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PED363303-12 CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON (Terminated)
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Main Details
Name
CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
Subdivision Name
AKRON CHILDREN'S HOSPITAL PEDIATRICS MEDINA OFFICE
Type
Children's Hospital
Rural
No
340B ID
PED363303-12
Medicare Provider Number
363303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/28/2022
Participating Start Date
4/1/2022
Participating Approval Date
3/15/2022
Last Recertification Date
Termination Date
Termination Reason
7/1/2022
Other
Contacts
Authorizing Official
Children's Hospital Medical Center of Akron
Alicia Lamancusa, Vice President Finance
(330) 543-8171
Primary Contact
Children's Hospital Medical Center of Akron
John E Lepto, Director of Pharmacy
(330) 543-8167
Addresses
Street Address
3443 Medina Road
SUITE 1115
MEDINA, OH 44256-5334
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 2/26/2010, terminated 7/1/2017. Reinstated 4/1/2022.
03/14/2022
May 2025
May 2025
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