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PED103300-01 JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC. (Terminated)
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Main Details
Name
JOHNS HOPKINS ALL CHILDREN'S HOSPITAL, INC.
Subdivision Name
JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE, TAMPA
Type
Children's Hospital
Rural
No
340B ID
PED103300-01
Medicare Provider Number
103300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/30/2010
Participating Start Date
9/30/2010
Participating Approval Date
9/30/2010
Last Recertification Date
9/6/2016
Termination Date
Termination Reason
7/1/2017
DSH percentage below statutory minimum
Contacts
Authorizing Official
Johns Hopkins All Children's Hospital
Thomas D Kmetz, President
(727) 767-6873
Primary Contact
Johns Hopkins All Children's Hospital, Inc.
Pamela Kravitz, Pharmacy Business Manager
(727) 767-2039
Addresses
Street Address
12220 BRUCE B DOWNS BLVD
TAMPA, FL 33612
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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