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PED073300-01 CONNECTICUT CHILDREN'S MEDICAL CENTER (Active)
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Main Details
Name
CONNECTICUT CHILDREN'S MEDICAL CENTER
Subdivision Name
Connecticut Children's Medical Center Infusion Center - Infusion Center
Type
Children's Hospital
Rural
No
340B ID
PED073300-01
Medicare Provider Number
073300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/25/2018
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
CT Children's
Robert Elijah Duncan, Executive Vice President & Chief Operating Officer
(860) 545-8648
Primary Contact
Connecticut Children's Medical Center
Heather Hipsky, Pharmacy Procurement Manager
(860) 837-5116
Addresses
Street Address
10 Birdseye Rd
Suite 220
Farmington, CT 06032
Billing Address
Connecticut Children's Medical Center - Infusion Center
282 Washington St
Hartford, CT 06106
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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