Covered Entity Details

HM1595 Ann and Robert H. Lurie Children's Hospital of Chicago (Active) - information as of 5/16/2025 11:27:03 PM

Main Details

Name

Ann and Robert H. Lurie Children's Hospital of Chicago

Subdivision Name

Type

Comprehensive Hemophilia Treatment Center

340B ID

HM1595

Grant Number

H30MC24052

Additional Details

Current Program Status

Active

Registration Date

7/1/2000

Participating Start Date

7/1/2000

Participating Approval Date

1/14/2010

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Ann & Robert H Lurie Children's Hospital of Chicago
Jenny Elhadary, VP Clinical Services
(312) 227-4161

Primary Contact

Ann & Robert H. Lurie Children's Hospital of Chicago
Matthew Ludwig, Division Administrator
(312) 227-4848

Addresses

Street Address

225 E Chicago Ave
CHICAGO, IL 60611

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	650 W GRAND AVE STE 102		ELMHURST	IL	60126-1024	02/25/2013	02/25/2013		03/28/2013
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/12/2017	01/01/2018		10/12/2017
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/07/2022	10/01/2022		10/01/2022
Contract Detail	ACCREDO HEALTH GROUP, INC.	11411 STRANG LINE RD	STE A	LENEXA	KS	66215	10/12/2017	01/01/2018		10/12/2017
Contract Detail	BIOPARTNERS IN CARE INC	11411 STRANG LINE RD		LENEXA	KS	66215-4047	04/01/2001	04/01/2001	12/31/2017	12/31/2017
Contract Detail	OPTION CARE ENTERPRISES, INC.	OPTION CARE	1410 HERIFORD ROAD	COLUMBIA	MO	65202-1907	04/05/2018	07/01/2018		04/05/2018
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	04/05/2018	07/01/2018		04/05/2018
Contract Detail	OPTION CARE ENTERPRISES, INC.	DBA OPTION CARE	870 N ARLINGTON HEIGHTS RD STE 102	ITASCA	IL	60143-1411	04/05/2018	07/01/2018		04/05/2018
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	4000 CHEMICAL RD STE 100		PLYMOUTH MEETING	PA	19462	07/17/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	07/17/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 550, LLC	1819 ASTON AVE STE 104		CARLSBAD	CA	92008	07/17/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 550, LLC	7167 E. KEMPER RD.		CINCINNATI	OH	45249	07/17/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 553, LLC	6531 MERIDIEN DR	SUITE 113	RALEIGH	NC	27616	07/17/2023	10/01/2023		10/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 11:02:53 AM	2/11/2025 4:11:27 PM	2/11/2025 4:11 PM
Details	Last Recertification Date	Update	Recertification	2/1/2023 11:04:28 AM	1/30/2024 11:02:53 AM	1/30/2024 11:02 AM
Details	Last Recertification Date	Update	Recertification	2/1/2022 3:42:38 PM	2/1/2023 11:04:28 AM	2/1/2023 11:04 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 3:14:17 PM	2/1/2022 3:42:38 PM	2/1/2022 3:42 PM
Contacts	Primary Contact	Update	Change Request	Jablonski, Meghan Senior Director, Pediatrics Administration Ann & Robert H. Lurie Children's Hospital of Chicago 3122274631	Ludwig, Matthew Division Administrator Ann & Robert H. Lurie Children's Hospital of Chicago 3122274848	1/25/2022 12:53 PM
Contacts	Primary Contact	Update	Change Request	Fox, Anna Kathleen Division Administrator Ann and Robert H. Lurie Children's Hospital of Chicago 3122274848	Jablonski, Meghan Senior Director, Pediatrics Administration Ann & Robert H. Lurie Children's Hospital of Chicago 3122274631	11/18/2021 11:45 AM
Details	Last Recertification Date	Update	Recertification	1/27/2020 9:35:27 AM	2/4/2021 3:14:17 PM	2/4/2021 3:14 PM
Contacts	Primary Contact	Update	Change Request	Underhil, Nicole SCT Quality & Safety Manager Ann & Robert H Lurie Chilren's Hospital of Chicago 3122274849	Fox, Anna Kathleen Division Administrator Ann and Robert H. Lurie Children's Hospital of Chicago 3122274848	7/29/2020 7:26 AM
Details	Last Recertification Date	Update	Recertification	1/30/2019 12:09:21 PM	1/27/2020 9:35:27 AM	1/27/2020 9:35 AM
