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PED363303-20 CHILDRENS HOSPITAL MEDICAL CENTER (Terminated)
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Main Details
Name
CHILDRENS HOSPITAL MEDICAL CENTER
Subdivision Name
Mahoning Valley Pediatrics Specialties
Type
Children's Hospital
Rural
No
340B ID
PED363303-20
Medicare Provider Number
363303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/29/2015
Last Recertification Date
8/19/2016
Termination Date
Termination Reason
1/1/2018
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Akron Childrens Hospital
Spencer Anthony Kowal, Chief Financial Officer and Treasurer
(330) 543-4456
Primary Contact
Children's Hospital Medical Center of Akron
JOHN E. LEPTO, DIRECTOR OF PHARMACY SERVICES
(330) 543-8320
Addresses
Street Address
8423 Market Street
Suite 300
Boardman, OH 44512
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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