340B Drug Pricing Program Database


PED263302-00 The Children's Mercy Hospital (Active) - information as of 5/3/2025 11:30:24 PM

Main Details
The Children's Mercy Hospital
Children's Hospital
No
PED263302-00
263302


Additional Details
Active
8/26/2011
12/8/2011
12/8/2011
9/6/2024

Contacts

Children's Mercy Hospital
Brian O'Neal, Senior VP of Allied Health
(816) 302-8059

Children's Mercy Hospital
Sarah Bledsoe, Senior Director of Pharmacy
(816) 983-6388

Addresses

2401 Gillham Road
Kansas City, MO 64108

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
MO019813500,606546901,600012849,600931604,600078073,600042359,0109316081366515488,1356408520,1902197270,1154400232,1720524846,1356839617,1598809600
KS30003904070094,30003904070088,30003904070083,30003904070016,30003904070084,30003904070014,300039040700151154400232,1356408520,1356839617,1366515488,1598809600,1720524846,1902197270
Shipping Addresses

The Children's Mercy Hospital
Riverside Pharmacy
700 NW Argosy Parkway
Riverside, MO 64150

The Children's Mercy Hospital
Outpatient Pharmacy on Broadway
3101 Broadway Blvd
Kansas City, MO 64111

The Children's Mercy Hospital
Outpatient Pharmacy
2401 Gillham Rd
Kansas City, MO 64108

University of Kansas Hospital
Cell Processing Lab
2015 W. 39th St.
Room B506
Kansas City, KS 66160

