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PED393303-31 THE CHILDREN'S HOSPITAL OF PHILADELPHIA (Active)
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Main Details
Name
THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Subdivision Name
Botox Therapy at Bryn Mawr - Botox Therapy at Bryn Mawr
Type
Children's Hospital
Rural
No
340B ID
PED393303-31
Medicare Provider Number
393303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2025
Participating Start Date
4/1/2025
Participating Approval Date
2/27/2025
Last Recertification Date
Contacts
Authorizing Official
Children's Hospital of Philadelphia
Jan Pieter Boswinkel, Senior Vice President & Chief Operating Officer, Hospital Operations
(215) 590-3055
Primary Contact
Children's Hospital of Philadelphia
Richard J. Dyke, Director of Pharmacy Business Operations
(267) 426-5834
Addresses
Street Address
135 S. Bryn Mawr Avenue Suite 240
Bryn Mawr, PA 19010
Billing Address
The Children's Hospital of Philadelphia
PO Box 2015
Secaucus, NJ 07096
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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