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PED363305-17 NATIONWIDE CHILDREN'S HOSPITAL (Terminated)
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Main Details
Name
NATIONWIDE CHILDREN'S HOSPITAL
Subdivision Name
PRIMARY CARE CLINIC RED
Type
Children's Hospital
Rural
No
340B ID
PED363305-17
Medicare Provider Number
363305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2017
Participating Start Date
4/1/2017
Participating Approval Date
1/10/2017
Last Recertification Date
9/4/2020
Termination Date
Termination Reason
7/1/2021
Site closure
Contacts
Authorizing Official
Nationwide Childrens Hospital
Luke Brown, Vice President of Finance and Treasury
(614) 355-3117
Primary Contact
Nationwide Children's Hospital
Crista Parsons, Pharmacy Business Manager
(614) 722-6972
Addresses
Street Address
380 Butterfly Gardens Drive, Suite 3E/F
Columbus, OH 43215
Billing Address
Nationwide Children's Hospital
Pharmacy
700 Children's Drive
Columbus, OH 43205
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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