The Children's Mercy Hospital Kansas
Outpatient Pharmacy
5808 West 110th Street
Overland Park, KS 66211
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884901/11/201904/01/2019  04/01/2019
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750201/11/201904/01/2019  04/01/2019
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201001/11/201904/01/2019  04/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349201/11/201904/01/2019  04/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624101/11/201904/01/2019 05/31/202309/07/2023
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282201/11/201904/01/2019  04/01/2019
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/14/202310/01/2023  10/01/2023
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503301/13/202304/01/2023  04/01/2023
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191310/14/202001/01/2021  01/01/2021
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713010/14/202001/01/2021  01/01/2021
Contract DetailOPTUM PHARMACY 705, LLC11142 RENNER BLVD
LENEXAKS6621910/14/202001/01/2021 08/01/202010/05/2021
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508510/14/202001/01/2021  01/01/2021
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983810/05/202101/01/2022  01/01/2022
Contract DetailWALGREEN CODBA: WALGREENS #09425 5455 ROBERTS ST
SHAWNEEKS6622601/13/202304/01/2023  04/01/2023
Contract DetailWALGREEN CODBA: WALGREENS #11925 400 S. BROADWAY
OAK GROVEMO6407501/13/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04183 545 E. SANTA FE ST
OLATHEKS6606101/11/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04204 401 NE BARRY ROAD
KANSAS CITYMO6415501/11/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04406 2630 NE VIVION RD.
KANSAS CITYMO6411901/11/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04225 1701 NW ST RTE 7
BLUE SPRINGSMO6401401/11/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 04439 1191 W KANSAS ST
LIBERTYMO6406801/11/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05247 3915 S NOLAND RD
INDEPENDENCEMO6405501/11/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05263 11021 SHAWNEE MISSION PKWY
SHAWNEEKS6620301/11/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05873 17811 E US HWY 24
INDEPENDENCEMO6405601/11/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07550 7739 STATE AVE
KANSAS CITYKS66112-281901/11/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS # 07789 3200 S 7 HWY
BLUE SPRINGSMO6401401/13/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 10130 6365 LEWIS DR
PARKVILLEMO64152-369901/13/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #12114 9700 N CEDAR AVE
KANSAS CITYMO6415701/13/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA; WALGREENS #12925 2301 RUNNING HORSE RD
PLATTE CITYMO6407901/13/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16072 3537 BROADWAY BLVD
KANSAS CITYMO6411101/13/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.COMMUNITY, A WALGREENS PHARMACY #16518 6407 W 119TH ST STE G5
OVERLAND PARKKS6620901/13/202304/01/2023 09/18/202309/18/2023
Contract DetailWalgreens Central Fill #213942601 Hughes Road
Suite 103 		LibertyMO6406801/13/202304/01/2023  04/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/13/202304/01/2023  04/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/13/202304/01/2023  04/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/13/202304/01/2023  04/01/2023
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
PED263302-01ChildPEDThe Children's Mercy HospitalChildren's Mercy Clinics on Broadway3101 Broadway StreetKansas CityMOActive
PED263302-02ChildPEDThe Children's Mercy HospitalAdolescent Clinic Broadway3101 Broadway BlvdKansas CityMOActive
PED263302-03ChildPEDThe Children's Mercy HospitalSt. Vincent's Daycare3039 Troost AveKansas CityMOTerminated
PED263302-04ChildPEDThe Children's Mercy HospitalReady Set Grow Clinic Broadway3101 Broadway BlvdKansas CityMOActive
PED263302-05ChildPEDThe Children's Mercy HospitalCrittenton10918 Elm AveKansas CityMOTerminated
PED263302-06ChildPEDThe Children's Mercy HospitalUniversity Academy6801 HolmesKansas CityMOTerminated
