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PED243302-12 Children’s Health Care d/b/a Children’s Minnesota (Terminated)
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Main Details
Name
Children’s Health Care d/b/a Children’s Minnesota
Subdivision Name
St. Paul/Ketogenic Clinic
Type
Children's Hospital
Rural
No
340B ID
PED243302-12
Medicare Provider Number
243302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/16/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/10/2014
Last Recertification Date
12/5/2017
Termination Date
Termination Reason
10/1/2018
Other
Contacts
Authorizing Official
Children's Hospitals and Clinics of Minnesota
MARIA CHRISTU, CHIEF LEGAL OFFICER
(612) 813-6110
Primary Contact
Children's Hospitals and Clinics of Minnesota
Dawn Marben, 340B Compliance Analyst
(952) 992-5288
Addresses
Street Address
347 N SMITH AVE
SUITE 404
ST. PAUL, MN 55102
Billing Address
Children's Business Campus
CBC-2-ACC
5901 Lincoln Drive
Edina, MN 55436
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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