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PED053301-21 CHILDRENS HOSP & RES CNTR OAKLAND (Terminated)
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Main Details
Name
CHILDRENS HOSP & RES CNTR OAKLAND
Subdivision Name
UCSF Benioff Childrens Hospital Walnut Creek - Psychiatry
Type
Children's Hospital
Rural
No
340B ID
PED053301-21
Medicare Provider Number
053301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/4/2019
Last Recertification Date
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
UCSF Benioff Childrens Hospital Oakland
Jamie Christine Phillips, Chief Operating Officer
(415) 353-9116
Primary Contact
UCSF Benioff Childrens Hospital Oakland
Patrick D. Fleming Jr., Director, Pharmacy Services
(510) 428-3851
Addresses
Street Address
2401 Shadelands Dr
Walnut Creek, CA 94598-2412
Billing Address
UCSF Benioff Childrens Hospital Oakland
747 52nd Street
Oakland, CA 94609
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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