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PED093300-04 Children's Hospital (Terminated)
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Main Details
Name
Children's Hospital
Subdivision Name
Goldberg- Good Hope Road
Type
Children's Hospital
Rural
No
340B ID
PED093300-04
Medicare Provider Number
093300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/31/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/14/2012
Last Recertification Date
9/5/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Children's National Medical Center
Kathleen Gorman, EVP, Patient Care services & Chief Operating Officer
(202) 476-2939
Primary Contact
Ursula Tachie-Menson, Chief of Pharmacy
(202) 476-2697
Addresses
Street Address
2501 Good Hope Road SE
Suite L1
Washington, DC 20020
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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