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PED103301-03 Nicklaus Children's Hospital (Active)
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Main Details
Name
Nicklaus Children's Hospital
Subdivision Name
Nicklaus Children's Nirvair Chowdhury Midtown Center
Type
Children's Hospital
Rural
No
340B ID
PED103301-03
Medicare Provider Number
103301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/26/2013
Last Recertification Date
8/27/2024
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
3915 Biscayne Boulevard
Miami, FL 33137
Billing Address
Nicklaus Children's Hospital
3100 SW 62nd Avenue
Miami, FL 33155
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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