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PED063301-07 THE CHILDREN'S HOSPITAL ASSOCIATION (Terminated)
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Main Details
Name
THE CHILDREN'S HOSPITAL ASSOCIATION
Subdivision Name
Children's Hospital Colorado - Pueblo Speech Pathology
Type
Children's Hospital
Rural
No
340B ID
PED063301-07
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
9/9/2015
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
704 Fortino Blvd
Suite A
Pueblo, CO 81008
Billing Address
The Children's Hospital Association
13123 E 16th Ave
B375
Aurora, CO 80045
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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