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PED363306-101 Dayton Children's Hospital (Terminated)
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Main Details
Name
Dayton Children's Hospital
Subdivision Name
DAYTON CHILDRENS BEHAVIORAL HEALTH - DEVPEDS/AUTISM BHCNTR
Type
Children's Hospital
Rural
No
340B ID
PED363306-101
Medicare Provider Number
363306
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2021
Participating Start Date
4/1/2021
Participating Approval Date
2/28/2021
Last Recertification Date
9/13/2022
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
Dayton Children's
Benjamin Goodstein, VICE PRESIDENT and Chief Ambulatory Officer
(937) 641-3450
Primary Contact
Dayton Children's
Chad Meyers, Director of Ambulatory Pharmacy Services
(937) 641-4591
Addresses
Street Address
76 REMICK BLVD
SPRINGBORO, OH 45066-9168
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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