Covered Entity Details

PED263302-03 The Children's Mercy Hospital (Terminated) - information as of 6/27/2025 12:30:48 AM

Main Details

Name

The Children's Mercy Hospital

Subdivision Name

St. Vincent's Daycare

Type

Children's Hospital

Rural

340B ID

PED263302-03

Medicare Provider Number

263302

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/11/2014

Participating Start Date

7/1/2014

Participating Approval Date

6/13/2014

Last Recertification Date

12/5/2017

Termination Date
Termination Reason

4/1/2018
Hospital Outpatient facility no longer eligible

Contacts

Authorizing Official

Children's Mercy Hospitals and Clinics
Cheri Hunt, Senior Vice President for Patient Care Services Chief Nursing Officer
(816) 234-3728

Primary Contact

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

Addresses

Street Address

3039 Troost Ave
Kansas City, MO 64109

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
MO	010931608
		1366515488

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
PED263302-01	Child	PED	The Children's Mercy Hospital	Children's Mercy Clinics on Broadway	3101 Broadway Street	Kansas City	MO	Active
PED263302-02	Child	PED	The Children's Mercy Hospital	Adolescent Clinic Broadway	3101 Broadway Blvd	Kansas City	MO	Active
PED263302-03	Child	PED	The Children's Mercy Hospital	St. Vincent's Daycare	3039 Troost Ave	Kansas City	MO	Terminated
PED263302-04	Child	PED	The Children's Mercy Hospital	Ready Set Grow Clinic Broadway	3101 Broadway Blvd	Kansas City	MO	Active
PED263302-05	Child	PED	The Children's Mercy Hospital	Crittenton	10918 Elm Ave	Kansas City	MO	Terminated
PED263302-06	Child	PED	The Children's Mercy Hospital	University Academy	6801 Holmes	Kansas City	MO	Terminated
PED263302-07	Child	PED	The Children's Mercy Hospital	Northland Allergy Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-08	Child	PED	The Children's Mercy Hospital	Northland Cardiology Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-09	Child	PED	The Children's Mercy Hospital	Northland Dermatology Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-10	Child	PED	The Children's Mercy Hospital	Northland Diabetes Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-11	Child	PED	The Children's Mercy Hospital	Northland Ear Nose and Throat Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-12	Child	PED	The Children's Mercy Hospital	Northland Endocrine Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-13	Child	PED	The Children's Mercy Hospital	Northland Hearing and Speech Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-14	Child	PED	The Children's Mercy Hospital	Northland Neurology Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-15	Child	PED	The Children's Mercy Hospital	Northland Sports Medicine Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-16	Child	PED	The Children's Mercy Hospital	Northland Orthopedic Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-17	Child	PED	The Children's Mercy Hospital	Northland Pulmonology Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-18	Child	PED	The Children's Mercy Hospital	Northland Rehabilitation Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-19	Child	PED	The Children's Mercy Hospital	Northland Sleep Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-20	Child	PED	The Children's Mercy Hospital	Northland Surgery Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-21	Child	PED	The Children's Mercy Hospital	North Ophthamology Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-22	Child	PED	The Children's Mercy Hospital	North Campus Urgent Care	501 NW Barry Road	Kansas City	MO	Active
