340B Drug Pricing Program Database


PED143300-59 Ann & Robert H. Lurie Children's Hospital of Chicago (Active) - information as of 6/5/2025 4:53:57 PM

Main Details
Ann & Robert H. Lurie Children's Hospital of Chicago
LURIE CHILDRENS OUTPATIENT CENTER - 103119 HOSP - Uptown - Behavior and Development
Children's Hospital
No
PED143300-59
143300


Additional Details
Active
1/13/2024
4/1/2024
2/15/2024
8/27/2024

Contacts

Ann & Robert H. Lurie Children's Hospital of Chicago
Brian Stahulak, Chief Nursing Officer
(312) 227-4622

Ann & Robert H Lurie Children's Hospital of Chicago
Jenny Elhadary, VP Clinical Services
(312) 227-4161

Addresses

4867 N BROADWAY ST
CHICAGO, IL 60640-3603

Same as Street Address


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

Yes
StateMedicaid NumberNPI Number
IL3621708331235234535
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
PED143300-02ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103030 HOSP - CLK/DEM - Embedded Mental Health Providers/Child Abuse467 W. Deming PlaceCHICAGOILActive
PED143300-03ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102210 HOSP - SKO - Cardiology Diagnostic3722 TOUHY AVESKOKIEILActive
PED143300-04ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102204 HOSP - WST - Cardiology2301 ENTERPRISE DRWESTCHESTERILActive
PED143300-05ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDREN'S SURGERY CENTER - 102191 HOSP - NB - Operating Room1121 TECHNY RDNORTHBROOKILActive
PED143300-06ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102190 HOSP - WST - Operating Room2301 ENTERPRISE DRWESTCHESTERILActive
PED143300-07ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102220/102202 HOSP - CLK/DEM - Cardiac Exercise Lab/ECG2515 N CLARK STCHICAGOILActive
PED143300-08ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102293/102263 HOSP - WST - Ultrasound/Radiology2301 ENTERPRISE DRWESTCHESTERILActive
PED143300-09ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102292/102262 HOSP - NB - Ultrasound/Radiology1131 TECHNY RDNORTHBROOKILActive
PED143300-10ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102297/102265 HOSP - SKO - Ultrasound/Radiology3722 TOUHY AVESKOKIEILActive
PED143300-11ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102291/102261 HOSP - CLK/DEM - Ultrasound/ Radiology2515 N CLARK STCHICAGOILActive
PED143300-12ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103053 HOSP - CLK/DEM - Urodynamics2515 N CLARK STCHICAGOILActive
PED143300-13ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103101 HOSP - NB - Immediate Care1131 TECHNY RDNORTHBROOKILTerminated
PED143300-14ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102283 HOSP - NB - MRI Scanning1131 TECHNY RDNORTHBROOKILActive
PED143300-15ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102281 HOSP - CLK/DEM - MRI Scanning2515 N CLARK STCHICAGOILActive
PED143300-16ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102282 HOSP - WST - MRI Scanning2301 ENTERPRISE DRWESTCHESTERILActive
PED143300-17ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102295 HOSP - NWC - Ultrasound880 W CENTRAL RDARLINGTON HEIGHTSILActive
PED143300-18ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103113 HOSP - WST - Psych Services2301 ENTERPRISE DRWESTCHESTERILActive
PED143300-19ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102207 HOSP - NWC - Cardiology Diagnostic880 W CENTRAL RDARLINGTON HEIGHTSILActive
PED143300-20ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102205 HOSP - NB - Cardiology Diagnostic1131 TECHNY RDNORTHBROOKILActive
PED143300-21ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102222 HOSP - LF Pulmonary Function Test900 N WESTMORELAND RDLAKE FORESTILActive
PED143300-22ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102224 HOSP - NWC - Pulmonary Function Test880 W CENTRAL RDARLINGTON HEIGHTSILActive
PED143300-23ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102223 HOSP - NB - Pulmonary Function Test1131 TECHNY RDNORTHBROOKILActive
PED143300-24ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103115/ 102121 Dayton - Psych Services1440 N DAYTON STCHICAGOILActive
PED143300-25ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102225 HOSP - WST - Pulmonary Function Test2301 ENTERPRISE DRWESTCHESTERILActive
PED143300-26ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103080 WST Outpatient Specialty Clinic2301 ENTERPRISE DRWESTCHESTERILActive
