Covered Entity Details

PED503300-29 SEATTLE CHILDREN'S HOSPITAL (Active) - information as of 5/6/2025 12:04:06 AM

Main Details

Name

SEATTLE CHILDREN'S HOSPITAL

Subdivision Name

North Urgent Care

Type

Children's Hospital

Rural

340B ID

PED503300-29

Medicare Provider Number

503300

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/15/2019

Participating Start Date

7/1/2019

Participating Approval Date

5/1/2019

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

Seattle Children's Hospital
Warren E Hewitt, VP, Finance and Chief Accounting Officer
(206) 884-2378

Primary Contact

Seattle Children's Hospital
Alisa Hawkins, 340B Program Analyst
(206) 898-5768

Addresses

Street Address

1815 13TH ST
EVERETT, WA 98201-1679

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
WA	1011158,1043435,2008921	1245342153,1326361395,1467536276,1245383348
AK	HS70OP	1245342153,1326361395
MT	0226508,0558722	1245342153,1326361395

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
PED503300-01	Child	PED	SEATTLE CHILDREN'S HOSPITAL	FEDERAL WAY CLINIC	34503 9TH AVENUE S.	FEDERAL WAY	WA	Terminated
PED503300-02	Child	PED	SEATTLE CHILDREN'S HOSPITAL	OLYMPIA CLINIC	615 LILLY ROAD NE	OLYMPIA	WA	Active
PED503300-03	Child	PED	SEATTLE CHILDREN'S HOSPITAL	BELLEVUE CLINIC	1500 116th Ave NE	BELLEVUE	WA	Active
PED503300-04	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Seattle Children's South Sound Cardiology Clinic- at Cedar	1901 S CEDAR ST STE 103	TACOMA	WA	Active
PED503300-05	Child	PED	SEATTLE CHILDREN'S HOSPITAL	EVERETT CLINIC	900 PACIFIC AVENUE	EVERETT	WA	Terminated
PED503300-06	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Autism Center	6901 Sand Point Way NE	Seattle	WA	Active
PED503300-07	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Mill Creek Urgent Care	12800 Bothell-Everett Highway, Suite 150	Everett	WA	Terminated
PED503300-08	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Orthotics & Prosthetics at Sand Point Way	4575 Sand Point Way NE, Suite 106	Seattle	WA	Terminated
PED503300-09	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Prenatal Diagnosis and Treatment	Springbrook Professional Center, Building #1	Seattle	WA	Terminated
PED503300-10	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Bellevue Surgery Center	1500 116th Ave NE	Bellevue	WA	Active
PED503300-11	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Bellevue Radiology	1500 116th Ave NE	Bellevue	WA	Active
PED503300-12	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Bellevue Audiology	1500 116th Ave NE	Bellevue	WA	Terminated
PED503300-13	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Bellevue Infusion	1500 116th Ave NE	Bellevue	WA	Active
PED503300-14	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Bellevue Sports Therapy	1500 116th Ave NE	Bellevue	WA	Terminated
PED503300-15	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Bellevue Urgent Care	1500 116th Ave NE	Bellevue	WA	Active
PED503300-16	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Bellevue Sleep Clinic	1231 116th AVE NE	Bellevue	WA	Active
PED503300-17	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Federal Way Radiology	34503 9th Avenue S, Suite 300	Federal Way	WA	Terminated
PED503300-18	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Federal Way Rehab Services	34503 9th Avenue S, Suite 300	Federal Way	WA	Terminated
PED503300-19	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Mill Creek Clinic	12800 Bothell-Everett Highway, Suite 150	Everett	WA	Terminated
PED503300-20	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Mill Creek Sports Therapy	12800 Bothell-Everett Highway, Suite 150	Everett	WA	Terminated
PED503300-21	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Adolescent Clinic	Springbrook Professional Center	Seattle	WA	Active
PED503300-22	Child	PED	SEATTLE CHILDRENS HOSPITAL	KITSAP CHILDRENS CLINIC / Seattle Children's South Sound Cardiology Clinic- at Kitsap	9951 MICKELBERRY RD STE 101	SILVERDALE	WA	Terminated
PED503300-23	Child	PED	SEATTLE CHILDRENS HOSPITAL	SILVERDALE PEDIATRICS / Seattle Children's South Sound Cardiology Clinic- at Silverdale	9910 LEVIN RD NW STE 200	SILVERDALE	WA	Terminated
PED503300-24	Child	PED	SEATTLE CHILDRENS HOSPITAL	THE DOCTORS CLINIC PEDIATRICS / Seattle Children's South Sound Cardiology Clinic- at the Doctors	1780 NW MYHRE RD STE 2120	SILVERDALE	WA	Terminated
PED503300-25	Child	PED	SEATTLE CHILDREN'S HOSPITAL	South Clinic	34920 ENCHANTED PKWY S	FEDERAL WAY	WA	Active
PED503300-26	Child	PED	SEATTLE CHILDREN'S HOSPITAL	South Urgent Care	34920 ENCHANTED PKWY S	FEDERAL WAY	WA	Active
PED503300-27	Child	PED	SEATTLE CHILDREN'S HOSPITAL	South Rehab Services	34920 ENCHANTED PKWY S	FEDERAL WAY	WA	Active
PED503300-28	Child	PED	SEATTLE CHILDREN'S HOSPITAL	North Clinic	1815 13TH ST	EVERETT	WA	Active
PED503300-29	Child	PED	SEATTLE CHILDREN'S HOSPITAL	North Urgent Care	1815 13TH ST	EVERETT	WA	Active
