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PED453315-27 CHRISTUS Children's (Active)
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Main Details
Name
CHRISTUS Children's
Subdivision Name
CHRISTUS CHILDREN'S - Stone Oak Pulmonology - Clinic
Type
Children's Hospital
Rural
No
340B ID
PED453315-27
Medicare Provider Number
453315
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/27/2025
Last Recertification Date
Contacts
Authorizing Official
CHRISTUS Santa Rosa
Steve Chen, CFO
(210) 321-8031
Primary Contact
CHRISTUS Santa Rosa Health System
Dustyn Tysdal, REGIONAL DIRECTOR OF PHARMACY
(210) 704-0130
Addresses
Street Address
1434 E SONTERRA BLVD
STE 300
SAN ANTONIO, TX 78258-4974
Billing Address
CHRISTUS Children's
333 North Santa Rosa Street
San Antonio, TX 78207
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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