340B Drug Pricing Program Database
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PED193300-25 Children's Hospital (Terminated)
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Main Details
Name
Children's Hospital
Subdivision Name
CHILDRENS HOSPITAL - Audrey Hepburn Care Center
Type
Children's Hospital
Rural
No
340B ID
PED193300-25
Medicare Provider Number
193300
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
9/5/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Children's Hospital
Lucio A. Fragoso, President & CEO
(504) 896-9452
Primary Contact
Children's Hospital
Lindy C Bosworth, Director of Pharmacy
(504) 894-6764
Addresses
Street Address
1101 CALHOUN STREET
AUDREY HEPBURN CARE CENTER
NEW ORLEANS, LA 70118-5915
Billing Address
Children's Hospital
200 Henry Clay Ave
New Orleans, LA 70118
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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