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PED263301-01 St. Louis Children's (Active)
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Main Details
Name
St. Louis Children's
Subdivision Name
Hematology-Oncology Clinic / Ambulatory Surgery
Type
Children's Hospital
Rural
No
340B ID
PED263301-01
Medicare Provider Number
263301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/8/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/10/2014
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
13001 North Outer Forty Road
Town and Country, MO 63017
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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