PED263302-07ChildPEDThe Children's Mercy HospitalNorthland Allergy Clinic501 NW Barry RoadKansas CityMOActive
PED263302-08ChildPEDThe Children's Mercy HospitalNorthland Cardiology Clinic501 NW Barry RoadKansas CityMOActive
PED263302-09ChildPEDThe Children's Mercy HospitalNorthland Dermatology Clinic501 NW Barry RoadKansas CityMOActive
PED263302-10ChildPEDThe Children's Mercy HospitalNorthland Diabetes Clinic501 NW Barry RoadKansas CityMOActive
PED263302-11ChildPEDThe Children's Mercy HospitalNorthland Ear Nose and Throat Clinic501 NW Barry RoadKansas CityMOActive
PED263302-12ChildPEDThe Children's Mercy HospitalNorthland Endocrine Clinic501 NW Barry RoadKansas CityMOActive
PED263302-13ChildPEDThe Children's Mercy HospitalNorthland Hearing and Speech Clinic501 NW Barry RoadKansas CityMOActive
PED263302-14ChildPEDThe Children's Mercy HospitalNorthland Neurology Clinic501 NW Barry RoadKansas CityMOActive
PED263302-15ChildPEDThe Children's Mercy HospitalNorthland Sports Medicine Clinic501 NW Barry RoadKansas CityMOActive
PED263302-16ChildPEDThe Children's Mercy HospitalNorthland Orthopedic Clinic501 NW Barry RoadKansas CityMOActive
PED263302-17ChildPEDThe Children's Mercy HospitalNorthland Pulmonology Clinic501 NW Barry RoadKansas CityMOActive
PED263302-18ChildPEDThe Children's Mercy HospitalNorthland Rehabilitation Clinic501 NW Barry RoadKansas CityMOActive
PED263302-19ChildPEDThe Children's Mercy HospitalNorthland Sleep Clinic501 NW Barry RoadKansas CityMOActive
PED263302-20ChildPEDThe Children's Mercy HospitalNorthland Surgery Clinic501 NW Barry RoadKansas CityMOActive
PED263302-21ChildPEDThe Children's Mercy HospitalNorth Ophthamology Clinic501 NW Barry RoadKansas CityMOActive
PED263302-22ChildPEDThe Children's Mercy HospitalNorth Campus Urgent Care501 NW Barry RoadKansas CityMOActive
PED263302-23ChildPEDThe Children's Mercy HospitalUrgent Care East Campus20300 East Valley View ParkwayIndependenceMOActive
PED263302-24ChildPEDThe Children's Mercy HospitalCenter For Weight Management Broadway3101 Broadway BlvdKansas CityMOActive
PED263302-25ChildPEDThe Children's Mercy HospitalOpthalmology Clinic Broadway3101 Broadway BlvdKansas CityMOActive
PED263302-26ChildPEDThe Children's Mercy HospitalEndorcrine Clinic Broadway3101 Broadway BlvdKansas CityMOActive
PED263302-27ChildPEDThe Children's Mercy HospitalPCC-ADHD Clinic-Broadway3101 Broadway BlvdKansas CityMOActive
PED263302-28ChildPEDThe Children's Mercy HospitalPCC- Diabetes Clinic-Broadway3101 Broadway BlvdKansas CityMOActive
PED263302-29ChildPEDThe Children's Mercy HospitalPCC- Nutrition Clinic-Broadway3101 Broadway BlvdKansas CityMOActive
PED263302-30ChildPEDThe Children's Mercy HospitalPCC- Pediactric Care Clinic-Broadway3101 Broadway BlvdKansas CityMOActive
PED263302-31ChildPEDThe Children's Mercy HospitalCMH Synergy Clinic3101 Broadway BlvdKansas CityMOTerminated
PED263302-32ChildPEDThe Children's Mercy HospitalEast Campus Cariology Clinic2401 Gillham RoadKansas CityMOTerminated
PED263302-33ChildPEDThe Children's Mercy HospitalEast Campus Diabetics Clinic20300 East Valley View ParkwayIndependenceMOActive
PED263302-34ChildPEDThe Children's Mercy HospitalEast Campus Cardiology Clinic20300 East Valley View ParkwayIndependenceMOActive
PED263302-35ChildPEDThe Children's Mercy HospitalNorthland Adolescent Clinic501 NW Barry RoadKansas CityMOActive
PED263302-36ChildPEDThe Children's Mercy HospitalEast Campus Ear Nose and Throat Clinic20300 East Valley View ParkwayIndependenceMOActive
PED263302-37ChildPEDThe Children's Mercy HospitalEast Campus Endocrine Clinic20300 East Valley View ParkwayIndependenceMOActive
PED263302-38ChildPEDThe Children's Mercy HospitalEast Campus Orthopedic Clinic20300 East Valley View ParkwayIndependenceMOActive
PED263302-39ChildPEDThe Children's Mercy HospitalEast Campus Rehabiliation Clinic20300 East Valley View ParkwayIndependenceMOActive
PED263302-40ChildPEDThe Children's Mercy HospitalEast Campus Sports Medicine Clinic20300 East Valley View ParkwayIndependenceMOActive
PED263302-41ChildPEDThe Children's Mercy HospitalCHILDREN'S MERCY CLINICS ON BROADWA - Dermatology Clinic3101 BROADWAY BLVDKANSAS CITYMOActive
