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PED243300-00 GILLETTE CHILDREN'S SPECIALTY HEALTHCARE (Active)
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Main Details
Name
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Subdivision Name
Type
Children's Hospital
Rural
No
340B ID
PED243300-00
Medicare Provider Number
243300
Additional Details
Current Program Status
Active
Registration Date
4/13/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/19/2019
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Gillette Children's Specialty Healthcare
Patrick Michael Nolan, Chief Financial Officer
(651) 312-3105
Primary Contact
Gillette Children's Specialty Healthcare - Saint Paul, MN
Kristen Beyer, Pharmacy Manager
(651) 726-2876
Addresses
Street Address
200 UNIVERSITY AVENUE EAST
ST. PAUL, MN 55101
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating start date 7/1/2010, Termination 10/1/2013, Reinstatement 7/1/2019
04/16/2019
April 2025
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