PED263302-23	Child	PED	The Children's Mercy Hospital	Urgent Care East Campus	20300 East Valley View Parkway	Independence	MO	Active
PED263302-24	Child	PED	The Children's Mercy Hospital	Center For Weight Management Broadway	3101 Broadway Blvd	Kansas City	MO	Active
PED263302-25	Child	PED	The Children's Mercy Hospital	Opthalmology Clinic Broadway	3101 Broadway Blvd	Kansas City	MO	Active
PED263302-26	Child	PED	The Children's Mercy Hospital	Endorcrine Clinic Broadway	3101 Broadway Blvd	Kansas City	MO	Active
PED263302-27	Child	PED	The Children's Mercy Hospital	PCC-ADHD Clinic-Broadway	3101 Broadway Blvd	Kansas City	MO	Active
PED263302-28	Child	PED	The Children's Mercy Hospital	PCC- Diabetes Clinic-Broadway	3101 Broadway Blvd	Kansas City	MO	Active
PED263302-29	Child	PED	The Children's Mercy Hospital	PCC- Nutrition Clinic-Broadway	3101 Broadway Blvd	Kansas City	MO	Active
PED263302-30	Child	PED	The Children's Mercy Hospital	PCC- Pediactric Care Clinic-Broadway	3101 Broadway Blvd	Kansas City	MO	Active
PED263302-31	Child	PED	The Children's Mercy Hospital	CMH Synergy Clinic	3101 Broadway Blvd	Kansas City	MO	Terminated
PED263302-32	Child	PED	The Children's Mercy Hospital	East Campus Cariology Clinic	2401 Gillham Road	Kansas City	MO	Terminated
PED263302-33	Child	PED	The Children's Mercy Hospital	East Campus Diabetics Clinic	20300 East Valley View Parkway	Independence	MO	Active
PED263302-34	Child	PED	The Children's Mercy Hospital	East Campus Cardiology Clinic	20300 East Valley View Parkway	Independence	MO	Active
PED263302-35	Child	PED	The Children's Mercy Hospital	Northland Adolescent Clinic	501 NW Barry Road	Kansas City	MO	Active
PED263302-36	Child	PED	The Children's Mercy Hospital	East Campus Ear Nose and Throat Clinic	20300 East Valley View Parkway	Independence	MO	Active
PED263302-37	Child	PED	The Children's Mercy Hospital	East Campus Endocrine Clinic	20300 East Valley View Parkway	Independence	MO	Active
PED263302-38	Child	PED	The Children's Mercy Hospital	East Campus Orthopedic Clinic	20300 East Valley View Parkway	Independence	MO	Active
PED263302-39	Child	PED	The Children's Mercy Hospital	East Campus Rehabiliation Clinic	20300 East Valley View Parkway	Independence	MO	Active
PED263302-40	Child	PED	The Children's Mercy Hospital	East Campus Sports Medicine Clinic	20300 East Valley View Parkway	Independence	MO	Active
PED263302-41	Child	PED	The Children's Mercy Hospital	CHILDREN'S MERCY CLINICS ON BROADWA - Dermatology Clinic	3101 BROADWAY BLVD	KANSAS CITY	MO	Active
PED263302-42	Child	PED	The Children's Mercy Hospital	CHILDREN'S MERCY CLINICS ON BROADWA - Allergy Clinic	3101 BROADWAY BLVD	KANSAS CITY	MO	Active
PED263302-43	Child	PED	The Children's Mercy Hospital	Northland Rheumatology Clinic - Rheumatology	501 NW Barry Road	Kansas City	MO	Approved
PED263302-44	Child	PED	The Children's Mercy Hospital	Northland Gastroenterology Clinic - Gastroenterology	501 NW Barry Road	Kansas City	MO	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	O'Neal, Brian Director of Pharmacy Children's Mercy Hospital 8162343545	O'Neal, Brian Senior VP of Allied Health Children's Mercy Hospital 8163028059	2/8/2021 3:50 PM
Contacts	Authorizing Official	Update	Change Request	Cox, Karen Executive Vice President/ COO Children's Mercy Hospital 8162343633	Hunt, Cheri Senior Vice President for Patient Care Services Chief Nursing Officer Children's Mercy Hospitals and Clinics 8162343728	8/14/2018 1:06 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/30/2017 12:00:00 AM	1/31/2018 10:08 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/31/2018 10:08 AM
