340B Drug Pricing Program Database
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PED193300-04 Children's Hospital (Active)
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Main Details
Name
Children's Hospital
Subdivision Name
CHMPC Tulane Clinic
Type
Children's Hospital
Rural
No
340B ID
PED193300-04
Medicare Provider Number
193300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2020
Participating Start Date
1/1/2021
Participating Approval Date
11/17/2020
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Children's Hospital
Lucio A. Fragoso, President & CEO
(504) 896-9452
Primary Contact
Children's Hospital
Lindy C Bosworth, Director of Pharmacy
(504) 894-6764
Addresses
Street Address
4740 S. I-10 SERVICE ROAD
2nd Floor
METAIRIE, LA 70001
Billing Address
CHILDREN'S HOSPITAL
200 HENRY CLAY AVENUE
NEW ORLEANS, LA 70118
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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participating start 1/1/2014, terminated 10/1/2016, reinstate 1/1/2021
10/20/2020
11/29/13 enrolled 4/1/10 thru 6/30/13, not enrolled 7/1/13 thru 12/31/13 due to inability to comply with GPO exclusion, re-instated based on on-line registration submitted in Oct. 2013
11/29/2013
Entity is no longer participating in 340B.
04/02/2013
5/24/2010-
03/11/2010
May 2025
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