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PED453301-01 Driscoll Children's Hospital (Terminated)
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Main Details
Name
Driscoll Children's Hospital
Subdivision Name
Satellite Clinic Harlingen
Type
Children's Hospital
Rural
No
340B ID
PED453301-01
Medicare Provider Number
453301
Outpatient Facility Provider Number
453301
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/4/2014
Last Recertification Date
9/13/2019
Termination Date
Termination Reason
10/1/2020
Other
Contacts
Authorizing Official
Driscoll Children's Hospital
Steven Eric King, CFO
(361) 694-5934
Primary Contact
Driscoll Children's Hospital
Jessy Varkey Thomas, Director of Pharmacy
(361) 694-5061
Addresses
Street Address
2121 Pease St. #604
Harlingen, TX 78550
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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