTR OAKLAND (Active)
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Main Details
Name
CHILDRENS HOSP & RES CNTR OAKLAND
Subdivision Name
CHILDRENS HOSP & RES CNTR OAKLAND - UCSF Benioff Childrens Hospital Walnut Creek - Cardiology
Type
Children's Hospital
Rural
No
340B ID
PED053301-108
Medicare Provider Number
053301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/1/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/23/2024
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
UCSF Medical Center & Benioff Children's Hospital
James Wentz, SVP & CFO
(415) 514-6118
Primary Contact
UCSF Health
Kayla Hubbard, 340B Program Coordinator
(808) 339-5697
Addresses
Street Address
2401 Shadelands Dr., Ste. 180C
Walnut Creek, CA 94598
Billing Address
CHILDRENS HOSP & RES CNTR OAKLAND
747 52nd Street
Oakland, CA 94609
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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