Covered Entity Details

PED173300-01 The Children's Mercy Hospital Kansas (Active) - information as of 5/6/2025 11:11:39 PM

Main Details

Name

The Children's Mercy Hospital Kansas

Subdivision Name

Children's Mercy College Boulevard - Pulmonary Clinic

Type

Children's Hospital

Rural

340B ID

PED173300-01

Medicare Provider Number

173300

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/12/2018

Participating Start Date

7/1/2018

Participating Approval Date

5/4/2018

Last Recertification Date

9/6/2024

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

5520 College Blvd
Overland Park, KS 66211

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
KS	30003904070014	1154400232
MO	019813500	1154400232

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
PED173300-01	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy College Boulevard - Pulmonary Clinic	5520 College Blvd	Overland Park	KS	Active
PED173300-02	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy College Boulevard - Infectious Disease Clinic	5520 College Blvd	Overland Park	KS	Active
PED173300-03	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy Blue Valley - Urgent Care	6750 W. 135th St	Overland Park	KS	Active
PED173300-04	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy College Boulevard - Rheumatology Clinic	5520 College Blvd	Overland Park	KS	Active
PED173300-05	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy College Boulevard - Cardiology Clinic	5520 College Blvd	Overland Park	KS	Active
PED173300-06	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy Blue Valley - Ortho/Sports Medicine Clinic	6750 W. 135th St	Overland Park	KS	Active
PED173300-07	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy College Boulevard - Weight Management Clinic	5520 College Blvd	Overland Park	KS	Active
PED173300-08	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy College Boulevard - Scan Clinic	5520 College Blvd	Overland Park	KS	Active
PED173300-09	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy College Boulevard - Sleep Clinic	5520 College Blvd	Overland Park	KS	Active
PED173300-10	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy College Boulevard - Nutrition Clinic	5520 College Blvd	Overland Park	KS	Active
PED173300-11	Child	PED	The Children's Mercy Hospital Kansas	Children's Mercy College Boulevard - Endocrine Clinic	5520 College Blvd	Overland Park	KS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/8/2024 3:06 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		30003904070014	10/8/2024 3:06 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	10/8/2024 3:06 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1154400232	10/8/2024 3:06 PM
Medicaid Billing	NPI: State	Insert	Change Request		MO	10/8/2024 3:06 PM
Details	Last Recertification Date	Update	Recertification	9/7/2023 2:41:34 PM	9/6/2024 3:11:18 PM	9/6/2024 3:11 PM
Details	Last Recertification Date	Update	Recertification	9/18/2022 10:12:24 PM	9/7/2023 2:41:34 PM	9/7/2023 2:41 PM
Details	Last Recertification Date	Update	Recertification	9/8/2021 12:44:27 PM	9/18/2022 10:12:24 PM	9/18/2022 10:12 PM
Contacts	Primary Contact	Update	Recertification	O'Neal, Brian Senior VP of Allied Health Children's Mercy Hospital 8163028059	Bledsoe, Sarah Senior Director of Pharmacy Children's Mercy Hospital 8169836388	9/8/2021 12:44 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 11:09:01 AM	9/8/2021 12:44:27 PM	9/8/2021 12:44 PM
Contacts	Authorizing Official	Update	Change Request	Coombs, Jodi Executive Vice President and Chief Operating Officer Children's Mercy Hospital 8162343623	O'Neal, Brian Senior VP of Allied Health Children's Mercy Hospital 8163028059	8/16/2021 12:01 PM
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	Hunt, Cheri Senior Vice President for Patient Care Services Chief Nursing Officer Children's Mercy Hospitals and Clinics 8162343728	Coombs, Jodi Executive Vice President and Chief Operating Officer Children's Mercy Hospital 8162343623	12/2/2020 10:27 AM
Medicaid Billing	NPI: State	Update	Recertification		KS	9/9/2020 11:09 AM
Details	Last Recertification Date	Update	Recertification	9/6/2019 8:38:33 AM	9/9/2020 11:09:01 AM	9/9/2020 11:09 AM
Details	Last Recertification Date	Update	Recertification	9/3/2018 9:14:06 AM	9/6/2019 8:38:33 AM	9/6/2019 8:38 AM
Details	Last Recertification Date	Update	Recertification		9/3/2018 9:14:06 AM	9/3/2018 9:14 AM
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	8/8/2018 4:04 PM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Cox, Karen Executive Vice President/ COO Children's Mercy Hospital 8162343633	5/4/2018 1:10 PM
Details	340B ID	Update	New Registration		PED173300-01	5/4/2018 1:10 PM
Details	Entity Subname	Update	New Registration	Children's Mercy College Boulevard	Children's Mercy College Boulevard - Pulmonary Clinic	5/4/2018 1:10 PM
Dates	Participating Approval Date	Update	New Registration		5/4/2018 1:10:12 PM	5/4/2018 1:10 PM
Details	State	Update	New Registration	Pending	Approved	5/4/2018 1:10 PM
Dates	Signed By Date	Update	New Registration		4/12/2018 5:41:14 PM	5/4/2018 1:10 PM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	5/4/2018 1:10 PM
Addresses	Main Address	Insert	New Registration		5520 College Blvd Overland Park, KS 66211	4/12/2018 5:41 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2018 5:41 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		019813500	4/12/2018 5:41 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MO	4/12/2018 5:41 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1154400232	4/12/2018 5:41 PM
Contacts	Authorizing Official	Insert	New Registration		Cox, Karen Executive Vice President/ COO Children's Mercy Hospital 8162343633	4/12/2018 5:41 PM
Contacts	Primary Contact	Insert	New Registration		O'Neal, Brian Director of Pharmacy Children's Mercy Hospital 8162343545	4/12/2018 5:41 PM
Details	Last Recertification Date	Insert	New Registration			4/12/2018 5:41 PM
Details	Grant Number	Insert	New Registration			4/12/2018 5:41 PM
Details	340B ID	Insert	New Registration			4/12/2018 5:41 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/12/2018 5:41 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/12/2018 5:41 PM
Details	Medicare Provider Number	Insert	New Registration		173300	4/12/2018 5:41 PM
Details	Entity Name	Insert	New Registration		The Children's Mercy Hospital Kansas	4/12/2018 5:41 PM
Details	Program Code	Insert	New Registration		PED	4/12/2018 5:41 PM
Details	Entity Subname	Insert	New Registration		Children's Mercy College Boulevard	4/12/2018 5:41 PM
Dates	Participating Approval Date	Insert	New Registration			4/12/2018 5:41 PM
Details	State	Insert	New Registration		Pending	4/12/2018 5:41 PM
Dates	Registration Date	Insert	New Registration		4/12/2018 5:41:11 PM	4/12/2018 5:41 PM
Dates	Signed By Date	Insert	New Registration			4/12/2018 5:41 PM
Dates	Start Date	Insert	New Registration			4/12/2018 5:41 PM
Terminations	Termination Comments	Insert	New Registration			4/12/2018 5:41 PM
Terminations	Termination Date	Insert	New Registration			4/12/2018 5:41 PM
Terminations	Termination Effective Date	Insert	New Registration			4/12/2018 5:41 PM
Terminations	Termination Reason	Insert	New Registration			4/12/2018 5:41 PM