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PED103304-01 NEMOURS CHILDRENS HOSPITAL (Active)
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Main Details
Name
NEMOURS CHILDRENS HOSPITAL
Subdivision Name
NCH, LAKE MARY - Cardiology
Type
Children's Hospital
Rural
No
340B ID
PED103304-01
Medicare Provider Number
103304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2024
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
3300 W LAKE MARY BLVD
STE 100
LAKE MARY, FL 32746-3499
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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