PED503300-30	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Sand Point Clinic - Endocrinology	4575 Sand Point Way NE	Seattle	WA	Active
PED503300-31	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Magnuson Clinic- Psychology	6901 SAND POINT WAY NE	SEATTLE	WA	Active
PED503300-32	Child	PED	SEATTLE CHILDREN'S HOSPITAL	CHILDRENS HOSPITAL & REGIONAL MEDIC - Magnuson - Psychiatry Partial Hospitalization Program	6901 SAND POINT WAY NE	SEATTLE	WA	Active
PED503300-33	Child	PED	SEATTLE CHILDREN'S HOSPITAL	Psychiatric Urgent Care Clinic - Psychiatric Urgent Care Clinic	6901 SAND POINT WAY NE	Seattle	WA	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Change Request		1245383348	3/10/2025 4:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		WA	3/10/2025 4:39 PM
Details	Last Recertification Date	Update	Recertification	8/14/2023 2:45:04 PM	8/26/2024 4:34:25 PM	8/26/2024 4:34 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 4:31:00 PM	8/14/2023 2:45:04 PM	8/14/2023 2:45 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	2207424 (WA)		6/1/2023 12:12 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1620559 (MT)		6/1/2023 12:12 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1735991 (AK)		6/1/2023 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760159651 (WA)		6/1/2023 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760159651 (MT)		6/1/2023 12:12 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1760159651 (AK)		6/1/2023 12:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/20/2023 12:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1735991	2/20/2023 12:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AK	2/20/2023 12:54 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1760159651	2/20/2023 12:54 PM
Medicaid Billing	NPI: State	Insert	Change Request		AK	2/20/2023 12:54 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	200008635 (MT)		1/26/2023 1:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/26/2023 1:04 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1620559	1/26/2023 1:04 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MT	1/26/2023 1:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/7/2022 5:16 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		200008635	12/7/2022 5:16 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MT	12/7/2022 5:16 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1760159651	12/7/2022 5:16 PM
Medicaid Billing	NPI: State	Insert	Change Request		MT	12/7/2022 5:16 PM
Details	Last Recertification Date	Update	Recertification	8/31/2021 4:22:39 PM	9/8/2022 4:31:00 PM	9/8/2022 4:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/1/2022 3:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2207424	6/1/2022 3:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	6/1/2022 3:35 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1760159651	6/1/2022 3:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		WA	6/1/2022 3:35 PM
Contacts	Primary Contact	Update	Profile Change Request	Hawkins, Alisa Pharmacy 340B Program Specialist Seattle Children's Hospital 2068985768	Hawkins, Alisa 340B Program Analyst Seattle Children's Hospital 2068985768	5/31/2022 4:02 PM
Details	Last Recertification Date	Update	Recertification	8/28/2020 2:40:30 PM	8/31/2021 4:22:39 PM	8/31/2021 4:22 PM
Contacts	Authorizing Official	Update	Profile Change Request	Hewitt, Warren E VP, Finance and Chief Accounting Officer Seattle Children's Hospital 2069874846	Hewitt, Warren E VP, Finance and Chief Accounting Officer Seattle Children's Hospital 2068842378	7/30/2021 4:44 PM
Contacts	Signed By	Update	Profile Change Request	Hewitt, Warren E VP, Finance and Chief Accounting Officer Seattle Children's Hospital 2069874846	Hewitt, Warren E VP, Finance and Chief Accounting Officer Seattle Children's Hospital 2068842378	7/30/2021 4:44 PM
Contacts	Primary Contact	Update	Profile Change Request	Hawkins, Alisa Pharmacy 340B Program Specialist Seattle Children's Hospital 2069870164	Hawkins, Alisa Pharmacy 340B Program Specialist Seattle Children's Hospital 2068985768	7/30/2021 1:29 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1245342153 (ID)		2/4/2021 12:51 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1326361395 (ID)		2/4/2021 12:51 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1245342153 (ID)		2/4/2021 12:51 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1326361395 (ID)		2/4/2021 12:51 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1467536276 ( )		8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1245342153 ( )		8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326361395 ( )		8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1245342153	8/28/2020 2:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326361395	8/28/2020 2:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		MT	8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1245342153	8/28/2020 2:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326361395	8/28/2020 2:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1467536276	8/28/2020 2:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1245342153	8/28/2020 2:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326361395	8/28/2020 2:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1245342153	8/28/2020 2:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	8/28/2020 2:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326361395	8/28/2020 2:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	8/28/2020 2:40 PM
