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PED453315-00 CHRISTUS Children's (Active)
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Main Details
Name
CHRISTUS Children's
Subdivision Name
Type
Children's Hospital
Rural
No
340B ID
PED453315-00
Medicare Provider Number
453315
Additional Details
Current Program Status
Active
Registration Date
1/14/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/10/2014
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
CHRISTUS Santa Rosa
Steve Chen, CFO
(210) 321-8031
Primary Contact
CHRISTUS Santa Rosa Health System
Dustyn Tysdal, REGIONAL DIRECTOR OF PHARMACY
(210) 704-0130
Addresses
Street Address
333 North Santa Rosa Street
San Antonio, TX 78207
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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