| Addresses | Billing Address | Update | Group Change Request | Dignity Health Accounts Payable
3400 Data Drive
3rd floor
Rancho Cordova, CA 95670 | UCSF - St. Francis Hospital
1500 Owens Street, Suite 460
San Francisco, CA 94158 | 4/7/2025 4:32 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 4/7/2025 4:05 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | HSC30116 | 4/7/2025 4:05 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | CA | 4/7/2025 4:05 PM |
| Addresses | Shipping Address | Delete | Change Request | St Mary's Medical Center
450 Stanyan Street
San Francisco, CA 94117 | | 1/21/2025 7:24 AM |
| Details | Entity Name | Update | Change Request | ST FRANCIS MEMORIAL HOSPITAL | UCSF HEALTH - ST. FRANCIS HOSPITAL | 1/21/2025 7:24 AM |
| Contacts | Primary Contact | Update | Group Change Request | Pearcy, Ryan
340B Region Manager
CommonSpirit Health
8592295654 | Hahn, Raechel
340B Analyst
UCSF Medical Center
5107367335 | 1/16/2025 7:45 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Bennan, James
COO Community Hospital Division
UCSF Medical Center
4155038667 | Bennan, James
COO Community Hospital Division
UCSF Health
4155038667 | 1/14/2025 8:42 AM |
| Contacts | Authorizing Official | Update | Change Request | Brown Sims, Kim
VP, CNE
UCSF Health
4153536600 | Bennan, James
COO Community Hospital Division
UCSF Medical Center
4155038667 | 1/14/2025 7:55 AM |
| Contacts | Authorizing Official | Update | Change Request | Brown Sims, Kim
VP, Chief Nurse Executive Officer
Saint Francis Memorial Hospital
4153536600 | Brown Sims, Kim
VP, CNE
UCSF Health
4153536600 | 1/6/2025 12:19 PM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2023 4:27:14 PM | 8/19/2024 12:30:52 PM | 8/19/2024 12:30 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Pearcy, Ryan
340B Division Manager
CommonSpirit Health
8592295654 | Pearcy, Ryan
340B Region Manager
CommonSpirit Health
8592295654 | 8/6/2024 9:42 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Brown Sims, Kim
VP, Chief Nurse Executive Officer
Saint Francis Memorial Hospital
5305740430 | Brown Sims, Kim
VP, Chief Nurse Executive Officer
Saint Francis Memorial Hospital
4153536600 | 1/4/2024 4:12 PM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2022 10:13:38 AM | 8/22/2023 4:27:14 PM | 8/22/2023 4:27 PM |
| Contacts | Primary Contact | Update | Change Request | Nosa-Idahosa, Osariemen
Director of Pharmcy
Dignity Health Saint Francis Memorial Hospital
4153536451 | Pearcy, Ryan
340B Division Manager
CommonSpirit Health
8592295654 | 9/26/2022 1:36 PM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2021 12:53:55 PM | 9/7/2022 10:13:38 AM | 9/7/2022 10:13 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Brown Sims, Kim
VP, Chief nurse Executive
Saint Francis Memorial Hospital
5305740430 | Brown Sims, Kim
VP, Chief Nurse Executive Officer
Saint Francis Memorial Hospital
5305740430 | 8/16/2021 12:59 PM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2020 10:38:46 AM | 8/16/2021 12:53:55 PM | 8/16/2021 12:53 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Kelly, Kecia
COO/CNO
Dignity Health Saint Francis Memorial Hospital
4153536173 | Brown Sims, Kim
VP, Chief nurse Executive
Saint Francis Memorial Hospital
5305740430 | 8/10/2021 7:39 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1316061997 | 8/21/2020 10:38 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | CA | 8/21/2020 10:38 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1316061997 ( ) | | 8/21/2020 10:38 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2019 8:24:59 PM | 8/21/2020 10:38:46 AM | 8/21/2020 10:38 AM |
| Addresses | Shipping Address | Insert | Change Request | | St Mary's Medical Center
450 Stanyan Street
San Francisco, CA 94117 | 9/23/2019 7:33 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2018 7:11:28 PM | 8/21/2019 8:24:59 PM | 8/21/2019 8:24 PM |
| Contacts | Primary Contact | Update | Change Request | MILLER, RAY
DIRECTOR OF PHARMACY
Saint Francis Memorial Hospital
4153536451 | Nosa-Idahosa, Osariemen
Director of Pharmcy
Dignity Health Saint Francis Memorial Hospital
4153536451 | 2/4/2019 4:26 PM |
| Contacts | Authorizing Official | Update | Change Request | Fergus, Gigi
CNO/COO
Saint Francis Memorial Hospital
4153536710 | Kelly, Kecia
COO/CNO
