Covered Entity Details

PED243302-80 Children’s Health Care d/b/a Children’s Minnesota (Active) - information as of 6/26/2025 12:22:28 AM

Main Details

Name

Children’s Health Care d/b/a Children’s Minnesota

Subdivision Name

St. Paul/Complex Care Clinic - General Pediatrics

Type

Children's Hospital

Rural

340B ID

PED243302-80

Medicare Provider Number

243302

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/3/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/28/2024

Last Recertification Date

Contacts

Authorizing Official

Children's Hospitals and Clinics of Minnesota
Christa Steene-Lyons, Compliance Officer
(612) 813-6316

Primary Contact

Children's Hospitals and Clinics of Minnesota
Dirk Killelea, Pharmacy Manager - 340B
(612) 813-7161

Addresses

Street Address

347 NORTH SMITH AVENUE
SUITE 302
ST. PAUL, MN 55102

Billing Address

Children's Business Campus
CBC-2-ACC
5901 Lincoln Drive
Edina, MN 55436

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MN	435247500	1063659183,1194824060,1700979861,1780727958,1841332764,1881793750

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
PED243302-01	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Adolescent Health	2530 Chicago Ave S	Minneapolis	MN	Active
PED243302-02	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/ED (SP)	345 N SMITH AVENUE	St. Paul	MN	Active
PED243302-03	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/SPS (SP)	345 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-04	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Radiology - General Diagnostics	345 N Smith Ave	St. Paul	MN	Active
PED243302-05	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/PACU (SP)	345 N Smith Ave	St. Paul	MN	Active
PED243302-06	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Surgery (SP)	345 N Smith Ave	St. Paul	MN	Active
PED243302-07	Child	PED	CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA	St. Paul /Rheumatology Clinic	347 N Smith Ave	St. Paul	MN	Terminated
PED243302-08	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Pain & Palliative Care	347 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-09	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Orthopaedics Clinic	310 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-10	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Neurosurgery Clinic	310 NORTH SMTH AVENUE	ST. PAUL	MN	Active
PED243302-11	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Neurology Clinic	310 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-12	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Ketogenic Clinic	347 N SMITH AVE	ST. PAUL	MN	Terminated
PED243302-13	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Integrative Medicine and Cultural Care	347 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-14	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Infectious Disease Clinic	347 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-15	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Hematology-Oncology Clinic StP	347 N Smith Ave	St. Paul	MN	Terminated
PED243302-16	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Gynecology Clinic	347 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-17	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Genetics Clinic	347 N Smith Ave	St. Paul	MN	Active
PED243302-18	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/General Pediatric Clinic- St. Paul	347 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-19	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Feeding Clinic	347 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-20	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Diabetes and Endocrine Center	347 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-21	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Asthma Clinic	347 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-22	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/VCF Clinic	2530 Chicago Ave S	Minneapolis	MN	Terminated
PED243302-23	Child	PED	CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA	Minneapolis/Rheumatology Clinic	2530 Chicago Ave S	Minneapolis	MN	Terminated
PED243302-24	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Pain and Palliative Care	2525 CHICAGO AVENUE SOUTH	MINNEAPOLIS	MN	Active
PED243302-25	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Orthopaedics Clinic	2530 CHICAGO AVENUE S	MINNEAPOLIS	MN	Active
PED243302-26	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/ Neurosurgery Clinic	2530 Chicago Ave S	Minneapolis	MN	Active
PED243302-27	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Neurology Clinic	2530 Chicago Ave S	Minneapolis	MN	Terminated
PED243302-28	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/ Nephrology Clinic	2530 CHICAGO AVENUE S	MINNEAPOLIS	MN	Active
PED243302-29	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis Infectious Disease Clinic	2530 CHICAGO AVENUE SOUTH	MINNEAPOLIS	MN	Active
PED243302-30	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Gynecology Clinic	2530 CHICAGO AVENUE S	MINNEAPOLIS	MN	Active
PED243302-31	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Genetics Clinic	2530 CHICAGO AVENUE S	MINNEAPOLIS	MN	Active
PED243302-32	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Feeding Clinic	2530 Chicago Ave S	MINNEAPOLIS	MN	Active
PED243302-33	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Diabetes and Endocrine Center	2530 Chicago Ave S	Minneapolis	MN	Active
