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PED393303-03 THE CHILDREN'S HOSPITAL OF PHILADELPHIA (Active)
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Main Details
Name
THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Subdivision Name
Children's Hospital Home Care
Type
Children's Hospital
Rural
No
340B ID
PED393303-03
Medicare Provider Number
393303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/16/2009
Participating Start Date
1/1/2010
Participating Approval Date
12/18/2009
Last Recertification Date
8/22/2024
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
3000 Horizon Drive
KING OF PRUSSIA, PA 19406
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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12/22/09 ADDED SHIP TO
01/22/2010
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