Covered Entity Details

PED263301-09 St. Louis Children's (Active) - information as of 5/20/2025 11:44:17 PM

Main Details

Name

St. Louis Children's

Subdivision Name

St. Louis Children's Specialty Care Center - South County - Hem-Onc Clinic CSCC SoCo

Type

Children's Hospital

Rural

340B ID

PED263301-09

Medicare Provider Number

263301

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/11/2022

Participating Start Date

10/1/2022

Participating Approval Date

8/2/2022

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

St. Louis Children's Hospital
Michele McKee, VP Finance
(314) 454-6044

Primary Contact

St. Louis Children's Hospital
Melissa Heigham, Director of Pharmacy
(314) 454-2361

Addresses

Street Address

5114 Mid America Plaza
St. Louis, MO 63129

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
IL	430654870-401	1124135744,1356362586,1992727663
MO	600930903,10930907	1124135744,1356362586,1992727663

Shipping Addresses

Shipping Address 1

Children's Hospital Specialty Care Center South County
5114 Mid America Plaza
1B
St. Louis, MO 63129

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
PED263301-01	Child	PED	St. Louis Children's	Hematology-Oncology Clinic / Ambulatory Surgery	13001 North Outer Forty Road	Town and Country	MO	Active
PED263301-02	Child	PED	St. Louis Children's	CHILDREN'S SPECIALTY CARE CENTER - Surgery 2	13001 North Outer Forty Road	Town and Country	MO	Active
PED263301-03	Child	PED	St. Louis Children's	CHILDREN'S SPECIALTY CARE CENTER - Surgery-Ambulatory Ctr	13001 North Outer Forty Road	Town and Country	MO	Active
PED263301-04	Child	PED	St. Louis Children's	CHILDREN'S SPECIALTY CARE CENTER - Anesthesiology Dept 2	13001 North Outer Forty Road	Town and Country	MO	Active
PED263301-05	Child	PED	St. Louis Children's	CHILDREN'S SPECIALTY CARE CENTER - MRI 2	13001 North Outer Forty Road	Town and Country	MO	Active
PED263301-06	Child	PED	St. Louis Children's	CHILDREN'S SPECIALTY CARE CENTER - Hematology-Oncology Clinic 2	13001 North Outer Forty Road	Town and Country	MO	Active
PED263301-07	Child	PED	St. Louis Children's	CHILDREN'S SPECIALTY CARE CENTER - Radiology 2	13001 North Outer Forty Road	Town and Country	MO	Active
PED263301-08	Child	PED	St. Louis Children's	St. Louis Children's Specialty Care Center - South County - Surgery-CSCC SoCo	5114 Mid America Plaza	St. Louis	MO	Active
PED263301-09	Child	PED	St. Louis Children's	St. Louis Children's Specialty Care Center - South County - Hem-Onc Clinic CSCC SoCo	5114 Mid America Plaza	St. Louis	MO	Active
PED263301-10	Child	PED	St. Louis Children's	St. Louis Children's Specialty Care Center - South County - Surgery-Amb Ctr CSCC SoCo	5114 Mid America Plaza	St. Louis	MO	Active
PED263301-11	Child	PED	St. Louis Children's	St. Louis Children's Specialty Care Center - South County - Anesthesiology Dept-CSCC SoCo	5114 Mid America Plaza	St. Louis	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/28/2023 11:11:32 AM	8/21/2024 3:12:41 PM	8/21/2024 3:12 PM
Details	Last Recertification Date	Update	Recertification		8/28/2023 11:11:32 AM	8/28/2023 11:11 AM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		McKee, Michele VP Finance St. Louis Children's Hospital 3144546044	8/2/2022 9:06 AM
Details	340B ID	Update	New Registration		PED263301-09	8/2/2022 9:06 AM
Details	Entity Name	Update	New Registration	ST. LOUIS CHILDRENS HOSPITAL	St. Louis Children's	8/2/2022 9:06 AM
Details	Entity Subname	Update	New Registration	St. Louis Children's Specialty Care Center - South County	St. Louis Children's Specialty Care Center - South County - Hem-Onc Clinic CSCC SoCo	8/2/2022 9:06 AM
Dates	Participating Approval Date	Update	New Registration		8/2/2022 9:06:11 AM	8/2/2022 9:06 AM
Details	State	Update	New Registration	Pending	Approved	8/2/2022 9:06 AM
