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PED063301-34 THE CHILDREN'S HOSPITAL ASSOCIATION (Terminated)
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Main Details
Name
THE CHILDREN'S HOSPITAL ASSOCIATION
Subdivision Name
CHILDRENS HOSPITAL COLORADO / Wheatridge Gastro
Type
Children's Hospital
Rural
No
340B ID
PED063301-34
Medicare Provider Number
063301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/8/2016
Last Recertification Date
12/5/2017
Termination Date
Termination Reason
4/1/2018
Site closure
Contacts
Authorizing Official
Children's Hospital Colorado
Casey Dugan, Vice President of Pharmacy Services
(720) 777-5683
Primary Contact
Children's Hospital Colorado
Ricardo Alexis Laremont, Pharmacy 340B Program Manager
(720) 777-8899
Addresses
Street Address
469 WEST STATE HIGHWAY 7
469 WEST 168TH AVENUE
BROOMFIELD, CO 80023-8965
Billing Address
Children's Hospital Colorado
13123 E. 16th Ave
Aurora, CO 80045
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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