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PED453304-194 Texas Children's Hospital (Active)
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Main Details
Name
Texas Children's Hospital
Subdivision Name
TEXAS CHILDREN'S HOSPITAL - WOO Adolescent Medicine
Type
Children's Hospital
Rural
No
340B ID
PED453304-194
Medicare Provider Number
453304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2021
Participating Start Date
10/1/2021
Participating Approval Date
8/16/2021
Last Recertification Date
9/7/2024
Contacts
Authorizing Official
Texas Children's Hospital
Weldon Gage, Executive Vice President/CFO
(832) 826-8084
Primary Contact
Texas Children's Hospital
Rosa I Lopez, Assistant Director , Pharmacy Financial Operations
(832) 824-1692
Addresses
Street Address
17580 INTERSTATE 45 S
TCH THE WOODLANDS OUTPT.SERVICES
THE WOODLANDS, TX 77384-4964
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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