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PED363305-10 NATIONWIDE CHILDREN'S HOSPITAL (Active)
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Main Details
Name
NATIONWIDE CHILDREN'S HOSPITAL
Subdivision Name
CLOSE TO HOME PHYSICIAN CARE CENTER / Linden Primary Care Center
Type
Children's Hospital
Rural
No
340B ID
PED363305-10
Medicare Provider Number
363305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/6/2015
Participating Start Date
4/1/2015
Participating Approval Date
2/10/2015
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Nationwide Childrens Hospital
Luke Brown, Vice President of Finance and Treasury
(614) 355-3117
Primary Contact
Nationwide Children's Hospital
Jonathan Labuhn, Director, Pharmacy Finance & Supply Chain
(614) 722-0412
Addresses
Street Address
1390 CLEVELAND AVENUE
2nd Floor
COLUMBUS, OH 43211-2767
Billing Address
Nationwide Children's Hospital
PO Box 31772
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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