340B Drug Pricing Program Database
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PED453300-48 COOK CHILDREN'S MEDICAL CENTER (Active)
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Main Details
Name
COOK CHILDREN'S MEDICAL CENTER
Subdivision Name
Alliance Behavioral Health - Psych
Type
Children's Hospital
Rural
No
340B ID
PED453300-48
Medicare Provider Number
453300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/6/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/17/2018
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Cook Children's Medical Center
Nancy Cychol, EVP, Hospital Services
(682) 885-4340
Primary Contact
Cook Childrens Medical Center
Haydee Melanie Madrigal, Manager, 340B Program
(682) 303-1606
Addresses
Street Address
10601 North Riverside Drive
Fort Worth, TX 76244
Billing Address
Cook Children's Medical Center
801 7th Avenue
Fort Worth, TX 76104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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