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PED243302-00 Children’s Health Care d/b/a Children’s Minnesota (Active)
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Main Details
Name
Children’s Health Care d/b/a Children’s Minnesota
Subdivision Name
MINNEAPOLIS CAMPUS
Type
Children's Hospital
Rural
No
340B ID
PED243302-00
Medicare Provider Number
243302
Additional Details
Current Program Status
Active
Registration Date
10/15/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/10/2014
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Children's Hospitals and Clinics of Minnesota
Christa Steene-Lyons, Compliance Officer
(612) 813-6316
Primary Contact
Children's Hospitals and Clinics of Minnesota
Dirk Killelea, Pharmacy Manager - 340B
(612) 813-7161
Addresses
Street Address
2525 CHICAGO AVENUE SOUTH
MINNEAPOLIS, MN 55404
Billing Address
CHILDRENS BUSINESS CAMPUS
CBC-2-ACC
5901 LINCOLN DRIVE
EDINA, MN 55436
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/29/10 TERMINATED UNDER THIS ID EFFECTIVE 1/1/11 DUE TO CMS REQUIRING MINNEAPOLIS CAMPUS TO MERGE WITH ST. PAUL CAMPUS AND USE THE SAME MEDICARE NUMBER. NEW ID: 243301-01.
12/30/2010
May 2025
May 2025
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