Covered Entity Details

DSH220020E STEWARD ST. ANNES HOSPITAL (Active) - information as of 4/30/2025 12:01:00 AM

Main Details

Name

STEWARD ST. ANNES HOSPITAL

Subdivision Name

Saint Annes Pain Management Center - Pain center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH220020E

Medicare Provider Number

220020

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/6/2025

Participating Start Date

4/1/2025

Participating Approval Date

2/6/2025

Last Recertification Date

Contacts

Authorizing Official

Saint Annes Hospital
Jason Levine, VP Finance
(508) 674-5600 Ext: 2007

Primary Contact

Brown University Health
Christine Collins, SVP, Pharmacy Periop Chief Pharmacy Officer
(401) 444-4434

Addresses

Street Address

440 Swansea Mall Drive
Floor 2
Swansea, MA 02777

Billing Address

Saint Annes Hospital
795 Middle St
Fall River, MA 02721

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
MA	110214545A,110214545B,110214545C	1972330165,1013744200

Shipping Addresses

Same as Street Address

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
DSH220020A	Child	DSH	STEWARD ST. ANNES HOSPITAL	Saint Annes Speech Therapy - Speech	222 Milliken Blvd	Fall River	MA	Active
DSH220020B	Child	DSH	STEWARD ST. ANNES HOSPITAL	Saint Annes Physical & Occupational Therapy - PT & OT	222 Milliken Blvd	Fall River	MA	Active
DSH220020C	Child	DSH	STEWARD ST. ANNES HOSPITAL	Saint Annes Sleep Satellite - Sleep Center	535 Faunce Corner Rd	Dartmouth	MA	Active
DSH220020D	Child	DSH	STEWARD ST. ANNES HOSPITAL	Saint Annes Hospital MRI - Satellite - MRI - Primacare	289 Pleasant St	Fall River	MA	Active
DSH220020E	Child	DSH	STEWARD ST. ANNES HOSPITAL	Saint Annes Pain Management Center - Pain center	440 Swansea Mall Drive	Swansea	MA	Active
DSH220020F	Child	DSH	STEWARD ST. ANNES HOSPITAL	Saint Annes Dartmouth Oncology Radiation - Rad onc	537 Faunce Corner Rd	Dartmouth	MA	Active
DSH220020G	Child	DSH	STEWARD ST. ANNES HOSPITAL	Saint Annes Dartmouth Oncology - Medical Oncology	537 Faunce Corner Rd	Dartmouth	MA	Active
DSH220020H	Child	DSH	STEWARD ST. ANNES HOSPITAL	Saint Annes Attleboro Surgery center - SNESC	738 Washington St	Attleboro	MA	Active
DSH220020J	Child	DSH	STEWARD ST. ANNES HOSPITAL	Saint Annes Dartmouth Surgery center - HMA Surgery Center	535 Faunce Corner Rd	Dartmouth	MA	Active
DSH220020K	Child	DSH	STEWARD ST. ANNES HOSPITAL	Saint Annes Center for Children and Families - FCCF	222 Milliken Blvd	Fall River	MA	Active
DSH220020L	Child	DSH	STEWARD ST. ANNES HOSPITAL	SAINT ANNES HOSPITAL WOUND CARE CE - Wound Care	851 MIDDLE ST	FALL RIVER	MA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		Levine, Jason VP Finance Saint Annes Hospital 5086745600-2007	2/6/2025 8:29 AM
Details	340B ID	Update	New Registration		DSH220020E	2/6/2025 8:29 AM
Details	Entity Subname	Update	New Registration	Saint Annes Pain Management Center	Saint Annes Pain Management Center - Pain center	2/6/2025 8:29 AM
Dates	Participating Approval Date	Update	New Registration		2/6/2025 8:29:07 AM	2/6/2025 8:29 AM
Details	State	Update	New Registration	Pending	Approved	2/6/2025 8:29 AM
Dates	Signed By Date	Update	New Registration		2/5/2025 3:14:31 PM	2/6/2025 8:29 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	2/6/2025 8:29 AM
Addresses	Main Address	Insert	New Registration		440 Swansea Mall Drive Floor 2 Swansea, MA 02777	1/6/2025 5:06 PM
Addresses	Billing Address	Insert	New Registration		Saint Annes Hospital 795 Middle St Fall River, MA 02721	1/6/2025 5:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2025 5:06 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		110214545A	1/6/2025 5:06 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MA	1/6/2025 5:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2025 5:06 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		110214545B	1/6/2025 5:06 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MA	1/6/2025 5:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2025 5:06 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		110214545C	1/6/2025 5:06 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MA	1/6/2025 5:06 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972330165	1/6/2025 5:06 PM
Medicaid Billing	NPI: State	Insert	New Registration		MA	1/6/2025 5:06 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1013744200	1/6/2025 5:06 PM
Medicaid Billing	NPI: State	Insert	New Registration		MA	1/6/2025 5:06 PM
Contacts	Authorizing Official	Insert	New Registration		Levine, Jason VP Finance Saint Annes Hospital 5086745600-2007	1/6/2025 5:06 PM
Contacts	Primary Contact	Insert	New Registration		Collins, Christine SVP, Pharmacy Periop Chief Pharmacy Officer Brown University Health 4014444434	1/6/2025 5:06 PM
Details	Assistance Received From Date	Insert	New Registration			1/6/2025 5:06 PM
Details	Assistance Received To Date	Insert	New Registration			1/6/2025 5:06 PM
Details	Last Recertification Date	Insert	New Registration			1/6/2025 5:06 PM
Details	Grant Number	Insert	New Registration			1/6/2025 5:06 PM
Details	340B ID	Insert	New Registration			1/6/2025 5:06 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/6/2025 5:06 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/6/2025 5:06 PM
Details	Medicare Provider Number	Insert	New Registration		220020	1/6/2025 5:06 PM
Details	Entity Name	Insert	New Registration		STEWARD ST. ANNES HOSPITAL	1/6/2025 5:06 PM
Details	NOFO Number	Insert	New Registration			1/6/2025 5:06 PM
Details	Program Code	Insert	New Registration		DSH	1/6/2025 5:06 PM
Details	Entity Subname	Insert	New Registration		Saint Annes Pain Management Center	1/6/2025 5:06 PM
Dates	Participating Approval Date	Insert	New Registration			1/6/2025 5:06 PM
Details	State	Insert	New Registration		Pending	1/6/2025 5:06 PM
Dates	Registration Date	Insert	New Registration		1/6/2025 5:06:06 PM	1/6/2025 5:06 PM
Dates	Signed By Date	Insert	New Registration			1/6/2025 5:06 PM
Dates	Start Date	Insert	New Registration			1/6/2025 5:06 PM
Terminations	Termination Comments	Insert	New Registration			1/6/2025 5:06 PM
Terminations	Termination Date	Insert	New Registration			1/6/2025 5:06 PM
Terminations	Termination Effective Date	Insert	New Registration			1/6/2025 5:06 PM
Terminations	Termination Reason	Insert	New Registration			1/6/2025 5:06 PM