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PED453304-192 Texas Children's Hospital (Active)
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Main Details
Name
Texas Children's Hospital
Subdivision Name
TEXAS CHILDREN'S HOSPITAL - WC Psychiatry
Type
Children's Hospital
Rural
No
340B ID
PED453304-192
Medicare Provider Number
453304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/29/2020
Participating Start Date
7/1/2020
Participating Approval Date
5/20/2020
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
18200 KATY FWY
TCH WEST CAMPUS
HOUSTON, TX 77094-1285
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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