Covered Entity Details

PED393303-01 THE CHILDREN'S HOSPITAL OF PHILADELPHIA (Terminated) - information as of 6/22/2025 12:10:32 AM

Main Details

Name

THE CHILDREN'S HOSPITAL OF PHILADELPHIA

Subdivision Name

CHILDRENS HOSPITAL SPECIALTY CARE CTR AT VOORHEES

Type

Children's Hospital

Rural

340B ID

PED393303-01

Medicare Provider Number

393303

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

12/16/2009

Participating Start Date

1/1/2010

Participating Approval Date

12/18/2009

Last Recertification Date

8/16/2018

Termination Date
Termination Reason

1/1/2019
Business decision by the Covered Entity

Contacts

Authorizing Official

Children's Hospital of Philadelphia
THOMAS J. TODOROW, EXECUTIVE VICE PRESIDENT FINANCE AND CHIEF FINANCIAL OFFICER
(267) 426-6957

Primary Contact

The Children's Hospital of Philadelphia
Winson Soo-Hoo, Director of Pharmacy
(215) 590-1893

Addresses

Street Address

1012-1014 LAUREL OAK ROAD
VOORHEES, NJ 08043

Billing Address
Same as Street Address

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
		1215921457

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
PED393303-01	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	CHILDRENS HOSPITAL SPECIALTY CARE CTR AT VOORHEES	1012-1014 LAUREL OAK ROAD	VOORHEES	NJ	Terminated
PED393303-02	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	ONCOLOGY CLINIC AT BUERGER CENTER	3500 Civic Center Blvd	PHILADELPHIA	PA	Active
PED393303-03	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Children's Hospital Home Care	3000 Horizon Drive	KING OF PRUSSIA	PA	Active
PED393303-04	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Oncology Clinic at King of Prussia	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-05	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Ambulatory Surgery at Bucks County	500 West Butler Rt 202 And Schoolhouse	Chalfont	PA	Active
PED393303-06	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Sedation Unit at King of Prussia	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-07	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Sedation Unit at Buerger Center	3500 Civic Center Boulevard	Philadelphia	PA	Active
PED393303-08	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Day Medicine at Buerger Center	3500 Civic Center Boulevard	Philadelphia	PA	Active
PED393303-09	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Ambulatory Surgery at Voorhees	1012 Laurel Oak Rd.	Voorhees	NJ	Active
PED393303-10	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Ambulatory Surgery at King of Prussia	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-11	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Dialysis	3500 Civic Center Blvd	Philadelphia	PA	Active
PED393303-12	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Apheresis	3500 Civic Center Blvd	Philadelphia	PA	Active
PED393303-13	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Botox Therapy at Buerger Center	3500 Civic Center Blvd	Philadelphia	PA	Active
PED393303-14	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Ultrasound at Buerger Center - Ultrasound	3500 Civic Center Blvd 2nd Floor	Philadelphia	PA	Active
PED393303-15	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Oncology Clinic at Voorhees - Oncology	1012 Laurel Oak Rd	Voorhees	NJ	Active
PED393303-16	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	CT Scan at King of Prussia - CT Scan	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-17	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Pet Scan at Buerger Center - Pet Scan	3500 Civic Center Blvd 2nd Floor	Philadelphia	PA	Active
PED393303-18	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Botox Therapy at Exton - Botox Therapy	481 John Young Way	Exton	PA	Terminated
PED393303-19	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Ambulatory Surgery at Brandywine Valley - Ambulatory Surgery	819 Baltimore Pike	Glen Mills	PA	Active
PED393303-20	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Fluoroscopy at King of Prussia - Fluoroscopy	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-21	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	MRI at King of Prussia - MRI	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-22	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Nuclear Medicine at King of Prussia - Nuclear Medicine	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-23	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Pulmonary Function Lab at Buerger Center - Pulmonary Function Lab	3500 Civic Center Blvd 7th Floor	Philadelphia	PA	Active
