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PED073300-00 CONNECTICUT CHILDREN'S MEDICAL CENTER (Active)
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Main Details
Name
CONNECTICUT CHILDREN'S MEDICAL CENTER
Subdivision Name
Type
Children's Hospital
Rural
No
340B ID
PED073300-00
Medicare Provider Number
073300
Additional Details
Current Program Status
Active
Registration Date
6/9/2010
Participating Start Date
7/1/2010
Participating Approval Date
6/15/2010
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
CT Children's
Robert Elijah Duncan, Executive Vice President & Chief Operating Officer
(860) 545-8648
Primary Contact
Connecticut Children's Medical Center
Heather Hipsky, Pharmacy Procurement Manager
(860) 837-5116
Addresses
Street Address
282 WASHINGTON STREET
HARTFORD, CT 06106
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/19/12 REMOVED NPI #S (WAS 1215947387 AND 1134271661)
04/19/2012
April 2025
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