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PED363306-62 Dayton Children's Hospital (Terminated)
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Main Details
Name
Dayton Children's Hospital
Subdivision Name
Specialty Care Center - Lima - Nephrology at SCL
Type
Children's Hospital
Rural
No
340B ID
PED363306-62
Medicare Provider Number
363306
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2021
Participating Start Date
4/1/2021
Participating Approval Date
3/3/2021
Last Recertification Date
9/15/2021
Termination Date
Termination Reason
10/1/2022
Hospital Outpatient facility no longer eligible
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 7/1/2019, terminated 4/1/2020. Reinstated 4/1/2021.
02/04/2021
April 2025
April 2025
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