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PED103301-14 Nicklaus Children's Hospital (Terminated)
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Main Details
Name
Nicklaus Children's Hospital
Subdivision Name
Nicklaus Children's Pediatric Specialists at Allapattah - Clinic
Type
Children's Hospital
Rural
No
340B ID
PED103301-14
Medicare Provider Number
103301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2020
Participating Start Date
1/1/2021
Participating Approval Date
11/4/2020
Last Recertification Date
8/26/2021
Termination Date
Termination Reason
10/1/2022
Never implemented the 340B Program
Contacts
Authorizing Official
NIcklaus Children's Health System
Perry Ann Reed, COO & President
(786) 624-2032
Primary Contact
Nicklaus Children's Hospital
Acirema Bastida, Pharmacy 340B Analyst
(786) 624-5789
Addresses
Street Address
3445 NW 7th St
Miami, FL 33125
Billing Address
Nicklaus Children's Hospital
3100 SW 62 Avenue
Miami, FL 33155
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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