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PED453301-26 Driscoll Children's Hospital (Active)
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Main Details
Name
Driscoll Children's Hospital
Subdivision Name
CPSST GASTRO - VICTORIA - Gastroenterology - Victoria
Type
Children's Hospital
Rural
No
340B ID
PED453301-26
Medicare Provider Number
453301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/10/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/31/2020
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Driscoll Children's Hospital
Steven Eric King, CFO
(361) 694-5934
Primary Contact
Driscoll Children's Hospital
Jessy Varkey Thomas, Director of Pharmacy
(361) 694-5061
Addresses
Street Address
106 Springwood Drive
Suite 200
Victoria, TX 77904
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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