Covered Entity Details

DSH260032B BARNES-JEWISH HOSPITAL (Active) - information as of 5/13/2025 10:49:35 PM

Main Details

Name

BARNES-JEWISH HOSPITAL

Subdivision Name

Barnes-Jewish Hospital Surgical and Wound Care Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH260032B

Medicare Provider Number

260032

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/9/2014

Participating Start Date

7/1/2014

Participating Approval Date

6/11/2014

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

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

Primary Contact

Barnes Jewish Hospital
Kristin Helton, Pharmacy Manager
(314) 249-7683

Addresses

Street Address

4901 Forest Park Avenue
Suite 340
ST. LOUIS, MO 63108

Billing Address

Barnes Jewish Hospital
4249 Clayton Ave Ste 310
St. Louis, MO 63110

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
MO	010724201,600724223,600117238	1649299827,1871609784,1750025565
IL	237309937001,237309937002,237309937006	1649299827,1871609784,1750025565

Shipping Addresses

Shipping Address 1

Barnes Jewish Hospital
One Barnes-Jewish Hospital Plaza
St. Louis, MO 63110

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
DSH260032A	Child	DSH	BARNES-JEWISH HOSPITAL	Barnes-Jewish Hospital Orthopedic Center	14532 South Outer Forty Drive	Chesterfield	MO	Active
DSH260032B	Child	DSH	BARNES-JEWISH HOSPITAL	Barnes-Jewish Hospital Surgical and Wound Care Center	4901 Forest Park Avenue	ST. LOUIS	MO	Active
DSH260032C	Child	DSH	BARNES-JEWISH HOSPITAL	Primary Care Medicine Clinic	4901 Forest Park Avenue	St. Louis	MO	Active
DSH260032D	Child	DSH	BARNES-JEWISH HOSPITAL	OB/GYN Clinic	4901 Forest Park Avenue	St. Louis	MO	Active
DSH260032E	Child	DSH	BARNES-JEWISH HOSPITAL	Specialty Care Clinic	4901 Forest Park Avenue	St. Louis	MO	Active
DSH260032F	Child	DSH	BARNES-JEWISH HOSPITAL	Psychiatry Clinic	4901 Forest Park Avenue	St. Louis	MO	Active
DSH260032G	Child	DSH	BARNES-JEWISH HOSPITAL	OB/GYN In Vitro	4444 Forest Park Avenue	Saint Louis	MO	Active
DSH260032H	Child	DSH	BARNES-JEWISH HOSPITAL	CENTER FOR ADVANCED MEDICINE SOUTH / Endoscopy-GI-CSC	5201 MID AMERICA PLZ	SAINT LOUIS	MO	Active
DSH260032J	Child	DSH	BARNES-JEWISH HOSPITAL	CENTER FOR ADVANCED MEDICINE SOUTH / Rad Interventional - CSC	5201 MID AMERICA PLZ	SAINT LOUIS	MO	Active
DSH260032K	Child	DSH	BARNES-JEWISH HOSPITAL	CENTER FOR ADVANCED MEDICINE SOUTH / Diagnostic Radiology - CSC	5201 MID AMERICA PLZ	SAINT LOUIS	MO	Active
DSH260032L	Child	DSH	BARNES-JEWISH HOSPITAL	CENTER FOR ADVANCED MEDICINE SOUTH / Post Anesth Care Unit- CSC	5201 MID AMERICA PLZ	SAINT LOUIS	MO	Active
DSH260032M	Child	DSH	BARNES-JEWISH HOSPITAL	CENTER FOR ADVANCED MEDICINE SOUTH / Surgery - CSC	5201 MID AMERICA PLZ	SAINT LOUIS	MO	Active
DSH260032N	Child	DSH	BARNES-JEWISH HOSPITAL	OUTPATIENT SURGERY CENTER / Ortho Center - Pain Management 2	14532 S OUTER 40 RD	CHESTERFIELD	MO	Active
DSH260032P	Child	DSH	BARNES-JEWISH HOSPITAL	OUTPATIENT SURGERY CENTER / Ortho Center - Recovery Room	14532 S OUTER 40 RD	CHESTERFIELD	MO	Active
DSH260032Q	Child	DSH	BARNES-JEWISH HOSPITAL	Ortho Center - Surgery-Ambulatory Ctr	14532 S OUTER 40 RD	CHESTERFIELD	MO	Active
DSH260032R	Child	DSH	BARNES-JEWISH HOSPITAL	SITEMAN CANCER CENTER SOUTH COUNTY - Siteman CC So - Radiation Oncology 2	5225 MID AMERICA PLZ	SAINT LOUIS	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Insert	Group Change Request		Barnes Jewish Hospital 4249 Clayton Ave Ste 310 St. Louis, MO 63110	1/21/2025 7:40 AM
Addresses	Shipping Address	Insert	Group Change Request		Barnes Jewish Hospital One Barnes-Jewish Hospital Plaza St. Louis, MO 63110	1/21/2025 7:40 AM
