Covered Entity Details

DSH040020AF ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER (Approved) - information as of 4/29/2025 4:37:49 AM

Main Details

Name

ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER

Subdivision Name

ST BERNARDS PREGNANCY CLINIC- OSC - OBGYN

Type

Disproportionate Share Hospital

Rural

340B ID

DSH040020AF

Medicare Provider Number

040020

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/11/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/24/2025

Last Recertification Date

Contacts

Authorizing Official

St Bernards Healthcare
Benjamin F Barylske, VP of Finance / CFO
(870) 207-4565

Primary Contact

St. Bernards Medical Center
James Douglas Welborn, Assistant Vice President of Pharmacy Services
(870) 207-1800

Addresses

Street Address

1420 W KEISER AVE
OSCEOLA, AR 72370-2800

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
AR	101693105,101854002	1336150374,1346301306,1396053096,1922043686
MO	010327302	1336150374,1346301306,1396053096,1922043686

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
DSH040020A	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS BEHAVIORAL HEALTH CENTER	2712 E. JOHNSON AVENUE	JONESBORO	AR	Active
DSH040020AA	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS CLOPTON CLINIC - Pulmonology	300 CARSON ST	JONESBORO	AR	Active
DSH040020AB	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Infusion Center – Five Rivers - Infusion Center	2801 Medical Center Dr.	Pocahontas	AR	Active
DSH040020AC	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS SPECIALTY CLINIC- LMH - Pregnancy Clinic	1309 W MAIN ST	WALNUT RIDGE	AR	Active
DSH040020AD	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS CLOPTON CLINIC - Endocrinology	300 CARSON ST	JONESBORO	AR	Active
DSH040020AE	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS CLOPTON CLINIC - Internal Medicine	300 CARSON ST	JONESBORO	AR	Active
DSH040020AF	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS PREGNANCY CLINIC- OSC - OBGYN	1420 W KEISER AVE	OSCEOLA	AR	Approved
DSH040020AG	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Heart and Vascular-Osceola - Cardiology	1420 West Keiser Ave.	Osceola	AR	Approved
DSH040020B	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Infusion Center	300 Carson Street	Jonesboro	AR	Terminated
DSH040020C	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Imaging Center and PAT	1144 East Mathews Avenue	Jonesboro	AR	Active
DSH040020D	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Dialysis Center - Jonesboro	540 East Washington Avenue	Jonesboro	AR	Active
DSH040020E	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Dialysis Center - Wynne	310 South Falls Blvd	Wynne	AR	Active
DSH040020F	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Infusion Center - Paragould	4000 Linwood, Suite B & C	Paragould	AR	Active
DSH040020G	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Heart and Vascular	201 East Oak Street	Jonesboro	AR	Active
DSH040020H	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Heart and Vascular -Paragould	314 South 12th Street	Paragould	AR	Active
DSH040020J	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Wound Healing - Paragould	4000 Linwood, Suite J	Paragould	AR	Active
DSH040020K	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Wound Healing	505 East Mathews Ave., Suite 201	Jonesboro	AR	Active
DSH040020L	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Senior Health Clinic	303 East Mathews, Suite 202	Jonesboro	AR	Active
DSH040020M	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Specialty Clinic I -Behaviorial Health and PAT- Paragould	4000 Linwood Drive Suite B	Paragould	AR	Terminated
DSH040020N	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Internal Medical Residency Clinic and Infectious Disease Clinic	300 Carson Street	Jonesboro	AR	Active
DSH040020P	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Pregnancy Clinic - Obstetrics	4334 East Highland Drive, Suite B	Jonesboro	AR	Active
DSH040020Q	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST. Bernards Dialysis Center- Osceola - Dialysis	1420 W. Keiser Ave.	Osceola	AR	Active
DSH040020R	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST. BERNARDS HOSPITAL INC - Psychiatric/Psychological Services	615 E MATTHEWS AVE	JONESBORO	AR	Active
DSH040020S	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Gastroenterology Associates - Gastroenterology	1007 E Matthews Ave	Jonesboro	AR	Active
DSH040020T	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Urology - Urology	303 E Matthews Ave Suite 100	Jonesboro	AR	Active
DSH040020U	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	Dermatology Clinic - Dermatology	800 S. Church St. Suite 202	Jonesboro	AR	Active
DSH040020V	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	Dermatology Procedure Center - Dermatology	800 S. Church St. Suite 103	Jonesboro	AR	Active