PED263302-42ChildPEDThe Children's Mercy HospitalCHILDREN'S MERCY CLINICS ON BROADWA - Allergy Clinic3101 BROADWAY BLVDKANSAS CITYMOActive
PED263302-43ChildPEDThe Children's Mercy HospitalNorthland Rheumatology Clinic - Rheumatology501 NW Barry RoadKansas CityMOApproved
PED263302-44ChildPEDThe Children's Mercy HospitalNorthland Gastroenterology Clinic - Gastroenterology501 NW Barry RoadKansas CityMOApproved
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification9/7/2023 1:16:55 PM9/6/2024 3:34:16 PM9/6/2024 3:34 PM
DetailsLast Recertification DateUpdateRecertification9/19/2022 12:48:15 PM9/7/2023 1:16:55 PM9/7/2023 1:16 PM
Medicaid BillingMedicaid: NumberDeleteChange Request100080290B (KS) 2/17/2023 10:36 AM
Medicaid BillingMedicaid: NumberDeleteChange Request100080290A (KS) 2/17/2023 10:36 AM
Medicaid BillingMedicaid: NumberDeleteChange Request100023380J (KS) 2/17/2023 10:36 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False2/17/2023 10:36 AM
Medicaid BillingMedicaid: NumberInsertChange Request 300039040700142/17/2023 10:36 AM
Medicaid BillingMedicaid: StateInsertChange Request KS2/17/2023 10:36 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False2/17/2023 10:36 AM
Medicaid BillingMedicaid: NumberInsertChange Request 300039040700152/17/2023 10:36 AM
Medicaid BillingMedicaid: StateInsertChange Request KS2/17/2023 10:36 AM
DetailsLast Recertification DateUpdateRecertification9/9/2021 8:59:59 AM9/19/2022 12:48:15 PM9/19/2022 12:48 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/25/2022 5:15 PM
Medicaid BillingMedicaid: NumberInsertChange Request 300039040700944/25/2022 5:15 PM
Medicaid BillingMedicaid: StateInsertChange Request KS4/25/2022 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/25/2022 5:15 PM
Medicaid BillingMedicaid: NumberInsertChange Request 300039040700884/25/2022 5:15 PM
Medicaid BillingMedicaid: StateInsertChange Request KS4/25/2022 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/25/2022 5:15 PM
Medicaid BillingMedicaid: NumberInsertChange Request 300039040700834/25/2022 5:15 PM
Medicaid BillingMedicaid: StateInsertChange Request KS4/25/2022 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/25/2022 5:15 PM
Medicaid BillingMedicaid: NumberInsertChange Request 300039040700164/25/2022 5:15 PM
Medicaid BillingMedicaid: StateInsertChange Request KS4/25/2022 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/25/2022 5:15 PM
Medicaid BillingMedicaid: NumberInsertChange Request 300039040700844/25/2022 5:15 PM
Medicaid BillingMedicaid: StateInsertChange Request KS4/25/2022 5:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2021 8:59 AM
Medicaid BillingMedicaid: NumberInsertRecertification 6000780739/9/2021 8:59 AM
Medicaid BillingMedicaid: StateInsertRecertification MO9/9/2021 8:59 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2021 8:59 AM
Medicaid BillingMedicaid: NumberInsertRecertification 6000423599/9/2021 8:59 AM
Medicaid BillingMedicaid: StateInsertRecertification MO9/9/2021 8:59 AM
DetailsLast Recertification DateUpdateRecertification9/9/2020 10:44:12 AM9/9/2021 8:59:59 AM9/9/2021 8:59 AM
ContactsAuthorizing OfficialUpdateChange RequestCoombs, Jodi Executive Vice President and Chief Operating Officer Children's Mercy Hospital 8162343623O'Neal, Brian Senior VP of Allied Health Children's Mercy Hospital 81630280598/16/2021 12:01 PM
ContactsPrimary ContactUpdateChange RequestO'Neal, Brian Senior VP of Allied Health Children's Mercy Hospital 8163028059Bledsoe, Sarah Senior Director of Pharmacy Children's Mercy Hospital 81698363888/16/2021 12:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/30/2021 4:45 PM
Medicaid BillingMedicaid: NumberInsertChange Request 6009316046/30/2021 4:45 PM
Medicaid BillingMedicaid: StateInsertChange Request MO6/30/2021 4:45 PM
ContactsPrimary ContactUpdateProfile Change RequestO'Neal, Brian Director of Pharmacy Children's Mercy Hospital 8162343545O'Neal, Brian Senior VP of Allied Health Children's Mercy Hospital 81630280592/8/2021 3:50 PM
