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PED453306-00 Methodist Children's Hospital d/b/a Covenant Children's Hospital (Active)
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Main Details
Name
Methodist Children's Hospital d/b/a Covenant Children's Hospital
Subdivision Name
Type
Children's Hospital
Rural
No
340B ID
PED453306-00
Medicare Provider Number
453306
Additional Details
Current Program Status
Active
Registration Date
10/16/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/13/2017
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Covenant Health
Jennifer Bryan, CFO
(806) 296-4265
Primary Contact
Covenant Health
Christine Farmer, Regional Executive Director of 340B Operations
(806) 725-6654
Addresses
Street Address
4015 22nd Place
Lubbock, TX 79410
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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