Terminations	Termination Date	Update	Termination Request		4/1/2018 12:00:00 AM	1/31/2018 10:08 AM
Terminations	Termination Effective Date	Update	Termination Request		11/30/2017 12:00:00 AM	1/31/2018 10:08 AM
Terminations	Termination Reason	Update	Termination Request		Hospital Outpatient facility no longer eligible	1/31/2018 10:08 AM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	12/5/2017 11:39:25 AM	12/5/2017 11:39 AM
Contacts	Authorizing Official	Update		Cox, Karen Executive Vice President/ COO 8162343633	Cox, Karen Executive Vice President/ COO Children's Mercy Hospital 8162343633	10/26/2017 11:05 AM
Contacts	Signed By	Update		Cox, Karen Executive Vice President/ COO 8162343633	Cox, Karen Executive Vice President/ COO Children's Mercy Hospital 8162343633	10/26/2017 11:05 AM
Contacts	Primary Contact	Update		O'Neal, Brian Director of Pharmacy 8162343545	O'Neal, Brian Director of Pharmacy Children's Mercy Hospital 8162343545	10/17/2017 1:16 PM
Contacts	Authorizing Official	Insert			Cox, Karen Executive Vice President/ COO 8162343633	7/3/2017 9:53 AM
Contacts	Signed By	Insert			Cox, Karen Executive Vice President/ COO 8162343633	7/3/2017 9:53 AM
Contacts	Primary Contact	Update		Odgen, Ricky Acting Director of Pharmacy 8162341622	O'Neal, Brian Director of Pharmacy 8162343545	7/3/2017 9:53 AM
Addresses	Main Address	Insert			3039 Troost Ave Kansas City, MO 64109	9/1/2016 3:29 PM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 3:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	12/1/2015 10:16 AM
Medicaid Billing	Medicaid: Number	Insert			010931608	12/1/2015 10:16 AM
Medicaid Billing	Medicaid: State	Insert			MO	12/1/2015 10:16 AM
Medicaid Billing	NPI: Number	Insert			1366515488	12/1/2015 10:16 AM
Details	Last Recertification Date	Update		8/28/2014 12:00:00 AM	8/17/2015 12:00:00 AM	8/17/2015 3:04 PM
Details	Last Recertification Date	Update			8/28/2014 12:00:00 AM	8/28/2014 8:14 AM
Contacts	Primary Contact	Insert			Odgen, Ricky Acting Director of Pharmacy 8162341622	6/20/2014 12:53 PM
Dates	Participating Approval Date	Update			6/13/2014 12:00:00 AM	6/13/2014 11:24 AM
Details	State	Update		Pending	Active	6/13/2014 11:24 AM
Dates	Start Date	Update			7/1/2014 12:00:00 AM	6/13/2014 11:24 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	PED263302-03	5/14/2014 9:38 AM
Details	Last Recertification Date	Insert				4/11/2014 4:04 PM
Details	Grant Number	Insert				4/11/2014 4:04 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	4/11/2014 4:04 PM
Details	Is Authorizing Official EHB Data	Insert				4/11/2014 4:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/11/2014 4:04 PM
Details	Medicare Provider Number	Insert			263302	4/11/2014 4:04 PM
Details	Entity Name	Insert			The Children's Mercy Hospital	4/11/2014 4:04 PM
Details	Program Code	Insert			PED	4/11/2014 4:04 PM
Details	Entity Subname	Insert			St. Vincent's Daycare	4/11/2014 4:04 PM
Dates	Participating Approval Date	Insert				4/11/2014 4:04 PM
Details	State	Insert			Pending	4/11/2014 4:04 PM
Dates	Registration Date	Insert			4/11/2014 12:00:00 AM	4/11/2014 4:04 PM
Dates	Signed By Date	Insert			4/11/2014 12:00:00 AM	4/11/2014 4:04 PM
Dates	Start Date	Insert				4/11/2014 4:04 PM
Terminations	Termination Comments	Insert				4/11/2014 4:04 PM
Terminations	Termination Date	Insert				4/11/2014 4:04 PM
Terminations	Termination Effective Date	Insert				4/11/2014 4:04 PM
Terminations	Termination Reason	Insert				4/11/2014 4:04 PM