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PED013301-12 USA Health Children's and Women's Hospital (Active)
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Main Details
Name
USA Health Children's and Women's Hospital
Subdivision Name
Pediatric Gastronenterology - Pediatrics-Gastroenterology
Type
Children's Hospital
Rural
No
340B ID
PED013301-12
Medicare Provider Number
013301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/5/2023
Participating Start Date
10/1/2023
Participating Approval Date
9/8/2023
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
USA Health Systems
Kristen Roberts, Chief Financial Officer
(251) 460-6241
Primary Contact
University of South Alabama Health System
Davin Patel, Pharmacy Compliance Manager
(251) 214-5465
Addresses
Street Address
1601 Center St
Strada Patient Care Center
Suite 1E
mobile, AL 36604
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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