Contacts	Primary Contact	Update	Change Request	Mixon, Leigh Anne Division Administrator Ann & Robert H Lurie Chilren's Hospital of Chicago 3122274848	Underhil, Nicole SCT Quality & Safety Manager Ann & Robert H Lurie Chilren's Hospital of Chicago 3122274849	12/20/2019 10:24 AM
Details	Last Recertification Date	Update	Recertification	2/20/2018 3:04:01 PM	1/30/2019 12:09:21 PM	1/30/2019 12:09 PM
Details	Grant Number	Update	Change Request	H30MC00032	H30MC24052	5/18/2018 3:23 PM
Details	Last Recertification Date	Update	Recertification	1/27/2017 12:00:00 AM	2/20/2018 3:04:01 PM	2/20/2018 3:04 PM
Contacts	Primary Contact	Update	Change Request	Mixon, Leigh Ann Division Administrator Ann & Robert H Lurie Chilren's Hospital of Chicago 3122274848	Mixon, Leigh Anne Division Administrator Ann & Robert H Lurie Chilren's Hospital of Chicago 3122274848	1/18/2018 3:41 PM
Contacts	Primary Contact	Update	Change Request	Patel, Lina Administrative Director, HemOncSCT 3122274848	Mixon, Leigh Ann Division Administrator Ann & Robert H Lurie Chilren's Hospital of Chicago 3122274848	1/17/2018 11:58 AM
Contacts	Authorizing Official	Update		Elhadary, Jenny VP Clinical Services 3122274161	Elhadary, Jenny VP Clinical Services Ann & Robert H Lurie Children's Hospital of Chicago 3122274161	10/9/2017 4:56 PM
Addresses	Main Address	Insert			225 E Chicago Ave CHICAGO, IL 60611	1/27/2017 12:30 PM
Contacts	Primary Contact	Update		SMITH-FIELDS, CASSANDRA ADMINISTRATOR 7738804092	Patel, Lina Administrative Director, HemOncSCT 3122274848	1/27/2017 12:30 PM
Contacts	Authorizing Official	Update		Heenan, Monica Chief, Ambulatory Executive 3122274303	Elhadary, Jenny VP Clinical Services 3122274161	1/27/2017 12:30 PM
Details	Last Recertification Date	Update		3/8/2016 12:00:00 AM	1/27/2017 12:00:00 AM	1/27/2017 12:30 PM
Details	Last Recertification Date	Update		2/9/2015 12:00:00 AM	3/8/2016 12:00:00 AM	3/8/2016 10:15 AM
Contacts	Authorizing Official	Insert			Heenan, Monica Chief, Ambulatory Executive 3122274303	2/9/2015 9:16 AM
Details	Last Recertification Date	Update		3/6/2014 12:00:00 AM	2/9/2015 12:00:00 AM	2/9/2015 9:16 AM
Details	Entity Name	Update		Ann and Robert H. Lurie Children’s Hospital of Chicago	Ann and Robert H. Lurie Children's Hospital of Chicago	11/14/2014 2:13 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/6/2014 12:00:00 AM	3/6/2014 3:06 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/19/2013 11:28 AM
Details	Grant Number	Update			H30MC00032	7/13/2012 12:45 PM
Details	Entity Name	Update		CHILDREN'S MEMORIAL HOSPITAL	Ann and Robert H. Lurie Children’s Hospital of Chicago	7/13/2012 12:45 PM
Contacts	Primary Contact	Insert			SMITH-FIELDS, CASSANDRA ADMINISTRATOR 7738804092	1/14/2010 2:35 PM
Details	Grant Number	Update		H30MC00032		1/14/2010 2:35 PM
Details	Last Recertification Date	Insert				7/1/2000 12:00 AM
Details	Grant Number	Insert			H30MC00032	7/1/2000 12:00 AM
Details	340B ID	Insert			HM1595	7/1/2000 12:00 AM
Details	Is Authorizing Official EHB Data	Insert				7/1/2000 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/1/2000 12:00 AM
Details	Medicare Provider Number	Insert				7/1/2000 12:00 AM
Details	Entity Name	Insert			CHILDREN'S MEMORIAL HOSPITAL	7/1/2000 12:00 AM
Details	Program Code	Insert			HM	7/1/2000 12:00 AM
Details	Entity Subname	Insert				7/1/2000 12:00 AM
Dates	Participating Approval Date	Insert			1/14/2010 12:00:00 AM	7/1/2000 12:00 AM
Details	State	Insert			Active	7/1/2000 12:00 AM
Dates	Registration Date	Insert			7/1/2000 12:00:00 AM	7/1/2000 12:00 AM
Dates	Signed By Date	Insert				7/1/2000 12:00 AM
Dates	Start Date	Insert			7/1/2000 12:00:00 AM	7/1/2000 12:00 AM
Terminations	Termination Comments	Insert				7/1/2000 12:00 AM
Terminations	Termination Date	Insert				7/1/2000 12:00 AM
Terminations	Termination Effective Date	Insert				7/1/2000 12:00 AM
Terminations	Termination Reason	Insert				7/1/2000 12:00 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History