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PED103301-11 Nicklaus Children's Hospital (Active)
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Main Details
Name
Nicklaus Children's Hospital
Subdivision Name
Nicklaus Children's Homestead Outpatient Center - UCC
Type
Children's Hospital
Rural
No
340B ID
PED103301-11
Medicare Provider Number
103301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/5/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/10/2019
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Nicklaus Children's Health System
Dawn Javersack, Sr. Vice President and Chief Financial Officer
(786) 624-2005
Primary Contact
Nicklaus Children's Hospital
Acirema Bastida, Pharmacy 340B Analyst
(786) 624-5789
Addresses
Street Address
2072 NE 8th Street
Homestead, FL 33033
Billing Address
Nicklaus Children's Hospital
3100 SW 62nd Avenue
Miami, FL 33155
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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