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PED103301-00 Nicklaus Children's Hospital (Active)
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Main Details
Name
Nicklaus Children's Hospital
Subdivision Name
Type
Children's Hospital
Rural
No
340B ID
PED103301-00
Medicare Provider Number
103301
Additional Details
Current Program Status
Active
Registration Date
8/31/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/20/2011
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Nicklaus Children's Health System
Dawn Javersack, Sr. Vice President and Chief Financial Officer
(786) 624-2005
Primary Contact
Nicklaus Children's Hospital
Acirema Bastida, Pharmacy 340B Analyst
(786) 624-5789
Addresses
Street Address
3100 SW 62nd Avenue
Miami, FL 33155
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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