340B Drug Pricing Program Database


RRC260180-00 CHRISTIAN HOSPITAL NORTHEAST (Active) - information as of 4/27/2025 11:36:50 PM

Main Details
CHRISTIAN HOSPITAL NORTHEAST
Rural Referral Center
No
RRC260180-00
260180


Additional Details
Active
1/10/2024
4/1/2024
2/26/2024
8/18/2024

Contacts

Barnes-Jewish Hospital
Paul John Irovic, Vice-president, Finance
(314) 265-8874

Memorial Hospital
Ryan Birk, Director of Pharmacy
(618) 606-0210

Addresses

11133 DUNN ROAD
ST. LOUIS, MO 63136

BJC Healthcare
4249 Clayton Avenue, 310
St. Louis, MO 63110


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
MO010490605,6067635141962518878,1073769329,1538177423,1639186760
IL43-6057893001,436057893006,436057893007,4360578930091962518878,1073769329,1538177423,1639186760
Shipping Addresses

Family Care Pharmacy at Christian Hospital
11125 Dunn Road
St Louis, MO 63136

Safecor Health LLC
4060 Business Park Drive
Columbus, OH 43204

CHRISTIAN HOSPITAL NORTHEAST
11133 DUNN ROAD
ST. LOUIS, MO 63136

CHRISTIAN HOSPITAL NORTHWEST
1225 Graham Road
Florissant, MO 63031
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailMISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10355 1550 SOUTH NEW FLORISSANT RD
FLORISSANTMO6303101/07/202504/01/2025  04/01/2025
Contract DetailMISSOURI CVS PHARMACY, L.L.C.CVS/PHARMACY # 10171 696-698 NORTH HWY 67 STREET
FLORISSANTMO6303101/07/202504/01/2025  04/01/2025
Contract DetailMISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 6745 6999 PARKER RD.
FLORISSANTMO6303301/07/202504/01/2025  04/01/2025
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
RRC260180-01ChildRRCCHRISTIAN HOSPITAL NORTHEASTCHRISTIAN HOSPITAL NORTHEAST - Pain Management - CHRISTIAN HOSPITAL NORTHEAST - Pain Management11125 Dunn RdSAINT LOUISMOActive
RRC260180-02ChildRRCCHRISTIAN HOSPITAL NORTHEASTChristian Hospital Northwest ED - EMERGENCY ROOM NW - Christian Hospital Northwest ED - EMERGENCY ROOM NW1225 Graham RdFlorissantMOActive
RRC260180-03ChildRRCCHRISTIAN HOSPITAL NORTHEASTChristian Hospital Northwest SCC RAD Onc - Christian Hospital Northwest SCC RAD Onc1255 Graham RdFlorissantMOActive
RRC260180-04ChildRRCCHRISTIAN HOSPITAL NORTHEASTCHRISTIAN HOSPITAL NORTHEAST - OP WOUND CARE - CHRISTIAN HOSPITAL NORTHEAST - OP WOUND CARE11125 Dunn RdSAINT LOUISMOActive
RRC260180-05ChildRRCCHRISTIAN HOSPITAL NORTHEASTCHRISTIAN HOSPITAL NORTHEAST - RECOVERY CENTER - CHRISTIAN HOSPITAL NORTHEAST - RECOVERY CENTER11125 Dunn RdSAINT LOUISMOActive
RRC260180-06ChildRRCCHRISTIAN HOSPITAL NORTHEASTChristian Hospital Northwest - NW CT - Christian Hospital Northwest - NW CT1225 Graham RdFlorissantMOActive
RRC260180-07ChildRRCCHRISTIAN HOSPITAL NORTHEASTCH GMC OP PT - CH GMC OP PT1150 Graham RdFlorissantMOTerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: NumberDeleteChange Request436057893005 (IL) 1/24/2025 9:18 AM
DetailsLast Recertification DateUpdateRecertification 8/18/2024 9:59:29 AM8/18/2024 9:59 AM
DetailsStateUpdate ApprovedActive4/1/2024 12:01 AM
ContactsSigned ByInsertHospital Type Change Request Irovic, Paul John Vice-president, Finance Barnes-Jewish Hospital 31426588742/26/2024 9:37 AM
Details340B IDUpdateHospital Type Change Request RRC260180-002/26/2024 9:37 AM
DatesParticipating Approval DateUpdateHospital Type Change Request 2/26/2024 9:37:15 AM2/26/2024 9:37 AM
DetailsStateUpdateHospital Type Change RequestPendingApproved2/26/2024 9:37 AM
DatesSigned By DateUpdateHospital Type Change Request 1/22/2024 12:50:03 PM2/26/2024 9:37 AM
DatesStart DateUpdateHospital Type Change Request 4/1/2024 12:00:00 AM2/26/2024 9:37 AM
AddressesMain AddressInsertHospital Type Change Request  11133 DUNN ROAD ST. LOUIS, MO 631361/10/2024 11:51 AM
AddressesBilling AddressInsertHospital Type Change Request BJC Healthcare 4249 Clayton Avenue, 310 St. Louis, MO 631101/10/2024 11:51 AM
AddressesShipping AddressInsertHospital Type Change Request Family Care Pharmacy at Christian Hospital 11125 Dunn Road St Louis, MO 631361/10/2024 11:51 AM
AddressesShipping AddressInsertHospital Type Change Request Safecor Health LLC 4060 Business Park Drive Columbus, OH 432041/10/2024 11:51 AM
AddressesShipping AddressInsertHospital Type Change Request CHRISTIAN HOSPITAL NORTHEAST 11133 DUNN ROAD ST. LOUIS, MO 631361/10/2024 11:51 AM