PED243302-34	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Developmental Peds Clinic	2530 CHICAGO AVENUE S	MINNEAPOLIS	MN	Active
PED243302-35	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Cystic Fibrosis Clinic (Pulmonary Team)	2530 CHICAGO AVENUE S	MINNEAPOLIS	MN	Active
PED243302-36	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	General Pediatrics Clinic - Minneapolis	2530 Chicago Ave S	Minneapolis	MN	Active
PED243302-37	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Asthma Clinic	2530 CHICAGO AVENUE S	MINNEAPOLIS	MN	Terminated
PED243302-39	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Hematology-Oncology Clinic	2530 CHICAGO AVENUE S	MINNEAPOLIS	MN	Active
PED243302-40	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Integrative Medicine and Cultural Care	2525 Chicago Ave S	Minneapolis	MN	Terminated
PED243302-41	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	MINNEAPOLIS/RADIOLOGY-ULTRA SOUND-CSC	2530 CHICAGO AVENUE S	MINNEAPOLIS	MN	Active
PED243302-42	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	MINNEAPOLIS/PHYSICAL MEDICINE CLINIC	2530 CHICAGO AVNEUE S	MINNEAPOLIS	MN	Terminated
PED243302-43	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST. PAUL/SLEEP CENTER	310 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-44	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST.PAUL/NON-INVASIVE CARDIOLOGY	345 NORTH SMITH AVE	ST. PAUL	MN	Active
PED243302-45	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST. PAUL/RADIOLOGY-GENERAL DIAGNOSTICS	345 NORTH SMITH AVE	ST. PAUL	MN	Terminated
PED243302-46	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST.PAUL/PICU	345 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-47	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST.PAUL/NEUROSCIENCE UNIT	345 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-48	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST. PAUL/FOURTH FLOOR MEDICAL/SURGICAL & OBSERVATION	345 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-49	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST. PAUL/NEURO DIAGNOSTICS	345 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-50	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST. PAUL/ANESTHESIOLOGY	345 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-51	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST.PAUL/RADIOLOGY-NUCLEAR MEDICINE	345 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-52	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST.PAUL/RADIOLOGY-MRI	345 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-53	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST.PAUL/RADIOLOGY-ULTRA SOUND	345 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-54	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST.PAUL/RADIOLOGY-CT	345 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-55	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST. PAUL/DEVELOPMENTAL PEDS CLINIC	347 N SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-56	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	WOODBURY/DIABETES ENDOCRINE CLINIC	628 BIELENBERG DRIVE	WOODBURY	MN	Active
PED243302-57	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	West/Gynecology Clinic	6060 Clearwater Drive	Minnetonka	MN	Active
PED243302-58	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST. PAUL/SIXTH FLOOR MED/SURG & OBSERVATION	345 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-59	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	MAPLE GROVE - GYNECOLOGY CLINIC	7767 ELM CREEK BLVD	MAPLE GROVE	MN	Active
PED243302-60	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST. PAUL - INTERVENTIONAL RADIOLOGY	345 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-61	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST. PAUL - PHYSICAL MEDICINE CLINIC	347 NORTH SMITH AVENUE	ST. PAUL	MN	Terminated
PED243302-62	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	MINNEAPOLIS/GENERAL DIAGNOSTICS - CSC	2530 CHICAGO AVENUE	MINNEAPOLIS	MN	Active
PED243302-63	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	ST.PAUL/CONCUSSION CLINIC	310 NORTH SMITH AVENUE	ST. PAUL	MN	Active
PED243302-64	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	WOODBURY - GENETICS CLINIC	628 BIELENBERG DRIVE	WOODBURY	MN	Terminated
PED243302-65	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Woodbury/Gynecology Clinic	628 Bielenberg Drive	Woodbury	MN	Active
PED243302-66	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/ - Genomics Clinic	2545 Chicago Avenue South	Minneapolis	MN	Terminated
PED243302-67	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minnetonka/ - Diabetes and Endocrine Center	6060 Clearwater Drive	Minnetonka	MN	Active
PED243302-68	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Maple Grove/Concussion Clinic	7677 Elm Creek Boulevard	Maple Grove	MN	Terminated
PED243302-69	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/ - Concussion Clinic	2530 Chicago Avenue South	Minneapolis	MN	Active
PED243302-70	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Maple Grove/Diabetes and Endocrine Center	7767 Elm Creek Blvd	Maple Grove	MN	Active
PED243302-71	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Skin Integrity-Wound Ostomy Clinic - Wound	2530 Chicago Avenue South	Minneapolis	MN	Active
PED243302-72	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Skin Integrity-Wound Ostomy Clinic - Wound	347 North Smith Avenue	St. Paul	MN	Terminated
