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PED453304-161 Texas Children's Hospital (Active)
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Main Details
Name
Texas Children's Hospital
Subdivision Name
TEXAS CHILDREN'S HOSPITAL - WOO Emergency Center
Type
Children's Hospital
Rural
No
340B ID
PED453304-161
Medicare Provider Number
453304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/24/2019
Last Recertification Date
9/7/2024
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
17600 INTERSTATE 45 SOUTH
THE WOODLANDS INPATIENT & EMERGENCY
THE WOODLANDS, TX 77384-4193
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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