Covered Entity Details

HV07849A WASHINGTON UNIVERSITY IN ST. LOUIS (Active) - information as of 4/30/2025 10:51:32 PM

Main Details

Name

WASHINGTON UNIVERSITY IN ST. LOUIS

Subdivision Name

Washington University Infectious Diseases Clinic North County

Type

Ryan White Part C

340B ID

HV07849A

Grant Number

H76HA07849

Additional Details

Current Program Status

Active

Registration Date

10/14/2022

Participating Start Date

1/1/2023

Participating Approval Date

10/24/2022

Last Recertification Date

2/20/2025

Time Period the Assistance was Received

1/1/2025 - 12/31/2027

Contacts

Authorizing Official

Washington University School of Medicine
Tina M Markovich, Program Director
(314) 747-3071

Primary Contact

Washington University ID Clinic
Megan Clare Lengerman, Director of 340B Programs & Initiatives
(314) 362-7595

Addresses

Street Address

1 VILLAGE SQ SHOPPING CTR
SUITE 1
HAZELWOOD, MO 63042-1817

Billing Address

WASHINGTON UNIVERSITY IN ST. LOUIS
660 S EUCLID AVE
SAINT LOUIS, MO 63110-1010

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

Shipping Address 1

WASH U - VILLAGE SQUARE PHARMACY
1 VILLAGE SQUARE SHOPPING STE 1
RM 103
HAZELWOOD, MO 63042

Shipping Address 2

WASH U SCHOOL OF MEDICINE - INFECTIOUS DISEASES PHARMACY
620 S TAYLOR AVE
RM 202
SAINT LOUIS, MO 63110

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04832	6505 N. ILLINOIS	FAIRVIEW HEIGHTS	IL	62208	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04602	2510 STATE STREET	EAST ST LOUIS	IL	62205	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04865	515 CARLYLE AVE.	BELLEVILLE	IL	62221	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02490	401 BELTLINE	COLLINSVILLE	IL	62234	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04407	3732 NAMEOKI	GRANITE CITY	IL	62040	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04599	704 CAMBRIDGE BLVD.	OFALLON	IL	62269	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04024	5890 NORTH BELT WEST	BELLEVILLE	IL	62226	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03136	1201 CAMP JACKSON	CAHOKIA	IL	62206	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04337	172 E. MCARTHUR	BETHALTO	IL	62010	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/17/2023	04/01/2023		04/01/2023
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	01/17/2023	04/01/2023		04/01/2023
Contract Detail	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	01/17/2023	04/01/2023		04/01/2023
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	01/17/2023	04/01/2023		04/01/2023
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	01/17/2023	04/01/2023		04/01/2023
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/17/2023	04/01/2023		04/01/2023
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/17/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN CO	DBA: WALGREENS #10588	1400 N GRAND BLVD	SAINT LOUIS	MO	63106-1909	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS #12395	6607 STATE ROUTE 162	MARYVILLE	IL	62062	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 11744	1302 CLARKSON CLAYTON CENTER	ELLISVILLE	MO	63011	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05894	6733 CLAYTON RD	CLAYTON	MO	63117	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02971	2 GRANDVIEW PLZ SHP CTR STE A	FLORISSANT	MO	63033	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10082	10941 OLIVE BLVD	CREVE COEUR	MO	63141	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02994	9285 HALLS FERRY RD	JENNINGS	MO	63136	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11711	1530 LAFAYETTE AVE.	