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PED363306-60 Dayton Children's Hospital (Active)
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Main Details
Name
Dayton Children's Hospital
Subdivision Name
Specialty Care Center - Lima - Hematology Clinic
Type
Children's Hospital
Rural
No
340B ID
PED363306-60
Medicare Provider Number
363306
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/30/2025
Last Recertification Date
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
967 Bellefontaine Avenue
Lima, OH 45801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2021, Terminated 10/1/2022, Reinstated 4/1/2025
01/30/2025
Participated starting 7/1/2019, terminated 4/1/2020. Reinstated 4/1/2021.
02/04/2021
April 2025
April 2025
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