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PED243302-55 Children’s Health Care d/b/a Children’s Minnesota (Terminated)
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Main Details
Name
Children’s Health Care d/b/a Children’s Minnesota
Subdivision Name
ST. PAUL/DEVELOPMENTAL PEDS CLINIC
Type
Children's Hospital
Rural
No
340B ID
PED243302-55
Medicare Provider Number
243302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/17/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/17/2017
Last Recertification Date
12/5/2017
Termination Date
Termination Reason
7/1/2018
Never implemented the 340B Program
Contacts
Authorizing Official
Children's Hospitals and Clinics of Minnesota
MARIA CHRISTU, CHIEF LEGAL OFFICER
(612) 813-6110
Primary Contact
Children's Hospitals and Clinics of Minnesota
Dawn Marben, 340B Compliance Analyst
(952) 992-5288
Addresses
Street Address
347 N SMITH AVENUE
ST. PAUL, MN 55102
Billing Address
CHILDREN'S MINNESOTA
345 NORTH SMITH AVENUE
ST. PAUL, MN 55102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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