SAINT LOUIS	MO	63104	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16552	628 N NEW BALLAS RD STE A	CREVE COEUR	MO	63141	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01633	7398 N LINDBERGH BLVD	HAZELWOOD	MO	63042	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 00854	5764 S LINDBERGH BLVD	ST LOUIS	MO	63123	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07680	8571 WATSON ROAD	WEBSTER GROVES	MO	63119-5218	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04834	1225 UNION BLVD	ST LOUIS	MO	63113	10/24/2022	01/01/2023	03/28/2023	04/19/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02741	12400 OLD HALLS FERRY	BLACK JACK	MO	63033	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03686	4140 S. BROADWAY	ST LOUIS	MO	63118	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03714	2610 STATE ST	ALTON	IL	62002-5150	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10205	640 EDWARDSVILLE RD	TROY	IL	62294	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04671	7501 OLIVE BLVD	UNIVERSITY CITY	MO	63130	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06432	2401 S BRENTWOOD BLVD	BRENTWOOD	MO	63144	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02227	250 E. 4TH STREET	EUREKA	MO	63025	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04090	2920 HIGHWAY K	O FALLON	MO	63368	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03652	1001 BOWLES AVENUE	FENTON	MO	63026	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09714	9978 KENNERLY ROAD	ST LOUIS	MO	63128-2704	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15941	10500 SAINT CHARLES ROCK ROAD	SAINT ANN	MO	63074	10/24/2022	01/01/2023	07/01/2024	07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06472	4218 LINDELL BLVD	ST LOUIS	MO	63108-2916	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #12927	2340 HAMPTON AVE	ST LOUIS	MO	63139	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06755	3920 HAMPTON AVE	ST LOUIS	MO	63109-1401	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07296	3720 N KINGSHIGHWAY BLVD	ST LOUIS	MO	63115-1701	10/24/2022	01/01/2023	03/27/2025	03/27/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09771	9801 MANCHESTER RD	SAINT LOUIS	MO	63119-1227	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #16326	2315 S KINGSHIGHWAY BLVD	SAINT LOUIS	MO	63110	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06023	190 N FLORISSANT RD	FERGUSON	MO	63135	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21346	3527 CHOUTEAU AVE	SAINT LOUIS	MO	63103	10/24/2022	01/01/2023		01/01/2023
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15311	115 N EUCLID AVE STE A	SAINT LOUIS	MO	63108	10/24/2022	01/01/2023		01/01/2023
Contract Detail	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	01/17/2023	04/01/2023		04/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Lengerman, Megan Clare 340B Project Manager Washington University ID Clinic 3143627595	Lengerman, Megan Clare Director of 340B Programs & Initiatives Washington University ID Clinic 3143627595	4/17/2025 1:32 PM
Details	Assistance Received From Date	Update	Recertification	1/1/2022 12:00:00 AM	1/1/2025 12:00:00 AM	2/20/2025 1:56 PM
Details	Assistance Received To Date	Update	Recertification	12/31/2024 12:00:00 AM	12/31/2027 12:00:00 AM	2/20/2025 1:56 PM
Details	Last Recertification Date	Update	Recertification	2/6/2024 6:14:38 PM	2/20/2025 1:56:56 PM	2/20/2025 1:56 PM
Addresses	Main Address	Update	Change Request	1 VILLAGE SQUARE SUITE 1 HAZELWOOD, MO 63042-1817	1 VILLAGE SQ SHOPPING CTR SUITE 1 HAZELWOOD, MO 63042-1817	5/10/2024 8:06 AM
Addresses	Billing Address	Update	Change Request	WASHINGTON UNIVERSITY INFECTIOUS DISEASES CLINIC NORTH COUNTY 660 S EUCLID CAMPUS BOX 8051 SAINT LOUIS, MO 63110-1010	WASHINGTON UNIVERSITY IN ST. LOUIS 660 S EUCLID AVE SAINT LOUIS, MO 63110-1010	5/10/2024 8:06 AM
Addresses	Shipping Address	Update	Change Request	WASHINGTON UNIVERSITY IN ST LOUIS VILLAGE SQUARE PHARMACY 1 VILLAGE SQ SHOPPING CTR STE 1 ROOM 103 HAZELWOOD, MO 63042-1817	WASH U - VILLAGE SQUARE PHARMACY 1 VILLAGE SQUARE SHOPPING STE 1 RM 103 HAZELWOOD, MO 63042	5/10/2024 8:06 AM
Addresses	Shipping Address	Update	Change Request	WASHINGTON UNIVERSITY IN ST LOUIS SCHOOL OF MEDICINE INFECTIOUS DISEASES PHARMACY 620 S TAYLOR AVE RM 202 SAINT LOUIS, MO 63110-1035	WASH U SCHOOL OF MEDICINE - INFECTIOUS DISEASES PHARMACY 620 S TAYLOR AVE RM 202 SAINT LOUIS, MO 63110	5/10/2024 8:06 AM