PED243302-73	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Pharmacogenomics (PGX) Clinic - Pharmacogenomics	2545 Chicago Avenue South	Minneapolis	MN	Terminated
PED243302-74	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/ - Plastics and Reconstructive Surgery Clinic	2530 Chicago Avenue South	Minneapolis	MN	Terminated
PED243302-75	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Pulmonary Diagnostic/Special Diagnostics - Diagnostics	345 North Smith Avenue	St. Paul	MN	Active
PED243302-76	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St.Paul/ Pulmonary Diagnostics/Special Diagnostics - Diagnostics	310 North Smith Avenue	St. Paul	MN	Active
PED243302-77	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Heart Clinic - Cardiology	2530 Chicago Avenue South	Minneapolis	MN	Active
PED243302-78	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Gender Health - Endocrinology	2530 Chicago Avenue South	Minneapolis	MN	Active
PED243302-79	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	Minneapolis/Complex Care Clinic - General Pediatrics	2530 Chicago Ave S	Minneapolis	MN	Active
PED243302-80	Child	PED	Children’s Health Care d/b/a Children’s Minnesota	St. Paul/Complex Care Clinic - General Pediatrics	347 NORTH SMITH AVENUE	ST. PAUL	MN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		Steene-Lyons, Christa Compliance Officer Children's Hospitals and Clinics of Minnesota 6128136316	10/28/2024 1:37 PM
Details	340B ID	Update	New Registration		PED243302-80	10/28/2024 1:37 PM
Details	Entity Name	Update	New Registration	CHILDRENS HEALTH CARE	Children’s Health Care d/b/a Children’s Minnesota	10/28/2024 1:37 PM
Details	Entity Subname	Update	New Registration	St. Paul/Complex Care Clinic	St. Paul/Complex Care Clinic - General Pediatrics	10/28/2024 1:37 PM
Dates	Participating Approval Date	Update	New Registration		10/28/2024 1:37:16 PM	10/28/2024 1:37 PM
Details	State	Update	New Registration	Pending	Approved	10/28/2024 1:37 PM
Dates	Signed By Date	Update	New Registration		10/11/2024 11:42:11 AM	10/28/2024 1:37 PM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/28/2024 1:37 PM
Addresses	Main Address	Insert	New Registration		347 NORTH SMITH AVENUE SUITE 302 ST. PAUL, MN 55102	10/3/2024 11:49 AM
Addresses	Billing Address	Insert	New Registration		Children's Business Campus CBC-2-ACC 5901 Lincoln Drive Edina, MN 55436	10/3/2024 11:49 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/3/2024 11:49 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		435247500	10/3/2024 11:49 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MN	10/3/2024 11:49 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1063659183	10/3/2024 11:49 AM
Medicaid Billing	NPI: State	Insert	New Registration		MN	10/3/2024 11:49 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1194824060	10/3/2024 11:49 AM
Medicaid Billing	NPI: State	Insert	New Registration		MN	10/3/2024 11:49 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1700979861	10/3/2024 11:49 AM
Medicaid Billing	NPI: State	Insert	New Registration		MN	10/3/2024 11:49 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1780727958	10/3/2024 11:49 AM
Medicaid Billing	NPI: State	Insert	New Registration		MN	10/3/2024 11:49 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1841332764	10/3/2024 11:49 AM
Medicaid Billing	NPI: State	Insert	New Registration		MN	10/3/2024 11:49 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1881793750	10/3/2024 11:49 AM
Medicaid Billing	NPI: State	Insert	New Registration		MN	10/3/2024 11:49 AM
Contacts	Primary Contact	Insert	New Registration		Killelea, Dirk Pharmacy Manager - 340B Children's Hospitals and Clinics of Minnesota 6128137161	10/3/2024 11:49 AM
Contacts	Authorizing Official	Insert	New Registration		Steene-Lyons, Christa Compliance Officer Children's Hospitals and Clinics of Minnesota 6128136316	10/3/2024 11:49 AM
Details	Assistance Received From Date	Insert	New Registration			10/3/2024 11:49 AM
Details	Assistance Received To Date	Insert	New Registration			10/3/2024 11:49 AM
Details	Last Recertification Date	Insert	New Registration			10/3/2024 11:49 AM
Details	Grant Number	Insert	New Registration			10/3/2024 11:49 AM
Details	340B ID	Insert	New Registration			10/3/2024 11:49 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/3/2024 11:49 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/3/2024 11:49 AM
Details	Medicare Provider Number	Insert	New Registration		243302	10/3/2024 11:49 AM
Details	Entity Name	Insert	New Registration		CHILDRENS HEALTH CARE	10/3/2024 11:49 AM
Details	NOFO Number	Insert	New Registration			10/3/2024 11:49 AM
Details	Program Code	Insert	New Registration		PED	10/3/2024 11:49 AM
Details	Entity Subname	Insert	New Registration		St. Paul/Complex Care Clinic	10/3/2024 11:49 AM
Dates	Participating Approval Date	Insert	New Registration			10/3/2024 11:49 AM
Details	State	Insert	New Registration		Pending	10/3/2024 11:49 AM
Dates	Registration Date	Insert	New Registration		10/3/2024 11:49:09 AM	10/3/2024 11:49 AM
Dates	Signed By Date	Insert	New Registration			10/3/2024 11:49 AM
Dates	Start Date	Insert	New Registration			10/3/2024 11:49 AM
Terminations	Termination Comments	Insert	New Registration			10/3/2024 11:49 AM
Terminations	Termination Date	Insert	New Registration			10/3/2024 11:49 AM
Terminations	Termination Effective Date	Insert	New Registration			10/3/2024 11:49 AM
Terminations	Termination Reason	Insert	New Registration			10/3/2024 11:49 AM