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PED063301-13 THE CHILDREN'S HOSPITAL ASSOCIATION (Terminated)
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Main Details
Name
THE CHILDREN'S HOSPITAL ASSOCIATION
Subdivision Name
Children's Hospital Colorado - Briargate COS OP Specialty Care
Type
Children's Hospital
Rural
No
340B ID
PED063301-13
Medicare Provider Number
063301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2013
Participating Start Date
10/1/2013
Participating Approval Date
8/28/2013
Last Recertification Date
9/8/2015
Termination Date
Termination Reason
1/1/2016
Site closure
Contacts
Authorizing Official
Children's Hospital Colorado
Casey Dugan, Vice President of Pharmacy Services
(720) 777-5683
Primary Contact
Children's Hospital Colorado
Casey Dugan, Vice President of Pharmacy Services
(720) 777-5683
Addresses
Street Address
4125 Briargate Parkway
Colorado Springs, CO 80920
Billing Address
The Children's Hospital Association
4125 Briargate Parkway
STE CS2100
Colorado Springs, CO 80920
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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