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PED073300-07 CONNECTICUT CHILDREN'S MEDICAL CENTER (Active)
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Main Details
Name
CONNECTICUT CHILDREN'S MEDICAL CENTER
Subdivision Name
CONNECTICUT CHILDRENS MEDICAL CENTE - Ambulatory Surgery Center
Type
Children's Hospital
Rural
No
340B ID
PED073300-07
Medicare Provider Number
073300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/9/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/31/2020
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
CT Children's
Robert Elijah Duncan, Executive Vice President & Chief Operating Officer
(860) 545-8648
Primary Contact
Connecticut Children's Medical Center
Heather Hipsky, Pharmacy Procurement Manager
(860) 837-5116
Addresses
Street Address
505 FARMINGTON AVE
FARMINGTON, CT 06032-1901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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