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PED053303-00 RADY CHILDRENS HOSPITAL - SAN DIEGO (Active)
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Main Details
Name
RADY CHILDRENS HOSPITAL - SAN DIEGO
Subdivision Name
Type
Children's Hospital
Rural
No
340B ID
PED053303-00
Medicare Provider Number
053303
Additional Details
Current Program Status
Active
Registration Date
8/31/2012
Participating Start Date
1/1/2015
Participating Approval Date
9/14/2012
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Rady Children's Hospital San Diego
Charles Brendan Davis, Interim Chief Operating Officer
(858) 966-4001
Primary Contact
Rady Children's Hospital San Diego
Chris Abe, VP, Operations
(858) 966-5968
Addresses
Street Address
3020 Children's Way
San Diego, CA 92123-4282
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/15/2014 - CE reinstated starting 01/01/2015, was participating 10/01/2012 to 12/31/2012, not participating 1/1/2013 to 12/31/2014 due to inability to comply with GPO prohibition (drugs were not purchased during active period).
12/15/2014
April 2025
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