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PED243302-07 CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA (Terminated)
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Main Details
Name
CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA
Subdivision Name
St. Paul /Rheumatology Clinic
Type
Children's Hospital
Rural
No
340B ID
PED243302-07
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
8/25/2016
Termination Date
Termination Reason
4/1/2017
Site closure
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
St. Paul, MN 55102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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