Details	Last Recertification Date	Update	Recertification	2/2/2023 12:26:02 PM	2/6/2024 6:14:38 PM	2/6/2024 6:14 PM
Details	NOFO Number	Update		HRSA-22-011		12/16/2023 10:34 AM
Addresses	Main Address	Update	Recertification	1 Village Square Suite 1 Hazelwood, MO 63042	1 VILLAGE SQUARE SUITE 1 HAZELWOOD, MO 63042-1817	2/2/2023 12:26 PM
Addresses	Billing Address	Update	Recertification	Washington University in St. Louis Infectious Diseases Clinic 660 S. Euclid Campus Box 8051 Saint Louis, MO 63110	WASHINGTON UNIVERSITY INFECTIOUS DISEASES CLINIC NORTH COUNTY 660 S EUCLID CAMPUS BOX 8051 SAINT LOUIS, MO 63110-1010	2/2/2023 12:26 PM
Addresses	Shipping Address	Insert	Recertification		WASHINGTON UNIVERSITY IN ST LOUIS VILLAGE SQUARE PHARMACY 1 VILLAGE SQ SHOPPING CTR STE 1 ROOM 103 HAZELWOOD, MO 63042-1817	2/2/2023 12:26 PM
Addresses	Shipping Address	Insert	Recertification		WASHINGTON UNIVERSITY IN ST LOUIS SCHOOL OF MEDICINE INFECTIOUS DISEASES PHARMACY 620 S TAYLOR AVE RM 202 SAINT LOUIS, MO 63110-1035	2/2/2023 12:26 PM
Details	Last Recertification Date	Update	Recertification		2/2/2023 12:26:02 PM	2/2/2023 12:26 PM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Markovich, Tina M Program Director Washington University School of Medicine 3147473071	10/24/2022 2:28 PM
Details	340B ID	Update	New Registration		HV07849A	10/24/2022 2:28 PM
Dates	Participating Approval Date	Update	New Registration		10/24/2022 2:28:10 PM	10/24/2022 2:28 PM
Details	State	Update	New Registration	Pending	Approved	10/24/2022 2:28 PM
Dates	Signed By Date	Update	New Registration		10/15/2022 11:36:58 AM	10/24/2022 2:28 PM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	10/24/2022 2:28 PM
Addresses	Main Address	Insert	New Registration		1 Village Square Suite 1 Hazelwood, MO 63042	10/14/2022 5:27 PM
Addresses	Billing Address	Insert	New Registration		Washington University in St. Louis Infectious Diseases Clinic 660 S. Euclid Campus Box 8051 Saint Louis, MO 63110	10/14/2022 5:27 PM
Contacts	Authorizing Official	Insert	New Registration		Markovich, Tina M Program Director Washington University School of Medicine 3147473071	10/14/2022 5:27 PM
Contacts	Primary Contact	Insert	New Registration		Lengerman, Megan Clare 340B Project Manager Washington University ID Clinic 3143627595	10/14/2022 5:27 PM
Details	Assistance Received From Date	Insert	New Registration		1/1/2022 12:00:00 AM	10/14/2022 5:27 PM
Details	Assistance Received To Date	Insert	New Registration		12/31/2024 12:00:00 AM	10/14/2022 5:27 PM
Details	Last Recertification Date	Insert	New Registration			10/14/2022 5:27 PM
Details	Grant Number	Insert	New Registration		H76HA07849	10/14/2022 5:27 PM
Details	340B ID	Insert	New Registration			10/14/2022 5:27 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/14/2022 5:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/14/2022 5:27 PM
Details	Medicare Provider Number	Insert	New Registration			10/14/2022 5:27 PM
Details	Entity Name	Insert	New Registration		WASHINGTON UNIVERSITY IN ST. LOUIS	10/14/2022 5:27 PM
Details	NOFO Number	Insert	New Registration		HRSA-22-011	10/14/2022 5:27 PM
Details	Program Code	Insert	New Registration		HV	10/14/2022 5:27 PM
Details	Entity Subname	Insert	New Registration		Washington University Infectious Diseases Clinic North County	10/14/2022 5:27 PM
Dates	Participating Approval Date	Insert	New Registration			10/14/2022 5:27 PM
Details	State	Insert	New Registration		Pending	10/14/2022 5:27 PM
Dates	Registration Date	Insert	New Registration		10/14/2022 5:27:21 PM	10/14/2022 5:27 PM
Dates	Signed By Date	Insert	New Registration			10/14/2022 5:27 PM
Dates	Start Date	Insert	New Registration			10/14/2022 5:27 PM
Terminations	Termination Comments	Insert	New Registration			10/14/2022 5:27 PM
Terminations	Termination Date	Insert	New Registration			10/14/2022 5:27 PM
Terminations	Termination Effective Date	Insert	New Registration			10/14/2022 5:27 PM
Terminations	Termination Reason	Insert	New Registration			10/14/2022 5:27 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History