340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PED053305-16 LUCILE PACKARD CHILDREN'S HOSPITAL (Terminated)
Print
Main Details
Name
LUCILE PACKARD CHILDREN'S HOSPITAL
Subdivision Name
DERMATOLOGY
Type
Children's Hospital
Rural
No
340B ID
PED053305-16
Medicare Provider Number
053305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/4/2016
Last Recertification Date
9/11/2018
Termination Date
Termination Reason
4/1/2019
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Lucile Packard Children's Hospital
Rick Stephen Majzun, COO
(650) 723-0418
Primary Contact
Lucile Packard Children's Hospital
Mindy Chuang, Pharmacy Finance Manager
(650) 736-4075
Addresses
Street Address
770 WELCH ROAD
PALO ALTO, CA 94304
Billing Address
LUCILE PACKARD CHILDREN'S HOSPITAL-ACCOUNTS PAYABLE
725 WELCH ROAD MC5553
PALO ALTO, CA 94304
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session