Covered Entity Details

RRC420065-02 BON SECOURS ST. FRANCIS XAVIER HOSPI (Approved) - information as of 6/23/2025 11:56:24 PM

Main Details

Name

BON SECOURS ST. FRANCIS XAVIER HOSPI

Subdivision Name

BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - WA - RSFH Oncology - WA RSFH ONCOLOGY CLINIC

Type

Rural Referral Center

Rural

340B ID

RRC420065-02

Medicare Provider Number

420065

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/22/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/25/2025

Last Recertification Date

Contacts

Authorizing Official

Roper St Francis Healthcare
Rebecca Ann Tucker, SVP, Chief Financial Officer
(843) 727-3403

Primary Contact

Bon Secours Saint Francis Hospital
Louis Glavinos, 340B Pharmacy Manager and Oncology Outpatient Pharmacy Infusion Manager
(843) 402-1675

Addresses

Street Address

2085 HENRY TECKLENBURG DR
FL 2
CHARLESTON, SC 29414

Billing Address

BON SECOURS ST FRANCIS XAVIER HOSPITAL
2095 HENRY TECKLENBURG DR
CHARLESTON, SC 29414

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
SC	381885	1851361778

Shipping Addresses

Shipping Address 1

BON SECOURS ST FRANCIS XAVIER HOSPITAL
2095 HENRY TECKLENBURG DR
CHARLESTON, SC 29414

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
RRC420065-01	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - DT - RSFH Oncology - DT RSFH ONCOLOGY CLINIC	125 DOUGHTY ST	CHARLESTON	SC	Approved
RRC420065-02	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - WA - RSFH Oncology - WA RSFH ONCOLOGY CLINIC	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-03	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology WA - RSFH Oncology - WA RSFH ONCOLOGY INFUSION	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-04	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - WA - RSFH Rheumatology - WA RSFH RHEUMATOLOGY CLINIC	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-05	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - LCHO University - RSFH Oncology - NC RSFH INFUSION THERAPY	8950 UNIVERSITY BLVD	N CHARLESTON	SC	Approved
RRC420065-06	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	ST. FRANCIS HOSPITAL THERAPEUTIC RADIOLOGY - WA RSFH THERAPEUTIC RADIOLOGY	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-07	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	ST FRANCIS HOSPITAL INFUSION THERAP - WA RSFH INFUSION THERAPY	2085 HENRY TECKLENBURG DRIVE	CHARLESTON	SC	Approved
RRC420065-08	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	ST FRANCIS HOSP PAIN MANAGEMENT EAST - WA RSFH PAIN MANAGEMENT	2093 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-09	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	ST FRANCIS HOSP BREAST CARE MEDICAL - WA RSFH MAMMOGRAPHY	2145 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-10	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology NC - RSFH Oncology - NC RSFH ONCOLOGY INFUSION	2910 TRICOM ST	N CHARLESTON	SC	Approved
RRC420065-11	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - NC - RSFH Oncology - NC RSFH ONCOLOGY CLINIC	2910 TRICOM ST	N CHARLESTON	SC	Approved
RRC420065-12	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology BK - RSFH Oncology - Charleston Oncology - BK RSFH ONCOLOGY INFUSION	300 CALLEN BLVD	SUMMERVILLE	SC	Approved
RRC420065-13	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - BK - RSFH Oncology - BK RSFH ONCOLOGY CLINIC	300 CALLEN BLVD	SUMMERVILLE	SC	Approved
RRC420065-14	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	RSFH INFUSION THERAPY BERKELEY A DEPARTMENT OF BON SECOURS ST FRANCIS XAVIER HOSPITAL - BK RSFH INFUSION THERAPY	300 CALLEN BLVD	SUMMERVILLE	SC	Approved
RRC420065-15	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology DT - RSFH Oncology - DT RSFH ONCOLOGY INFUSION	316 CALHOUN ST	CHARLESTON	SC	Approved
RRC420065-16	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	RSFH INFUSION THERAPY MT PLEASANT A DEPARTMENT OF BON SECOURS ST FRANCIS XAVIER HOSPITAL - MP RSFH INFUSION THERAPY	3510 N HIGHWAY 17	MT PLEASANT	SC	Approved