ContactsAuthorizing OfficialUpdateChange RequestHunt, Cheri Senior Vice President for Patient Care Services Chief Nursing Officer Children's Mercy Hospitals and Clinics 8162343728Coombs, Jodi Executive Vice President and Chief Operating Officer Children's Mercy Hospital 816234362312/10/2020 10:42 AM
Medicaid BillingNPI: StateUpdateRecertification MO9/9/2020 10:44 AM
Medicaid BillingNPI: StateUpdateRecertification MO9/9/2020 10:44 AM
Medicaid BillingNPI: StateUpdateRecertification MO9/9/2020 10:44 AM
Medicaid BillingNPI: StateUpdateRecertification MO9/9/2020 10:44 AM
Medicaid BillingNPI: NumberInsertRecertification 11544002329/9/2020 10:44 AM
Medicaid BillingNPI: StateInsertRecertification KS9/9/2020 10:44 AM
Medicaid BillingNPI: NumberInsertRecertification 13564085209/9/2020 10:44 AM
Medicaid BillingNPI: StateInsertRecertification KS9/9/2020 10:44 AM
Medicaid BillingNPI: NumberInsertRecertification 13568396179/9/2020 10:44 AM
Medicaid BillingNPI: StateInsertRecertification KS9/9/2020 10:44 AM
Medicaid BillingNPI: NumberInsertRecertification 13665154889/9/2020 10:44 AM
Medicaid BillingNPI: StateInsertRecertification KS9/9/2020 10:44 AM
Medicaid BillingNPI: NumberInsertRecertification 15988096009/9/2020 10:44 AM
Medicaid BillingNPI: StateInsertRecertification KS9/9/2020 10:44 AM
Medicaid BillingNPI: NumberInsertRecertification 17205248469/9/2020 10:44 AM
Medicaid BillingNPI: StateInsertRecertification KS9/9/2020 10:44 AM
Medicaid BillingNPI: NumberInsertRecertification 19021972709/9/2020 10:44 AM
Medicaid BillingNPI: StateInsertRecertification KS9/9/2020 10:44 AM
Medicaid BillingNPI: StateUpdateRecertification MO9/9/2020 10:44 AM
Medicaid BillingNPI: StateUpdateRecertification MO9/9/2020 10:44 AM
Medicaid BillingNPI: StateUpdateRecertification MO9/9/2020 10:44 AM
DetailsLast Recertification DateUpdateRecertification9/8/2019 10:14:42 AM9/9/2020 10:44:12 AM9/9/2020 10:44 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2019 10:14 AM
Medicaid BillingMedicaid: NumberInsertRecertification 6000128499/8/2019 10:14 AM
Medicaid BillingMedicaid: StateInsertRecertification MO9/8/2019 10:14 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2019 10:14 AM
Medicaid BillingMedicaid: NumberInsertRecertification 100023380J9/8/2019 10:14 AM
Medicaid BillingMedicaid: StateInsertRecertification KS9/8/2019 10:14 AM
DetailsLast Recertification DateUpdateRecertification8/30/2018 2:09:08 PM9/8/2019 10:14:42 AM9/8/2019 10:14 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/5/2019 9:10 AM
Medicaid BillingMedicaid: NumberInsertChange Request 6065469014/5/2019 9:10 AM
Medicaid BillingMedicaid: StateInsertChange Request MO4/5/2019 9:10 AM
AddressesShipping AddressInsertChange Request The Children's Mercy Hospital Kansas Outpatient Pharmacy 5808 West 110th Street Overland Park, KS 662113/25/2019 11:39 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/25/2019 11:39 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0198135003/25/2019 11:39 AM
Medicaid BillingMedicaid: StateInsertChange Request MO3/25/2019 11:39 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/25/2019 11:39 AM
Medicaid BillingMedicaid: NumberInsertChange Request 100080290A3/25/2019 11:39 AM
Medicaid BillingMedicaid: StateInsertChange Request KS3/25/2019 11:39 AM
Medicaid BillingNPI: NumberInsertChange Request 11544002323/25/2019 11:39 AM
Medicaid BillingNPI: NumberInsertChange Request 17205248463/25/2019 11:39 AM
Medicaid BillingNPI: NumberInsertChange Request 13568396173/25/2019 11:39 AM
Medicaid BillingNPI: NumberInsertChange Request 15988096003/25/2019 11:39 AM
DetailsLast Recertification DateUpdateRecertification12/5/2017 11:33:08 AM8/30/2018 2:09:08 PM8/30/2018 2:09 PM
ContactsAuthorizing OfficialUpdateChange RequestCox, Karen Executive Vice President/ COO Children's Mercy Hospital 8162343633Hunt, Cheri Senior Vice President for Patient Care Services Chief Nursing Officer Children's Mercy Hospitals and Clinics 81623437288/14/2018 1:06 PM
AddressesShipping AddressInsertChange Request University of Kansas Hospital Cell Processing Lab 2015 W. 39th St. Room B506 Kansas City, KS 661608/7/2018 9:23 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/7/2018 9:23 AM
