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PED243302-56 Children’s Health Care d/b/a Children’s Minnesota (Active)
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Main Details
Name
Children’s Health Care d/b/a Children’s Minnesota
Subdivision Name
WOODBURY/DIABETES ENDOCRINE CLINIC
Type
Children's Hospital
Rural
No
340B ID
PED243302-56
Medicare Provider Number
243302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/17/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/17/2017
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Children's Hospitals and Clinics of Minnesota
Christa Steene-Lyons, Compliance Officer
(612) 813-6316
Primary Contact
Children's Hospitals and Clinics of Minnesota
Dirk Killelea, Pharmacy Manager - 340B
(612) 813-7161
Addresses
Street Address
628 BIELENBERG DRIVE
SUITE 200
WOODBURY, MN 55125
Billing Address
Children's Business Campus
CBC-2-ACC
5901 Lincoln Drive
Edina, MN 55436
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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