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PED443303-01 East Tennessee Children’s Hospital (Active)
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Main Details
Name
East Tennessee Children’s Hospital
Subdivision Name
Sevierville Pediatric Pulmonology - Pulmonology
Type
Children's Hospital
Rural
No
340B ID
PED443303-01
Medicare Provider Number
443303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/17/2023
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
East Tennessee Childrens Hospital
Caryn Hawthorne, Chief Financial Officer
(865) 541-8154
Primary Contact
East Tennessee Children's Hospital Assoc, Inc
Derek Phillips, Outpatient Pharmacy Manager
(865) 541-8980
Addresses
Street Address
502 Winfield Dunn Pkwy
Sevierville, TN 37876
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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