Details	Last Recertification Date	Update	Recertification	9/9/2019 1:25:07 PM	8/28/2020 2:40:30 PM	8/28/2020 2:40 PM
Contacts	Primary Contact	Update	Change Request	KINZIG, JERRY DIRECTOR OF REIMBURSEMENT Seattle Children's Hospital 2069874852	Hawkins, Alisa Pharmacy 340B Program Specialist Seattle Children's Hospital 2069870164	6/8/2020 7:57 AM
Details	Last Recertification Date	Update	Recertification		9/9/2019 1:25:07 PM	9/9/2019 1:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/6/2019 2:16 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1326361395	8/6/2019 2:16 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ID	8/6/2019 2:16 PM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Details	Entity Subname	Update	Change Request	CHILDRENS HOSPITAL & REGIONAL MEDIC - North Clinic Urgent Care	North Urgent Care	5/30/2019 1:34 PM
Contacts	Signed By	Insert	New Registration		Hewitt, Warren E VP, Finance and Chief Accounting Officer Seattle Children's Hospital 2069874846	5/1/2019 2:29 PM
Details	340B ID	Update	New Registration		PED503300-29	5/1/2019 2:29 PM
Details	Entity Name	Update	New Registration	SEATTLE CHILDRENS HOSPITAL	SEATTLE CHILDREN'S HOSPITAL	5/1/2019 2:29 PM
Details	Entity Subname	Update	New Registration	CHILDRENS HOSPITAL & REGIONAL MEDIC	CHILDRENS HOSPITAL & REGIONAL MEDIC - North Clinic Urgent Care	5/1/2019 2:29 PM
Dates	Participating Approval Date	Update	New Registration		5/1/2019 2:29:54 PM	5/1/2019 2:29 PM
Details	State	Update	New Registration	Pending	Approved	5/1/2019 2:29 PM
Dates	Signed By Date	Update	New Registration		4/15/2019 9:44:16 PM	5/1/2019 2:29 PM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	5/1/2019 2:29 PM
Addresses	Main Address	Insert	New Registration		1815 13TH ST EVERETT, WA 98201-1679	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1011158	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WA	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1043435	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WA	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		2008921	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WA	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HS70OP	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AK	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1245342153	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		ID	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0226508	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MT	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0558722	4/15/2019 6:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MT	4/15/2019 6:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467536276	4/15/2019 6:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1245342153	4/15/2019 6:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326361395	4/15/2019 6:14 PM
Contacts	Primary Contact	Insert	New Registration		KINZIG, JERRY DIRECTOR OF REIMBURSEMENT Seattle Children's Hospital 2069874852	4/15/2019 6:14 PM
Contacts	Authorizing Official	Insert	New Registration		Hewitt, Warren E VP, Finance and Chief Accounting Officer Seattle Children's Hospital 2069874846	4/15/2019 6:14 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2019 6:14 PM
Details	Grant Number	Insert	New Registration			4/15/2019 6:14 PM
Details	340B ID	Insert	New Registration			4/15/2019 6:14 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2019 6:14 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2019 6:14 PM
Details	Medicare Provider Number	Insert	New Registration		503300	4/15/2019 6:14 PM
Details	Entity Name	Insert	New Registration		SEATTLE CHILDRENS HOSPITAL	4/15/2019 6:14 PM
Details	Program Code	Insert	New Registration		PED	4/15/2019 6:14 PM
Details	Entity Subname	Insert	New Registration		CHILDRENS HOSPITAL & REGIONAL MEDIC	4/15/2019 6:14 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2019 6:14 PM
Details	State	Insert	New Registration		Pending	4/15/2019 6:14 PM
Dates	Registration Date	Insert	New Registration		4/15/2019 6:14:09 PM	4/15/2019 6:14 PM
Dates	Signed By Date	Insert	New Registration			4/15/2019 6:14 PM
Dates	Start Date	Insert	New Registration			4/15/2019 6:14 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2019 6:14 PM
Terminations	Termination Date	Insert	New Registration			4/15/2019 6:14 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2019 6:14 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2019 6:14 PM