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PED103301-08 Nicklaus Children's Hospital (Active)
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Main Details
Name
Nicklaus Children's Hospital
Subdivision Name
Nicklaus Children's Miami Lakes Outpatient Center
Type
Children's Hospital
Rural
No
340B ID
PED103301-08
Medicare Provider Number
103301
Outpatient Facility Provider Number
103301
Additional Details
Current Program Status
Active
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/8/2014
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
15025 NW 77 AVENUE
MIAMI LAKES, FL 33014-6852
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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