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PED523300-31 CHILDREN'S HOSPITAL OF WISCONSIN, INC. (Active)
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Main Details
Name
CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Subdivision Name
CHILDRENS HOSPITAL OF WISCONSIN INC / Delafield Clinic - Dermatology (CC8954)
Type
Children's Hospital
Rural
No
340B ID
PED523300-31
Medicare Provider Number
523300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/27/2016
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Children's Hospital of Wisconsin
Scott Turner, COO CHW and EVP CHHS
(414) 266-2648
Primary Contact
Children's Wisconsin
Megan Elizabeth Ose, Director of Pharmacy Services
(414) 266-5773
Addresses
Street Address
3195 HILLSIDE DR
DELAFIELD, WI 53018-2189
Billing Address
Children's Hospital of Wisconsin
9000 W WISCONSIN AVENUE
Milwaukee, WI 53226
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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