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PED103300-19 JOHNS HOPKINS ALL CHILDREN'S HOSPITAL (Terminated)
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Main Details
Name
JOHNS HOPKINS ALL CHILDREN'S HOSPITAL
Subdivision Name
JOHNS HOPKINS ALL CHILDREN'S OUTPATIENT CARE CENTER (NEUROLOGY/NEUROSURGERY)
Type
Children's Hospital
Rural
No
340B ID
PED103300-19
Medicare Provider Number
103300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/5/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/21/2016
Last Recertification Date
11/16/2017
Termination Date
Termination Reason
7/1/2018
Other
Contacts
Authorizing Official
Johns Hopkins All Children's Hospital
Thomas D Kmetz, President
(727) 767-6873
Primary Contact
Johns Hopkins All Children's Hospital, Inc.
Pamela Kravitz, Pharmacy Business Manager
(727) 767-2039
Addresses
Street Address
601 5TH STREET SOUTH-Suites 510-511
St. Petersburg, FL 33701
Billing Address
Johns Hopkins Enterprise
JH A/P Shared Service Center
PO Box #33499
Baltimore, MD 21218
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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