RRC420065-17	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology MP - MP RSFH ONCOLOGY INFUSION	3510 N HIGHWAY 17	MT PLEASANT	SC	Approved
RRC420065-18	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - MP - RSFH Oncology - MP RSFH ONCOLOGY CLINIC	3510 N HIGHWAY 17	MT PLEASANT	SC	Approved
RRC420065-19	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - WA - RSFH Oncology - WA RSFH ONCOLOGY CLINIC	2093 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-20	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - WA - RSFH Cardiology - WA RSFH CARDIOLOGY CLINIC	2093 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Tucker, Rebecca Ann SVP, Chief Financial Officer Roper St Francis Healthcare 8437273403	4/25/2025 9:05 AM
Details	340B ID	Update	New Registration		RRC420065-02	4/25/2025 9:05 AM
Details	Entity Subname	Update	New Registration	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - WA - RSFH Oncology	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - WA - RSFH Oncology - WA RSFH ONCOLOGY CLINIC	4/25/2025 9:05 AM
Dates	Participating Approval Date	Update	New Registration		4/25/2025 9:05:26 AM	4/25/2025 9:05 AM
Details	State	Update	New Registration	Pending	Approved	4/25/2025 9:05 AM
Dates	Signed By Date	Update	New Registration		4/23/2025 12:57:31 PM	4/25/2025 9:05 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/25/2025 9:05 AM
Addresses	Main Address	Insert	New Registration		2085 HENRY TECKLENBURG DR FL 2 CHARLESTON, SC 29414	4/22/2025 3:09 PM
Addresses	Billing Address	Insert	New Registration		BON SECOURS ST FRANCIS XAVIER HOSPITAL 2095 HENRY TECKLENBURG DR CHARLESTON, SC 29414	4/22/2025 3:09 PM
Addresses	Shipping Address	Insert	New Registration		BON SECOURS ST FRANCIS XAVIER HOSPITAL 2095 HENRY TECKLENBURG DR CHARLESTON, SC 29414	4/22/2025 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/22/2025 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		381885	4/22/2025 3:09 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		SC	4/22/2025 3:09 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1851361778	4/22/2025 3:09 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	4/22/2025 3:09 PM
Contacts	Primary Contact	Insert	New Registration		Glavinos, Louis 340B Pharmacy Manager and Oncology Outpatient Pharmacy Infusion Manager Bon Secours Saint Francis Hospital 8434021675	4/22/2025 3:09 PM
Contacts	Authorizing Official	Insert	New Registration		Tucker, Rebecca Ann SVP, Chief Financial Officer Roper St Francis Healthcare 8437273403	4/22/2025 3:09 PM
Details	Assistance Received From Date	Insert	New Registration			4/22/2025 3:09 PM
Details	Assistance Received To Date	Insert	New Registration			4/22/2025 3:09 PM
Details	Last Recertification Date	Insert	New Registration			4/22/2025 3:09 PM
Details	Grant Number	Insert	New Registration			4/22/2025 3:09 PM
Details	340B ID	Insert	New Registration			4/22/2025 3:09 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/22/2025 3:09 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/22/2025 3:09 PM
Details	Medicare Provider Number	Insert	New Registration		420065	4/22/2025 3:09 PM
Details	Entity Name	Insert	New Registration		BON SECOURS ST. FRANCIS XAVIER HOSPI	4/22/2025 3:09 PM
Details	NOFO Number	Insert	New Registration			4/22/2025 3:09 PM
Details	Program Code	Insert	New Registration		RRC	4/22/2025 3:09 PM
Details	Entity Subname	Insert	New Registration		BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - WA - RSFH Oncology	4/22/2025 3:09 PM
Dates	Participating Approval Date	Insert	New Registration			4/22/2025 3:09 PM
Details	State	Insert	New Registration		Pending	4/22/2025 3:09 PM
Dates	Registration Date	Insert	New Registration		4/22/2025 3:09:22 PM	4/22/2025 3:09 PM
Dates	Signed By Date	Insert	New Registration			4/22/2025 3:09 PM
Dates	Start Date	Insert	New Registration			4/22/2025 3:09 PM
Terminations	Termination Comments	Insert	New Registration			4/22/2025 3:09 PM
Terminations	Termination Date	Insert	New Registration			4/22/2025 3:09 PM
Terminations	Termination Effective Date	Insert	New Registration			4/22/2025 3:09 PM
Terminations	Termination Reason	Insert	New Registration			4/22/2025 3:09 PM