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PED453300-15 COOK CHILDREN'S MEDICAL CENTER (Active)
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Main Details
Name
COOK CHILDREN'S MEDICAL CENTER
Subdivision Name
Dodson Specialty Clinic ~ Neurosciences
Type
Children's Hospital
Rural
No
340B ID
PED453300-15
Medicare Provider Number
453300
Outpatient Facility Provider Number
453300
Additional Details
Current Program Status
Active
Registration Date
11/22/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/12/2013
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Cook Children's Medical Center
Nancy Cychol, EVP, Hospital Services
(682) 885-4340
Primary Contact
Cook Childrens Medical Center
Haydee Melanie Madrigal, Manager, 340B Program
(682) 303-1606
Addresses
Street Address
1500 Cooper St
Fort Worth, TX 76104
Billing Address
Cook Children's Medical Center
801 7th Avenue
Fort Worth, TX 76104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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