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MEDPRO RX, INC.
PED093300-00 Children's National Medical Center
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Covered Entity Details
Entity Name
Children's National Medical Center
Subdivision Name
Type
Children's Hospital
340B ID
PED093300-00
Entity Address
111 Michigan Avenue, NW
Washington, DC 20010-2970
Medicare Provider Number
093300
Participating Start Date
10/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
MEDPRO RX, INC.
Pharmacy Address
DBA DIPLOMAT SPECIALTY INFUSION GROUP
140 NORTHWAY CT
RALEIGH, NC 27615-4916
Pharmacy Comments
Contract Details
Approval Date
7/20/2022
Contract Begin Date
8/29/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathleen Gorman, EVP, Patient Care services & Chief Operating Officer
(202) 476-2939
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/20/2022
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