Medicaid BillingMedicaid: NumberInsertChange Request 100080290B8/7/2018 9:23 AM
Medicaid BillingMedicaid: StateInsertChange Request KS8/7/2018 9:23 AM
Medicaid BillingNPI: NumberInsertChange Request 13564085208/7/2018 9:23 AM
Medicaid BillingNPI: NumberInsertChange Request 19021972708/7/2018 9:23 AM
AddressesShipping AddressInsertChange Request The Children's Mercy Hospital Outpatient Pharmacy on Broadway 3101 Broadway Blvd Kansas City, MO 641116/14/2018 1:22 PM
AddressesShipping AddressInsertChange Request The Children's Mercy Hospital Outpatient Pharmacy 2401 Gillham Rd Kansas City, MO 641086/14/2018 1:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1356408520 ( ) 6/14/2018 1:22 PM
Medicaid BillingNPI: NumberDeleteChange Request1902197270 ( ) 6/14/2018 1:22 PM
AddressesShipping AddressInsertChange Request The Children's Mercy Hospital Riverside Pharmacy 700 NW Argosy Parkway Riverside, MO 641504/13/2018 7:23 AM
Medicaid BillingNPI: NumberInsertChange Request 13564085204/13/2018 7:23 AM
Medicaid BillingNPI: NumberInsertChange Request 19021972704/13/2018 7:23 AM
DetailsLast Recertification DateUpdateRecertification9/1/2016 12:00:00 AM12/5/2017 11:33:08 AM12/5/2017 11:33 AM
ContactsAuthorizing OfficialUpdate Cox, Karen Executive Vice President/ COO 8162343633Cox, Karen Executive Vice President/ COO Children's Mercy Hospital 816234363310/26/2017 11:05 AM
ContactsSigned ByUpdate Cox, Karen Executive Vice President/ COO 8162343633Cox, Karen Executive Vice President/ COO Children's Mercy Hospital 816234363310/26/2017 11:05 AM
ContactsPrimary ContactUpdate O'Neal, Brian Director of Pharmacy 8162343545O'Neal, Brian Director of Pharmacy Children's Mercy Hospital 816234354510/17/2017 1:16 PM
ContactsAuthorizing OfficialInsert  Cox, Karen Executive Vice President/ COO 81623436337/3/2017 9:53 AM
ContactsSigned ByInsert  Cox, Karen Executive Vice President/ COO 81623436337/3/2017 9:53 AM
ContactsPrimary ContactInsert  O'Neal, Brian Director of Pharmacy 81623435457/3/2017 9:53 AM
AddressesMain AddressInsert   2401 Gillham Road Kansas City, MO 641089/1/2016 3:29 PM
DetailsLast Recertification DateUpdate 8/17/2015 12:00:00 AM9/1/2016 12:00:00 AM9/1/2016 3:29 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False12/1/2015 10:17 AM
Medicaid BillingMedicaid: NumberInsert  01093160812/1/2015 10:17 AM
Medicaid BillingMedicaid: StateInsert  MO12/1/2015 10:17 AM
Medicaid BillingNPI: NumberInsert  136651548812/1/2015 10:17 AM
DetailsLast Recertification DateUpdate 8/28/2014 12:00:00 AM8/17/2015 12:00:00 AM8/17/2015 3:04 PM
DetailsLast Recertification DateUpdate 8/28/2013 12:00:00 AM8/28/2014 12:00:00 AM8/28/2014 8:13 AM
DetailsLast Recertification DateUpdate  8/28/2013 12:00:00 AM8/28/2013 2:50 PM
DatesParticipating Approval DateUpdate  12/8/2011 12:00:00 AM12/8/2011 3:09 PM
DetailsStateUpdate PendingActive12/8/2011 3:09 PM
DatesStart DateUpdate 12/7/2011 12:00:00 AM12/8/2011 12:00:00 AM12/8/2011 3:09 PM
Details340B IDUpdate ONLINE_REGPED263302-0012/7/2011 9:40 AM
DatesStart DateUpdate  12/7/2011 12:00:00 AM12/7/2011 9:40 AM
DetailsLast Recertification DateInsert   8/26/2011 2:03 PM
DetailsGrant NumberInsert   8/26/2011 2:03 PM
Details340B IDInsert  ONLINE_REG8/26/2011 2:03 PM
DetailsIs Authorizing Official EHB DataInsert   8/26/2011 2:03 PM
DatesLast Date That 340B Drugs PurchasedInsert   8/26/2011 2:03 PM
DetailsMedicare Provider NumberInsert  2633028/26/2011 2:03 PM
DetailsEntity NameInsert  The Children's Mercy Hospital8/26/2011 2:03 PM
DetailsProgram CodeInsert  PED8/26/2011 2:03 PM
DetailsEntity SubnameInsert   8/26/2011 2:03 PM
DatesParticipating Approval DateInsert   8/26/2011 2:03 PM
DetailsStateInsert  Pending8/26/2011 2:03 PM
DatesRegistration DateInsert  8/26/2011 12:00:00 AM8/26/2011 2:03 PM
DatesSigned By DateInsert  8/26/2011 12:00:00 AM8/26/2011 2:03 PM
DatesStart DateInsert   8/26/2011 2:03 PM
TerminationsTermination CommentsInsert   8/26/2011 2:03 PM
TerminationsTermination DateInsert   8/26/2011 2:03 PM
TerminationsTermination Effective DateInsert   8/26/2011 2:03 PM
TerminationsTermination ReasonInsert   8/26/2011 2:03 PM