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PED103301-10 Nicklaus Children's Hospital (Terminated)
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Main Details
Name
Nicklaus Children's Hospital
Subdivision Name
Nicklaus Children's Pinecrest Urgent Care Center - Urgent Care
Type
Children's Hospital
Rural
No
340B ID
PED103301-10
Medicare Provider Number
103301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/17/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/24/2018
Last Recertification Date
9/8/2022
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
NIcklaus Children's Health System
Perry Ann Reed, COO & President
(786) 624-2032
Primary Contact
Nicklaus Children's Hospital
Acirema Bastida, Pharmacy 340B Analyst
(786) 624-5789
Addresses
Street Address
11521 South Dixie Highway
1st Floor
Pinecrest, FL 33156
Billing Address
Nicklaus Children's Hospital
3100 SW 62 Avenue
Miami, FL 33155
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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