PED393303-24	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	MRI at Buerger Center - MRI	3500 Civic Center Blvd - 2nd Floor	Philadelphia	PA	Active
PED393303-25	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	King of Prussia - Sleep Center	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-26	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	King of Prussia - Ultrasound - Hospital Services	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-27	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	King of Prussia - Pulmonary Function	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-28	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	King of Prussia - Emergency Department	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-29	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	King of Prussia - PACU	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-30	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	King of Prussia - OR General Anesthesia	550 South Goddard Blvd	King of Prussia	PA	Active
PED393303-31	Child	PED	THE CHILDREN'S HOSPITAL OF PHILADELPHIA	Botox Therapy at Bryn Mawr - Botox Therapy at Bryn Mawr	135 S. Bryn Mawr Avenue Suite 240	Bryn Mawr	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		9/30/2018 12:00:00 AM	10/23/2018 7:15 AM
Details	State	Update	Termination Request	Active	To Be Terminated	10/23/2018 7:15 AM
Terminations	Termination Date	Update	Termination Request		1/1/2019 12:00:00 AM	10/23/2018 7:15 AM
Terminations	Termination Effective Date	Update	Termination Request		10/1/2018 12:00:00 AM	10/23/2018 7:15 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	10/23/2018 7:15 AM
Details	Last Recertification Date	Update	Recertification	11/8/2017 7:28:22 AM	8/16/2018 7:39:05 AM	8/16/2018 7:39 AM
Details	Last Recertification Date	Update	Recertification	8/30/2016 12:00:00 AM	11/8/2017 7:28:22 AM	11/8/2017 7:28 AM
Contacts	Authorizing Official	Update	Change Request	TODOROW, THOMAS J. EXECUTIVE VICE PRESIDENT FINANCE AND CHIEF FINANCIAL OFFICER 2674266957	TODOROW, THOMAS J. EXECUTIVE VICE PRESIDENT FINANCE AND CHIEF FINANCIAL OFFICER Children's Hospital of Philadelphia 2674266957	10/13/2017 10:56 AM
Contacts	Primary Contact	Update		Soo-Hoo, Winson Director of Pharmacy 2155901893	Soo-Hoo, Winson Director of Pharmacy The Children's Hospital of Philadelphia 2155901893	10/4/2017 12:12 PM
Contacts	Primary Contact	Insert			Soo-Hoo, Winson Director of Pharmacy 2155901893	7/21/2017 4:45 PM
Contacts	Authorizing Official	Insert			TODOROW, THOMAS J. EXECUTIVE VICE PRESIDENT FINANCE AND CHIEF FINANCIAL OFFICER 2674266957	7/21/2017 4:45 PM
Addresses	Main Address	Insert			1012-1014 LAUREL OAK ROAD VOORHEES, NJ 08043	7/21/2017 4:45 PM
Details	Last Recertification Date	Update		9/8/2015 12:00:00 AM	8/30/2016 12:00:00 AM	8/30/2016 2:27 PM
Details	Last Recertification Date	Update		9/10/2014 12:00:00 AM	9/8/2015 12:00:00 AM	9/8/2015 9:57 AM
Medicaid Billing	NPI: Number	Insert			1215921457	9/10/2014 5:01 PM
Details	Last Recertification Date	Update		9/13/2013 12:00:00 AM	9/10/2014 12:00:00 AM	9/10/2014 5:01 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/13/2013 12:00:00 AM	9/13/2013 2:23 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/9/2012 8:43 AM
Details	Last Recertification Date	Insert				12/18/2009 10:21 AM
Details	Grant Number	Insert				12/18/2009 10:21 AM
Details	340B ID	Insert			PED393303-01	12/18/2009 10:21 AM
Details	Is Authorizing Official EHB Data	Insert				12/18/2009 10:21 AM
Dates	Last Date That 340B Drugs Purchased	Insert				12/18/2009 10:21 AM
Details	Medicare Provider Number	Insert			393303	12/18/2009 10:21 AM
Details	Entity Name	Insert			THE CHILDREN'S HOSPITAL OF PHILADELPHIA	12/18/2009 10:21 AM
Details	Program Code	Insert			PED	12/18/2009 10:21 AM
Details	Entity Subname	Insert			CHILDRENS HOSPITAL SPECIALTY CARE CTR AT VOORHEES	12/18/2009 10:21 AM
Dates	Participating Approval Date	Insert			12/18/2009 12:00:00 AM	12/18/2009 10:21 AM
Details	State	Insert			Active	12/18/2009 10:21 AM
Dates	Registration Date	Insert			12/16/2009 12:00:00 AM	12/18/2009 10:21 AM
Dates	Signed By Date	Insert			11/20/2009 12:00:00 AM	12/18/2009 10:21 AM
Dates	Start Date	Insert			1/1/2010 12:00:00 AM	12/18/2009 10:21 AM
Terminations	Termination Comments	Insert				12/18/2009 10:21 AM
Terminations	Termination Date	Insert				12/18/2009 10:21 AM
Terminations	Termination Effective Date	Insert				12/18/2009 10:21 AM
Terminations	Termination Reason	Insert				12/18/2009 10:21 AM