DSH040020W	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS CLOPTON CLINIC - Nephrology	300 CARSON ST	JONESBORO	AR	Active
DSH040020X	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS CLOPTON CLINIC - Rheumatology	300 CARSON ST	JONESBORO	AR	Active
DSH040020Y	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS SPECIALTY CLINIC- LMH - Wound Healing	1309 W MAIN ST	WALNUT RIDGE	AR	Active
DSH040020Z	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Dialysis- Walnut Ridge - Dialysis	1051 W Free St	Walnut Ridge	AR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Barylske, Benjamin F VP of Finance / CFO St Bernards Healthcare 8702074565	4/24/2025 10:33 AM
Details	340B ID	Update	New Registration		DSH040020AF	4/24/2025 10:33 AM
Details	Entity Subname	Update	New Registration	ST BERNARDS PREGNANCY CLINIC- OSC	ST BERNARDS PREGNANCY CLINIC- OSC - OBGYN	4/24/2025 10:33 AM
Dates	Participating Approval Date	Update	New Registration		4/24/2025 10:33:14 AM	4/24/2025 10:33 AM
Details	State	Update	New Registration	Pending	Approved	4/24/2025 10:33 AM
Dates	Signed By Date	Update	New Registration		4/23/2025 1:03:09 PM	4/24/2025 10:33 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/24/2025 10:33 AM
Addresses	Main Address	Insert	New Registration		1420 W KEISER AVE OSCEOLA, AR 72370-2800	4/11/2025 5:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/11/2025 5:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		101693105	4/11/2025 5:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AR	4/11/2025 5:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/11/2025 5:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		101854002	4/11/2025 5:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AR	4/11/2025 5:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/11/2025 5:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		010327302	4/11/2025 5:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MO	4/11/2025 5:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1336150374	4/11/2025 5:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		AR	4/11/2025 5:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346301306	4/11/2025 5:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		AR	4/11/2025 5:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1396053096	4/11/2025 5:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		AR	4/11/2025 5:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1922043686	4/11/2025 5:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		AR	4/11/2025 5:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1336150374	4/11/2025 5:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		MO	4/11/2025 5:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346301306	4/11/2025 5:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		MO	4/11/2025 5:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1396053096	4/11/2025 5:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		MO	4/11/2025 5:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1922043686	4/11/2025 5:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		MO	4/11/2025 5:14 PM
Contacts	Authorizing Official	Insert	New Registration		Barylske, Benjamin F VP of Finance / CFO St Bernards Healthcare 8702074565	4/11/2025 5:14 PM
Contacts	Primary Contact	Insert	New Registration		Welborn, James Douglas Assistant Vice President of Pharmacy Services St. Bernards Medical Center 8702071800	4/11/2025 5:14 PM
Details	Assistance Received From Date	Insert	New Registration			4/11/2025 5:14 PM
Details	Assistance Received To Date	Insert	New Registration			4/11/2025 5:14 PM
Details	Last Recertification Date	Insert	New Registration			4/11/2025 5:14 PM
Details	Grant Number	Insert	New Registration			4/11/2025 5:14 PM
Details	340B ID	Insert	New Registration			4/11/2025 5:14 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2025 5:14 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2025 5:14 PM
Details	Medicare Provider Number	Insert	New Registration		040020	4/11/2025 5:14 PM
Details	Entity Name	Insert	New Registration		ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	4/11/2025 5:14 PM
Details	NOFO Number	Insert	New Registration			4/11/2025 5:14 PM
Details	Program Code	Insert	New Registration		DSH	4/11/2025 5:14 PM
Details	Entity Subname	Insert	New Registration		ST BERNARDS PREGNANCY CLINIC- OSC	4/11/2025 5:14 PM
Dates	Participating Approval Date	Insert	New Registration			4/11/2025 5:14 PM
Details	State	Insert	New Registration		Pending	4/11/2025 5:14 PM
Dates	Registration Date	Insert	New Registration		4/11/2025 5:14:14 PM	4/11/2025 5:14 PM
Dates	Signed By Date	Insert	New Registration			4/11/2025 5:14 PM
Dates	Start Date	Insert	New Registration			4/11/2025 5:14 PM
Terminations	Termination Comments	Insert	New Registration			4/11/2025 5:14 PM
Terminations	Termination Date	Insert	New Registration			4/11/2025 5:14 PM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2025 5:14 PM
Terminations	Termination Reason	Insert	New Registration			4/11/2025 5:14 PM