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BJC HOME CARE SVC PHARMACY
PED263301-00 St. Louis Children's
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Covered Entity Details
Entity Name
St. Louis Children's
Subdivision Name
Type
Children's Hospital
340B ID
PED263301-00
Entity Address
One Children's Place
St. Louis, MO 63110
Medicare Provider Number
263301
Participating Start Date
1/1/2013
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
BJC HOME CARE SVC PHARMACY
Pharmacy Address
HOME INFUSION
710 S BOYLE AVE
SAINT LOUIS, MO 63110
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michele McKee, VP Finance
(314) 454-6044
Contract Pharmacy Representative
BJC Healthcare
Lori Weilmuenster, Pharmacy Manager
(314) 953-2060
Signed By Date
1/11/2019
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