Dates	Signed By Date	Update	New Registration		7/13/2022 1:55:17 PM	8/2/2022 9:06 AM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	8/2/2022 9:06 AM
Addresses	Main Address	Insert	New Registration		5114 Mid America Plaza St. Louis, MO 63129	7/11/2022 11:51 AM
Addresses	Shipping Address	Insert	New Registration		Children's Hospital Specialty Care Center South County 5114 Mid America Plaza 1B St. Louis, MO 63129	7/11/2022 11:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/11/2022 11:51 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		430654870-401	7/11/2022 11:51 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	7/11/2022 11:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/11/2022 11:51 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		600930903	7/11/2022 11:51 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MO	7/11/2022 11:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/11/2022 11:51 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		10930907	7/11/2022 11:51 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MO	7/11/2022 11:51 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1124135744	7/11/2022 11:51 AM
Medicaid Billing	NPI: State	Insert	New Registration		IL	7/11/2022 11:51 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1356362586	7/11/2022 11:51 AM
Medicaid Billing	NPI: State	Insert	New Registration		IL	7/11/2022 11:51 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1992727663	7/11/2022 11:51 AM
Medicaid Billing	NPI: State	Insert	New Registration		IL	7/11/2022 11:51 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1124135744	7/11/2022 11:51 AM
Medicaid Billing	NPI: State	Insert	New Registration		MO	7/11/2022 11:51 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1356362586	7/11/2022 11:51 AM
Medicaid Billing	NPI: State	Insert	New Registration		MO	7/11/2022 11:51 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1992727663	7/11/2022 11:51 AM
Medicaid Billing	NPI: State	Insert	New Registration		MO	7/11/2022 11:51 AM
Contacts	Primary Contact	Insert	New Registration		Heigham, Melissa Director of Pharmacy St. Louis Children's Hospital 3144542361	7/11/2022 11:51 AM
Contacts	Authorizing Official	Insert	New Registration		McKee, Michele VP Finance St. Louis Children's Hospital 3144546044	7/11/2022 11:51 AM
Details	Assistance Received From Date	Insert	New Registration			7/11/2022 11:51 AM
Details	Assistance Received To Date	Insert	New Registration			7/11/2022 11:51 AM
Details	Last Recertification Date	Insert	New Registration			7/11/2022 11:51 AM
Details	Grant Number	Insert	New Registration			7/11/2022 11:51 AM
Details	340B ID	Insert	New Registration			7/11/2022 11:51 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/11/2022 11:51 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/11/2022 11:51 AM
Details	Medicare Provider Number	Insert	New Registration		263301	7/11/2022 11:51 AM
Details	Entity Name	Insert	New Registration		ST. LOUIS CHILDRENS HOSPITAL	7/11/2022 11:51 AM
Details	NOFO Number	Insert	New Registration			7/11/2022 11:51 AM
Details	Program Code	Insert	New Registration		PED	7/11/2022 11:51 AM
Details	Entity Subname	Insert	New Registration		St. Louis Children's Specialty Care Center - South County	7/11/2022 11:51 AM
Dates	Participating Approval Date	Insert	New Registration			7/11/2022 11:51 AM
Details	State	Insert	New Registration		Pending	7/11/2022 11:51 AM
Dates	Registration Date	Insert	New Registration		7/11/2022 11:51:38 AM	7/11/2022 11:51 AM
Dates	Signed By Date	Insert	New Registration			7/11/2022 11:51 AM
Dates	Start Date	Insert	New Registration			7/11/2022 11:51 AM
Terminations	Termination Comments	Insert	New Registration			7/11/2022 11:51 AM
Terminations	Termination Date	Insert	New Registration			7/11/2022 11:51 AM
Terminations	Termination Effective Date	Insert	New Registration			7/11/2022 11:51 AM
Terminations	Termination Reason	Insert	New Registration			7/11/2022 11:51 AM