Details	Last Recertification Date	Update	Recertification	9/5/2023 10:06:14 AM	9/3/2024 11:12:42 AM	9/3/2024 11:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/5/2023 10:06 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		600117238	9/5/2023 10:06 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MO	9/5/2023 10:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/5/2023 10:06 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		237309937006	9/5/2023 10:06 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	9/5/2023 10:06 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1750025565	9/5/2023 10:06 AM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/5/2023 10:06 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1750025565	9/5/2023 10:06 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/5/2023 10:06 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 3:20:00 PM	9/5/2023 10:06:14 AM	9/5/2023 10:06 AM
Details	Last Recertification Date	Update	Recertification	9/3/2021 1:39:10 PM	9/1/2022 3:20:00 PM	9/1/2022 3:20 PM
Contacts	Primary Contact	Update	Group Change Request	Leesman, Jonathan Pharmacy Manager Barnes-Jewish Hospital 3147473266	Helton, Kristin Pharmacy Manager Barnes Jewish Hospital 3142497683	11/16/2021 10:10 AM
Contacts	Authorizing Official	Update	AO Change Request	Krieger, Mark CFO Barnes-Jewish Hospital 3143620605	Irovic, Paul John Vice-president, Finance Barnes-Jewish Hospital 3142658874	10/12/2021 8:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2021 1:39 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		237309937002	9/3/2021 1:39 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	9/3/2021 1:39 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1033132220 (MO)		9/3/2021 1:39 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1033132220 (IL)		9/3/2021 1:39 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 5:25:53 PM	9/3/2021 1:39:10 PM	9/3/2021 1:39 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1033132220 ( )		9/11/2020 5:25 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649299827 ( )		9/11/2020 5:25 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1871609784 ( )		9/11/2020 5:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033132220	9/11/2020 5:25 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/11/2020 5:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1649299827	9/11/2020 5:25 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/11/2020 5:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1871609784	9/11/2020 5:25 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/11/2020 5:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033132220	9/11/2020 5:25 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/11/2020 5:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1649299827	9/11/2020 5:25 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/11/2020 5:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1871609784	9/11/2020 5:25 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/11/2020 5:25 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 10:59:14 AM	9/11/2020 5:25:53 PM	9/11/2020 5:25 PM
Contacts	Authorizing Official	Update	Change Request	Cannon, Robert President Barnes-Jewish Hospital 3142862118	Krieger, Mark CFO Barnes-Jewish Hospital 3143620605	8/12/2020 7:52 AM
Details	Last Recertification Date	Update	Recertification	8/30/2018 11:51:25 AM	8/21/2019 10:59:14 AM	8/21/2019 10:59 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	194630407 (AR)		4/22/2019 2:53 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	220496 (MS)		4/22/2019 2:53 PM
Details	Last Recertification Date	Update	Recertification	11/30/2017 10:52:51 AM	8/30/2018 11:51:25 AM	8/30/2018 11:51 AM
