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HM92123 RADY CHILDRENS HOSPITAL - SAN DIEGO (Active)
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Main Details
Name
RADY CHILDRENS HOSPITAL - SAN DIEGO
Subdivision Name
HEMOPHILIA TREATMENT CENTER
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM92123
Grant Number
H30MC24045
Additional Details
Current Program Status
Active
Registration Date
7/1/2002
Participating Start Date
7/1/2002
Participating Approval Date
5/24/2010
Last Recertification Date
2/19/2025
Contacts
Authorizing Official
Rady Children's Hospital San Diego
Charles Brendan Davis, Interim Chief Operating Officer
(858) 966-4001
Primary Contact
Rady Children's Hospital San Diego
MICHAEL DWAINE CLARK, PHARMACY MANAGER
(858) 966-4941 Ext: 6917
Addresses
Street Address
3020 CHILDRENS WAY
SAN DIEGO, CA 92123
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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9/26/07 - UPDATED ENTITY NAME AND ADDED MEDICAID NUMBER
07/01/2002
April 2025
April 2025
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