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ACCREDO HEALTH GROUP, INC.
PED053305-00 LUCILE PACKARD CHILDREN'S HOSPITAL
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Covered Entity Details
Entity Name
LUCILE PACKARD CHILDREN'S HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED053305-00
Entity Address
725 WELCH ROAD
PALO ALTO, CA 94304
Medicare Provider Number
053305
Participating Start Date
1/19/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
5/1/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/20/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dana Haering, Chief Financial Officer
(650) 721-2222
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
5/1/2017
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