PED143300-27ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103088 SKO Outpatient Specialty Clinic3722 TOUHY AVESKOKIEILActive
PED143300-28ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103008 CLK/DEM Endocrinology Clinic2515 N CLARK STCHICAGOILActive
PED143300-29ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103085 LF Outpatient Specialty Clinic900 N WESTMORELAND RDLAKE FORESTILActive
PED143300-30ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103025 Dayton Adolescent Medicine1440 N DAYTON STCHICAGOILActive
PED143300-31ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103087 NWC Outpatient Specialty Clinic880 W CENTRAL RDARLINGTON HEIGHTSILActive
PED143300-32ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103082 NB Outpatient Specialty Clinic1131 TECHNY RDNORTHBROOKILActive
PED143300-33ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103046 HOSP - CLK/DEM - Orthopaedic Clinic2515 N CLARK STCHICAGOILActive
PED143300-34ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103052 HOSP - CLK/DEM - Urology2515 N CLARK STCHICAGOILActive
PED143300-35ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103023 HOSP - CLK/DEM - Special ID Clinic2515 N CLARK STCHICAGOILActive
PED143300-36ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103005 HOSP - CLK/DEM - Cardiology Clinic2515 N CLARK STCHICAGOILActive
PED143300-37ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103010 HOSP - CLK/DEM - Gastroenterology Clinic2515 N CLARK STCHICAGOILActive
PED143300-38ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103042 HOSP - CLK/DEM - Neurosurgery2515 N CLARK STCHICAGOILActive
PED143300-39ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103028 HOSP - CLK/DEM NEPHROLOGY CLINIC2515 N CLARK STCHICAGOILActive
PED143300-40ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103016 HOSP - CLK/DEM - Neurology2515 N CLARK STCHICAGOILActive
PED143300-41ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103018 HOSP - CLK/DEM - Pulmonary Medicine Clinic2515 N CLARK STCHICAGOILActive
PED143300-42ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103020 HOSP - CLK/DEM - Rheumatology Clinic2515 N CLARK STCHICAGOILActive
PED143300-43ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103027 HOSP - CLK/DEM Genetics Clinic467 W. Deming PlaceChicagoILActive
PED143300-44ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103100 HOSP - CLK/DEM - Immediate Care2515 N CLARK STCHICAGOILActive
PED143300-45ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103058 HOSP - CLK/DEM - Pediatric Surgery Clinic2515 N CLARK STCHICAGOILActive
PED143300-46ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103026 HOSP - CLK/DEM Dermatology Clinic467 W. Deming PlaceChicagoILActive
PED143300-47ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103048 HOSP - CLK/DEM - Otolaryngology Clinic467 W. Deming PlaceChicagoILActive
PED143300-48ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 104030 HOSP - CLK/DEM Medical Imaging Nursing2515 N CLARK STCHICAGOILActive
PED143300-49ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103044 HOSP - CLK/DEM - Ophthalmology Clinic467 W. Deming PlaceChicagoILActive
PED143300-50ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103003 HOSP - CLK/DEM - Allergy467 W. Deming PlaceChicagoILActive
PED143300-51ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103029 HOSP - CLK/DEM Behavior and Development467 W. Deming PlaceChicagoILActive
PED143300-52ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103050 HOSP - CLK/DEM - Plastic Surgery Clinic467 W. Deming PlaceChicagoILActive
PED143300-53ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103111 - HOSP - CLK/DEM - Psych Services467 W. Deming PlaceChicagoILActive
PED143300-54ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103091 HOSP - Dayton - Outpatient Services1440 N DAYTON STCHICAGOILActive
PED143300-55ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102165 HOSP - WST - Neurology Lab (EEG)2301 ENTERPRISE DRWESTCHESTERILActive
PED143300-56ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103112 HOSP - NB - Psych Services1131 TECHNY RDNORTHBROOKILActive
PED143300-57ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102163 HOSP - NWC - Neurology Lab (EEG)880 W CENTRAL RDARLINGTON HEIGHTSILActive
