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PED193300-15 Children's Hospital (Terminated)
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Main Details
Name
Children's Hospital
Subdivision Name
CHILDREN'S HOSPITAL DIALYSIS UNIT
Type
Children's Hospital
Rural
No
340B ID
PED193300-15
Medicare Provider Number
193300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/25/2010
Participating Start Date
1/1/2014
Participating Approval Date
3/25/2010
Last Recertification Date
8/25/2023
Termination Date
Termination Reason
10/1/2024
Other
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
200 HENRY CLAY AVENUE
NEW ORLEANS, LA 70118
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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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 with 340B.
04/02/2013
May 2025
May 2025
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