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PED363305-21 NATIONWIDE CHILDREN'S HOSPITAL (Active)
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Main Details
Name
NATIONWIDE CHILDREN'S HOSPITAL
Subdivision Name
CLOSE TO HOME HEALTH CARE CENTER - Endocrinology Clinic Dublin
Type
Children's Hospital
Rural
No
340B ID
PED363305-21
Medicare Provider Number
363305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/7/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/13/2020
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Nationwide Childrens Hospital
Luke Brown, Vice President of Finance and Treasury
(614) 355-3117
Primary Contact
Nationwide Children's Hospital
Jonathan Labuhn, Director, Pharmacy Finance & Supply Chain
(614) 722-0412
Addresses
Street Address
5665 VENTURE DR
DUBLIN, OH 43017-2159
Billing Address
Nationwide Children's Hospital
PO Box 31772
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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