Details	Last Recertification Date	Update	Recertification	8/26/2016 12:00:00 AM	11/30/2017 10:52:51 AM	11/30/2017 10:52 AM
Contacts	Authorizing Official	Update		Cannon, Robert President 3142862118	Cannon, Robert President Barnes-Jewish Hospital 3142862118	11/30/2017 10:47 AM
Contacts	Primary Contact	Update		Leesman, Jonathan Pharmacy Manager 3147473266	Leesman, Jonathan Pharmacy Manager Barnes-Jewish Hospital 3147473266	10/3/2017 10:37 AM
Contacts	Primary Contact	Insert			Leesman, Jonathan Pharmacy Manager 3147473266	7/24/2017 6:29 PM
Contacts	Authorizing Official	Insert			Cannon, Robert President 3142862118	7/24/2017 6:29 PM
Addresses	Main Address	Insert			4901 Forest Park Avenue Suite 340 ST. LOUIS, MO 63108	7/24/2017 6:29 PM
Contacts	Signed By	Insert			Liekwig, Richard President 3142865400	7/24/2017 6:29 PM
Details	Last Recertification Date	Update		8/13/2015 12:00:00 AM	8/26/2016 12:00:00 AM	8/26/2016 2:48 PM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/13/2015 12:00:00 AM	8/13/2015 2:26 PM
Details	Last Recertification Date	Update			8/7/2014 12:00:00 AM	8/7/2014 2:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/8/2014 8:07 AM
Medicaid Billing	Medicaid: Number	Insert			220496	7/8/2014 8:07 AM
Medicaid Billing	Medicaid: State	Insert			MS	7/8/2014 8:07 AM
Medicaid Billing	NPI: Number	Insert			1871609784	7/8/2014 8:07 AM
Medicaid Billing	Medicaid: Number	Update		234309937001	237309937001	7/3/2014 11:40 AM
Dates	Participating Approval Date	Update			6/11/2014 12:00:00 AM	6/11/2014 4:38 PM
Details	State	Update		Pending	Active	6/11/2014 4:38 PM
Dates	Start Date	Update			7/1/2014 12:00:00 AM	6/11/2014 4:38 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH260032B	4/15/2014 10:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: Number	Insert			010724201	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: State	Insert			MO	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: Number	Insert			600724223	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: State	Insert			MO	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: Number	Insert			234309937001	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: State	Insert			IL	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: Number	Insert			194630407	4/9/2014 9:22 AM
Medicaid Billing	Medicaid: State	Insert			AR	4/9/2014 9:22 AM
Medicaid Billing	NPI: Number	Insert			1033132220	4/9/2014 9:22 AM
Medicaid Billing	NPI: Number	Insert			1649299827	4/9/2014 9:22 AM
Details	Last Recertification Date	Insert				4/9/2014 9:22 AM
Details	Grant Number	Insert				4/9/2014 9:22 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	4/9/2014 9:22 AM
Details	Is Authorizing Official EHB Data	Insert				4/9/2014 9:22 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/9/2014 9:22 AM
Details	Medicare Provider Number	Insert			260032	4/9/2014 9:22 AM
Details	Entity Name	Insert			BARNES-JEWISH HOSPITAL	4/9/2014 9:22 AM
Details	Program Code	Insert			DSH	4/9/2014 9:22 AM
Details	Entity Subname	Insert			Barnes-Jewish Hospital Surgical and Wound Care Center	4/9/2014 9:22 AM
Dates	Participating Approval Date	Insert				4/9/2014 9:22 AM
Details	State	Insert			Pending	4/9/2014 9:22 AM
Dates	Registration Date	Insert			4/9/2014 12:00:00 AM	4/9/2014 9:22 AM
Dates	Signed By Date	Insert			4/9/2014 12:00:00 AM	4/9/2014 9:22 AM
Dates	Start Date	Insert				4/9/2014 9:22 AM
Terminations	Termination Comments	Insert				4/9/2014 9:22 AM
Terminations	Termination Date	Insert				4/9/2014 9:22 AM
Terminations	Termination Effective Date	Insert				4/9/2014 9:22 AM
Terminations	Termination Reason	Insert				4/9/2014 9:22 AM