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PED363306-01 Dayton Children's Hospital (Terminated)
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Main Details
Name
Dayton Children's Hospital
Subdivision Name
DAYTON CHILDREN'S SPECIALTY CARE CENTER-WARREN COUNTY-ENT
Type
Children's Hospital
Rural
No
340B ID
PED363306-01
Medicare Provider Number
363306
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/10/2010
Participating Start Date
4/1/2010
Participating Approval Date
3/11/2010
Last Recertification Date
8/21/2019
Termination Date
Termination Reason
4/1/2020
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Dayton Children's
Benjamin Goodstein, VICE PRESIDENT and Chief Ambulatory Officer
(937) 641-3450
Primary Contact
Dayton Children's
Chad Meyers, Director of Ambulatory Pharmacy Services
(937) 641-4591
Addresses
Street Address
100 CAMPUS LOOP ROAD
FRANKLIN, OH 45005
Billing Address
Dayton Children's
ONE CHILDREN'S PLAZA
DAYTON, OH 45404
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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