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PED243302-64 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
WOODBURY - GENETICS CLINIC
Type
Children's Hospital
Rural
No
340B ID
PED243302-64
Medicare Provider Number
243302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/13/2018
Last Recertification Date
9/10/2018
Termination Date
Termination Reason
10/1/2019
Site closure
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
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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