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PED243302-58 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/SIXTH FLOOR MED/SURG & OBSERVATION
Type
Children's Hospital
Rural
No
340B ID
PED243302-58
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
8/29/2023
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
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
345 NORTH SMITH AVENUE
ST. PAUL, MN 55102
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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