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PED363306-54 Dayton Children's Hospital (Terminated)
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Main Details
Name
Dayton Children's Hospital
Subdivision Name
Dayton Children's- Neurology Clinic - Neurology
Type
Children's Hospital
Rural
No
340B ID
PED363306-54
Medicare Provider Number
363306
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/7/2018
Last Recertification Date
8/21/2019
Termination Date
Termination Reason
1/1/2020
Other
Contacts
Authorizing Official
Dayton Children's
Benjamin Goodstein, VICE PRESIDENT and Chief Ambulatory Officer
(937) 641-3450
Primary Contact
Dayton Children's
Chad Meyers, Director of Ambulatory Pharmacy Services
(937) 641-4591
Addresses
Street Address
One Children's Plaza
Dayton, OH 45404
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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