AddressesShipping AddressInsertHospital Type Change Request CHRISTIAN HOSPITAL NORTHWEST 1225 Graham Road Florissant, MO 630311/10/2024 11:51 AM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False1/10/2024 11:51 AM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 0104906051/10/2024 11:51 AM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request MO1/10/2024 11:51 AM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False1/10/2024 11:51 AM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 43-60578930011/10/2024 11:51 AM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request IL1/10/2024 11:51 AM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False1/10/2024 11:51 AM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 6067635141/10/2024 11:51 AM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request MO1/10/2024 11:51 AM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False1/10/2024 11:51 AM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 4360578930051/10/2024 11:51 AM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request IL1/10/2024 11:51 AM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False1/10/2024 11:51 AM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 4360578930061/10/2024 11:51 AM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request IL1/10/2024 11:51 AM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False1/10/2024 11:51 AM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 4360578930071/10/2024 11:51 AM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request IL1/10/2024 11:51 AM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False1/10/2024 11:51 AM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 4360578930091/10/2024 11:51 AM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request IL1/10/2024 11:51 AM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 19625188781/10/2024 11:51 AM
Medicaid BillingNPI: StateInsertHospital Type Change Request MO1/10/2024 11:51 AM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 19625188781/10/2024 11:51 AM
Medicaid BillingNPI: StateInsertHospital Type Change Request IL1/10/2024 11:51 AM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 10737693291/10/2024 11:51 AM
Medicaid BillingNPI: StateInsertHospital Type Change Request MO1/10/2024 11:51 AM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 15381774231/10/2024 11:51 AM
Medicaid BillingNPI: StateInsertHospital Type Change Request MO1/10/2024 11:51 AM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 16391867601/10/2024 11:51 AM
Medicaid BillingNPI: StateInsertHospital Type Change Request MO1/10/2024 11:51 AM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 10737693291/10/2024 11:51 AM
Medicaid BillingNPI: StateInsertHospital Type Change Request IL1/10/2024 11:51 AM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 15381774231/10/2024 11:51 AM
Medicaid BillingNPI: StateInsertHospital Type Change Request IL1/10/2024 11:51 AM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 16391867601/10/2024 11:51 AM
Medicaid BillingNPI: StateInsertHospital Type Change Request IL1/10/2024 11:51 AM
ContactsAuthorizing OfficialInsertHospital Type Change Request Irovic, Paul John Vice-president, Finance Barnes-Jewish Hospital 31426588741/10/2024 11:51 AM
ContactsPrimary ContactInsertHospital Type Change Request Birk, Ryan Director of Pharmacy Memorial Hospital 61860602101/10/2024 11:51 AM
DetailsAssistance Received From DateInsertHospital Type Change Request  1/10/2024 11:51 AM
DetailsAssistance Received To DateInsertHospital Type Change Request  1/10/2024 11:51 AM
DetailsLast Recertification DateInsertHospital Type Change Request  1/10/2024 11:51 AM
DetailsGrant NumberInsertHospital Type Change Request  1/10/2024 11:51 AM
Details340B IDInsertHospital Type Change Request  1/10/2024 11:51 AM
DetailsIs Authorizing Official EHB DataInsertHospital Type Change Request  1/10/2024 11:51 AM
DatesLast Date That 340B Drugs PurchasedInsertHospital Type Change Request  1/10/2024 11:51 AM
DetailsMedicare Provider NumberInsertHospital Type Change Request 2601801/10/2024 11:51 AM
DetailsEntity NameInsertHospital Type Change Request CHRISTIAN HOSPITAL NORTHEAST1/10/2024 11:51 AM
DetailsNOFO NumberInsertHospital Type Change Request  1/10/2024 11:51 AM
DetailsProgram CodeInsertHospital Type Change Request RRC1/10/2024 11:51 AM
DetailsEntity SubnameInsertHospital Type Change Request  1/10/2024 11:51 AM
DatesParticipating Approval DateInsertHospital Type Change Request  1/10/2024 11:51 AM
DetailsStateInsertHospital Type Change Request Pending1/10/2024 11:51 AM
DatesRegistration DateInsertHospital Type Change Request 1/10/2024 11:51:12 AM1/10/2024 11:51 AM
DatesSigned By DateInsertHospital Type Change Request  1/10/2024 11:51 AM
DatesStart DateInsertHospital Type Change Request  1/10/2024 11:51 AM
TerminationsTermination CommentsInsertHospital Type Change Request  1/10/2024 11:51 AM
TerminationsTermination DateInsertHospital Type Change Request  1/10/2024 11:51 AM
TerminationsTermination Effective DateInsertHospital Type Change Request  1/10/2024 11:51 AM
TerminationsTermination ReasonInsertHospital Type Change Request  1/10/2024 11:51 AM