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PED193300-32 Children's Hospital (Active)
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Main Details
Name
Children's Hospital
Subdivision Name
CHMPC Rainbow Clinic
Type
Children's Hospital
Rural
No
340B ID
PED193300-32
Medicare Provider Number
193300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/17/2023
Participating Start Date
4/1/2023
Participating Approval Date
2/9/2023
Last Recertification Date
9/6/2024
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
451 RUE DE SANTE
LA PLACE, LA 70068-5462
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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Participated starting 1/1/2022, terminated 1/1/2023. Reinstated 4/1/2023.
01/23/2023
May 2025
May 2025
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