340B Drug Pricing Program Database
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PED453304-172 Texas Children's Hospital (Terminated)
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Main Details
Name
Texas Children's Hospital
Subdivision Name
TEXAS CHILDREN'S HOSPITAL - Bellaire Outpatient Therapy Center
Type
Children's Hospital
Rural
No
340B ID
PED453304-172
Medicare Provider Number
453304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/19/2019
Last Recertification Date
9/4/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Texas Children's Hospital
Weldon Gage, Executive Vice President/CFO
(832) 826-8084
Primary Contact
Texas Children's Hospital
Rosa I Lopez, Assistant Director , Pharmacy Financial Operations
(832) 824-1692
Addresses
Street Address
6330 WEST LOOP SOUTH STE 300
SPECIALITY CARE BELLAIRE
BELLAIRE, TX 77401-2928
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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