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PED053303-30 RADY CHILDRENS HOSPITAL - SAN DIEGO (Terminated)
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Main Details
Name
RADY CHILDRENS HOSPITAL - SAN DIEGO
Subdivision Name
Palliative Care and Pain - Supportive Care
Type
Children's Hospital
Rural
No
340B ID
PED053303-30
Medicare Provider Number
053303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/19/2018
Last Recertification Date
8/26/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Rady Children's Hospital San Diego
Nicholas Matthew Holmes, Senior VP, Chief Operating Officer
(858) 966-5948
Primary Contact
Rady Childrens Hospital
Mark Sey, Pharmicist in Chief
(858) 966-8023
Addresses
Street Address
Rady Children's Hospital San Diego
3030 Children's Way
2nd floor
San Diego, CA 92123
Billing Address
Rady Children's Hospital San Diego
3020 Children's Way
San Diego, CA 92123
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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