340B Drug Pricing Program Database
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PED453300-38 COOK CHILDREN'S MEDICAL CENTER (Terminated)
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Main Details
Name
COOK CHILDREN'S MEDICAL CENTER
Subdivision Name
Cardiology Outreach
Type
Children's Hospital
Rural
No
340B ID
PED453300-38
Medicare Provider Number
453300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/13/2015
Last Recertification Date
8/17/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Cook Children's Medical Center
Nancy Cychol, EVP, Hospital Services
(682) 885-4340
Primary Contact
Cook Children's Medical Center
Chelsea Baria, Strategic Business Manager, Finance
(682) 885-2167
Addresses
Street Address
1500 Cooper St
Fort Worth, TX 76104
Billing Address
Cook Childrens Medical Center
801 7th Ave
Fort Worth, TX 76104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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