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PED073300-08 CONNECTICUT CHILDREN'S MEDICAL CENTER (Active)
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Main Details
Name
CONNECTICUT CHILDREN'S MEDICAL CENTER
Subdivision Name
CONNECTICUT CHILDREN'S MEDICAL CENT - Connecticut Children's Medical Center - Infusion Center Westport
Type
Children's Hospital
Rural
No
340B ID
PED073300-08
Medicare Provider Number
073300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/11/2023
Participating Start Date
7/1/2023
Participating Approval Date
5/10/2023
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
CT Children's
Robert Elijah Duncan, Executive Vice President & Chief Operating Officer
(860) 545-8648
Primary Contact
Connecticut Children's Medical Center
Heather Hipsky, Pharmacy Procurement Manager
(860) 837-5116
Addresses
Street Address
191 POST RD W
WESTPORT, CT 06880-4625
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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