PED143300-58ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102128 HOSP - Dayton - Substance Use1440 N DAYTON STCHICAGOILActive
PED143300-59ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS OUTPATIENT CENTER - 103119 HOSP - Uptown - Behavior and Development4867 N BROADWAY STCHICAGOILActive
PED143300-60ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102106 HOSP - DAYTON PSYCH ADOLESCENT MED1440 N DAYTON STCHICAGOILActive
PED143300-61ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102211 HOSP - CLK/DEM - Echocardiology2515 N CLARK STCHICAGOILActive
PED143300-62ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDREN'S SURGERY CENTER - 103093 HOSP - NB - Outpatient Services (ASTC 1121)1121 TECHNY RDNORTHBROOKILActive
PED143300-63ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 103034 HOSP - Clark High Consequence Infectious Diseases Clinic2515 N CLARK STCHICAGOILActive
PED143300-64ChildPEDAnn & Robert H. Lurie Children's Hospital of ChicagoLURIE CHILDRENS HOSPITAL OUTPATIENT - 102222 HOSP - Clark Pulmonary Function Test2515 N CLARK STCHICAGOILActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification 8/27/2024 12:38:03 PM8/27/2024 12:38 PM
DetailsStateUpdate ApprovedActive4/1/2024 12:01 AM
ContactsSigned ByInsertNew Registration Stahulak, Brian Chief Nursing Officer Ann & Robert H. Lurie Children's Hospital of Chicago 31222746222/15/2024 5:09 PM
Details340B IDUpdateNew Registration PED143300-592/15/2024 5:09 PM
DetailsEntity NameUpdateNew RegistrationANN & ROBERT H. LURIE CHILDRENS HOSAnn & Robert H. Lurie Children's Hospital of Chicago2/15/2024 5:09 PM
DetailsEntity SubnameUpdateNew RegistrationLURIE CHILDRENS OUTPATIENT CENTERLURIE CHILDRENS OUTPATIENT CENTER - 103119 HOSP - Uptown - Behavior and Development2/15/2024 5:09 PM
DatesParticipating Approval DateUpdateNew Registration 2/15/2024 5:09:04 PM2/15/2024 5:09 PM
DetailsStateUpdateNew RegistrationPendingApproved2/15/2024 5:09 PM
DatesSigned By DateUpdateNew Registration 1/14/2024 7:33:42 PM2/15/2024 5:09 PM
DatesStart DateUpdateNew Registration 4/1/2024 12:00:00 AM2/15/2024 5:09 PM
AddressesMain AddressInsertNew Registration  4867 N BROADWAY ST CHICAGO, IL 60640-36031/13/2024 6:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/13/2024 6:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 3621708331/13/2024 6:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration IL1/13/2024 6:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 12352345351/13/2024 6:34 PM
Medicaid BillingNPI: StateInsertNew Registration IL1/13/2024 6:34 PM
ContactsPrimary ContactInsertNew Registration Elhadary, Jenny VP Clinical Services Ann & Robert H Lurie Children's Hospital of Chicago 31222741611/13/2024 6:34 PM
ContactsAuthorizing OfficialInsertNew Registration Stahulak, Brian Chief Nursing Officer Ann & Robert H. Lurie Children's Hospital of Chicago 31222746221/13/2024 6:34 PM
DetailsAssistance Received From DateInsertNew Registration  1/13/2024 6:34 PM
DetailsAssistance Received To DateInsertNew Registration  1/13/2024 6:34 PM
DetailsLast Recertification DateInsertNew Registration  1/13/2024 6:34 PM
DetailsGrant NumberInsertNew Registration  1/13/2024 6:34 PM
Details340B IDInsertNew Registration  1/13/2024 6:34 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/13/2024 6:34 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/13/2024 6:34 PM
DetailsMedicare Provider NumberInsertNew Registration 1433001/13/2024 6:34 PM
DetailsEntity NameInsertNew Registration ANN & ROBERT H. LURIE CHILDRENS HOS1/13/2024 6:34 PM
DetailsNOFO NumberInsertNew Registration  1/13/2024 6:34 PM
DetailsProgram CodeInsertNew Registration PED1/13/2024 6:34 PM
DetailsEntity SubnameInsertNew Registration LURIE CHILDRENS OUTPATIENT CENTER1/13/2024 6:34 PM
DatesParticipating Approval DateInsertNew Registration  1/13/2024 6:34 PM
DetailsStateInsertNew Registration Pending1/13/2024 6:34 PM
DatesRegistration DateInsertNew Registration 1/13/2024 6:34:34 PM1/13/2024 6:34 PM
DatesSigned By DateInsertNew Registration  1/13/2024 6:34 PM
DatesStart DateInsertNew Registration  1/13/2024 6:34 PM
TerminationsTermination CommentsInsertNew Registration  1/13/2024 6:34 PM
TerminationsTermination DateInsertNew Registration  1/13/2024 6:34 PM
TerminationsTermination Effective DateInsertNew Registration  1/13/2024 6:34 PM
TerminationsTermination ReasonInsertNew Registration  1/13/2024 6:34 PM