Dignity Health Saint Francis Memorial Hospital
4153536173 | 10/22/2018 7:02 AM |
| Details | Last Recertification Date | Update | Recertification | 11/9/2017 1:37:17 PM | 8/21/2018 7:11:28 PM | 8/21/2018 7:11 PM |
| Contacts | Authorizing Official | Update | Change Request | Welton, Jill
VP COO, CNO
Dignity Health
4153536173 | Fergus, Gigi
CNO/COO
Saint Francis Memorial Hospital
4153536710 | 7/24/2018 9:05 AM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2016 12:00:00 AM | 11/9/2017 1:37:17 PM | 11/9/2017 1:37 PM |
| Contacts | Authorizing Official | Update | | Welton, Jill
VP COO, CNO
4153536173 | Welton, Jill
VP COO, CNO
Dignity Health
4153536173 | 10/10/2017 9:09 PM |
| Contacts | Primary Contact | Update | | MILLER, RAY
DIRECTOR OF PHARMACY
4153536451 | MILLER, RAY
DIRECTOR OF PHARMACY
Saint Francis Memorial Hospital
4153536451 | 9/26/2017 12:36 PM |
| Addresses | Main Address | Insert | | |
900 HYDE STREET
SAN FRANCISCO, CA 94109 | 3/14/2017 9:24 AM |
| Addresses | Billing Address | Insert | | | Dignity Health Accounts Payable
3400 Data Drive
3rd floor
Rancho Cordova, CA 95670 | 3/14/2017 9:24 AM |
| Addresses | Shipping Address | Insert | | | Saint Francis Memorial Hospital
900 Hyde Street
San Francisco, CA 94109 | 3/14/2017 9:24 AM |
| Addresses | Shipping Address | Insert | | | Safecor Health, LLC
4060 Business Park Drive, Suite B
Columbus, OH 43204 | 3/14/2017 9:24 AM |
| Contacts | Authorizing Official | Update | | FOX, ALAN
CFO
4153536757 | Welton, Jill
VP COO, CNO
4153536173 | 3/14/2017 9:24 AM |
| Contacts | Primary Contact | Update | | MILLER, RAY
DIRECTOR OF PHARMACY
4153536451 | MILLER, RAY
DIRECTOR OF PHARMACY
4153536451 | 3/14/2017 9:24 AM |
| Details | Last Recertification Date | Update | | 8/12/2015 12:00:00 AM | 8/18/2016 12:00:00 AM | 8/18/2016 1:26 PM |
| Medicaid Billing | NPI: Number | Update | | 1235263625 | 1316061997 | 9/18/2015 8:59 PM |
| Details | Last Recertification Date | Update | | 8/18/2014 12:00:00 AM | 8/12/2015 12:00:00 AM | 8/12/2015 5:21 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/14/2015 4:46 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | HSC00152F | 7/14/2015 4:46 PM |
| Medicaid Billing | Medicaid: State | Insert | | | CA | 7/14/2015 4:46 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1235263625 | 7/14/2015 4:46 PM |
| Details | Last Recertification Date | Update | | 8/26/2013 12:00:00 AM | 8/18/2014 12:00:00 AM | 8/18/2014 8:38 AM |
| Contacts | Primary Contact | Insert | | | MILLER, RAY
DIRECTOR OF PHARMACY
4153536451 | 7/3/2014 4:20 PM |
| Contacts | Authorizing Official | Insert | | | FOX, ALAN
CFO
4153536757 | 7/3/2014 4:20 PM |
| Details | Last Recertification Date | Update | | 1/1/2013 12:00:00 AM | 8/26/2013 12:00:00 AM | 8/26/2013 6:32 AM |
| Details | Last Recertification Date | Update | | | 1/1/2013 12:00:00 AM | 12/13/2012 5:07 PM |
| Dates | Participating Approval Date | Update | | 4/29/2008 4:08:11 PM | 4/29/2008 12:00:00 AM | 10/25/2012 9:10 AM |
| Details | Last Recertification Date | Insert | | | | 4/29/2008 4:10 PM |
| Details | Grant Number | Insert | | | | 4/29/2008 4:10 PM |
| Details | 340B ID | Insert | | | DSH050152 | 4/29/2008 4:10 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/29/2008 4:10 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/29/2008 4:10 PM |
| Details | Medicare Provider Number | Insert | | | 050152 | 4/29/2008 4:10 PM |
| Details | Entity Name | Insert | | | ST FRANCIS MEMORIAL HOSPITAL | 4/29/2008 4:10 PM |
| Details | Program Code | Insert | | | DSH | 4/29/2008 4:10 PM |
| Details | Entity Subname | Insert | | | | 4/29/2008 4:10 PM |
| Dates | Participating Approval Date | Insert | | | 4/29/2008 4:08:11 PM | 4/29/2008 4:10 PM |
| Details | State | Insert | | | Active | 4/29/2008 4:10 PM |
| Dates | Registration Date | Insert | | | 4/29/2008 12:00:00 AM | 4/29/2008 4:10 PM |
| Dates | Signed By Date | Insert | | | | 4/29/2008 4:10 PM |
| Dates | Start Date | Insert | | | 10/1/2004 12:00:00 AM | 4/29/2008 4:10 PM |
| Terminations | Termination Comments | Insert | | | | 4/29/2008 4:10 PM |
| Terminations | Termination Date | Insert | | | | 4/29/2008 4:10 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/29/2008 4:10 PM |
| Terminations | Termination Reason | Insert | | | | 4/29/2008 4:10 PM |