340B Drug Pricing Program Database


DSH320002 ST. VINCENT HOSPITAL (Active) - information as of 5/9/2025 10:43:49 PM

Main Details
ST. VINCENT HOSPITAL
Disproportionate Share Hospital
Yes
DSH320002
320002


Additional Details
Active
7/16/2008
1/1/2014
7/16/2008
8/23/2024

Contacts

St. Vincent Hospital
Lillian Montoya, President and CEO
(505) 913-5258

St. Vincent Hospital
Christine Atwell, Director of Pharmacy
(505) 913-5522

Addresses

455 ST. MICHAELS DRIVE
SANTA FE, NM 87505

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
11/19/13 enrolled 10/1/2004 thru 9/30/13, not enrolled 10/1/13 thru 12/31/13 due to failure to recertify, reinstated based on on-line registration submitted in Oct. 2013; 6/27/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS11/19/2013
6/27/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS07/06/2011
6/27/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS07/06/2011
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NM005471578587150
Shipping Addresses

ST. VINCENT HOSPITAL
455 ST. MICHAELS DRIVE
Santa Fe, NM 87505

Christus St. Vincent Outpatient Pharmacy
465 St. Michaels Drive #112
Santa Fe, NM 87505
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/15/202006/08/2020  06/08/2020
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/15/202006/08/2020 10/01/202310/23/2023
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/15/202006/08/2020  06/08/2020
Contract DetailACCREDO HEALTH GROUP INC2410 WARDLOW RD STE 101
CORONACA9287804/15/202006/08/2020 10/01/202310/23/2023
Contract DetailACCREDO HEALTH GROUP INC4343 W ROYAL LN STE 124
IRVINGTX75063-229904/15/202006/08/2020  06/08/2020
Contract DetailACCREDO HEALTH GROUP INC261 CEDAR HILL ST BUILDING C
MARLBOROUGHMA01752-305604/15/202006/08/2020 10/01/202310/23/2023
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/15/202006/08/2020 07/01/202307/17/2023
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/15/202006/08/2020 10/01/202310/23/2023
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/15/202006/08/2020 10/01/202310/23/2023
Contract DetailACCREDO HEALTH GROUP, INC.11411 STRANG LINE RD STE A
LENEXAKS6621504/15/202006/08/2020 10/01/202310/23/2023
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/17/202310/01/2023  10/01/2023
Contract DetailALBERTSONS LLCSAV-ON PHARMACY #3914 1956 HIGHWAY 180 EAST
SILVER CITYNM8806101/12/201804/01/2018  01/12/2018
Contract DetailAVELLA OF DEER VALLEY23620 N 20TH DR #12
PHOENIXAZ85085-062101/15/201604/01/2016  08/08/2017
Contract DetailAVELLA OF DEER VALLEY, INC. #38DBA AVELLA SPECIALTY PHARMACY 24416 N. 19TH AVE
PHOENIXAZ8508507/13/201610/01/2016 05/19/202005/19/2020
Contract DetailAVELLA OF DENVER1245 E COLFAX AVE STE 102
DENVERCO80218-221604/15/202006/08/2020 07/01/202208/25/2022
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526105/02/202305/05/2023 08/14/202410/04/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771305/02/202305/05/2023 08/14/202410/04/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267005/02/202307/01/2023 05/05/202305/05/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267005/12/202307/01/2023 08/14/202410/04/2024
Contract DetailCAREMARK ILLINOIS MAIL PHARMACY, LLCDBA CVS/CAREMARK OR CARELONRX MAIL #8702 800 BIERMANN COURT
SUITE A 		MOUNT PROSPECTIL6005610/14/202201/01/2023 10/19/202210/19/2022
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/09/201701/01/2018  10/09/2017
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/09/201701/01/2018  10/09/2017
Contract DetailCHRISTUS SPECIALTY PHARMACYMOTHER FRANCES REGIONAL HEALTH CARE CTR 800 E DAWSON ST STE 100
TYLERTX75701-203607/08/202110/01/2021  01/21/2025
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005601/04/202304/01/2023  04/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 09269 195 PASEO DE PERALTA
SANTA FENM8750110/14/202201/01/2023  02/01/2023
Contract DetailCVS PHARMACY, INC.DBA CVS/PHARMACY # 10227 2907 CERRILLOS RD.
SANTA FENM8750710/14/202201/01/2023  02/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 09263 511 W. CORDOVA RD.
SANTA FENM8750510/14/202201/01/2023  02/01/2023
Contract DetailCVS PHARMACY, INC.DBA CVS/PHARMACY # 5994 1202 N. RIVERSIDE DR.
ESPANOLANM8753210/14/202201/01/2023  02/01/2023
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/14/202201/01/2023 08/08/202408/23/2024
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268304/15/202006/08/2020 04/01/202201/04/2023
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654105/02/202305/05/2023 08/14/202410/04/2024
Contract DetailDOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K 		GREENVILLESC29607-654005/02/202307/01/2023 05/02/202305/02/2023
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111204/15/202006/08/2020  06/08/2020
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313404/15/202006/08/2020  06/08/2020
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/15/202006/08/2020  06/08/2020
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607504/15/202006/08/2020  06/08/2020
Contract DetailH E B FULFILLMENT CENTER  6520 FRATT ROAD
SAN ANTONIOTX7821804/12/201907/01/2019 07/14/202307/14/2023
Contract DetailHEALTHCARE CENTER PHARMACY2604 ST MICHAEL DRIVE, SUITE 200
TEXARKANATX7550301/15/201604/01/2016 04/10/202504/10/2025
Contract DetailHEB PHARMACY #5995225A BUFFALO SPEEDWAY
HOUSTONTX7700504/12/201907/01/2019 04/28/202404/29/2024
Contract DetailHEB PHARMACY WAREHOUSE 208H-E-B, LP 5311 DIETRICH RD STE 100
SAN ANTONIOTX7821907/14/202307/14/2023  07/17/2023
Contract DetailHEB SPECIALTY PHARMACY #7013503 FREDERICKSBURG RD STE 450
SAN ANTONIOTX7820110/05/202201/01/2023 04/28/202404/29/2024
Contract DetailK & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906001/04/202304/01/2023 03/04/202403/05/2024
Contract DetailLOVELACE ST MICHAELS PHARMACY  465 ST MICHAELS DR SUITE# 112
SANTA FENM8750501/02/201404/01/2014 11/18/201608/08/2017
Contract DetailONCO360  4041 HADLEY ROAD
SOUTH PLAINFIELDNJ0708007/14/201410/01/2014 08/26/202008/26/2020
Contract DetailONCOMED PHARMACEUTICAL SERVICES OF MA, IONCOMED 150 BEAR HILL ROAD
WALTHAMMA0245107/14/201410/01/2014 05/30/201805/30/2018
Contract DetailONCOMED PHARMACEUTICAL SERVICES OF MA, LD/B/A ONCO360 335 BEAR HILL RD
STE 2100 		WALTHAMMA0245104/14/201507/01/2015 07/01/201508/08/2017
Contract DetailONCOMED THE ONCOLOGY PHARMACY OF BUFFALOD/B/A ONCO360 140 JOHN JAMES AUDUBON PKWY STE 101
AMHERSTNY1422807/14/201410/01/2014  08/08/2017
Contract DetailONCOMED THE ONCOLOGY PHARMACY OF PHILADELLC DBA ONCO360 1553 CHESTER PIKE SUITE 206
CRUM LYNNEPA1902207/14/201410/01/2014 05/30/201805/30/2018
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191304/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 100, INC.25 POST RD STE 5
ALBANYNY12205-675104/15/202006/08/2020 07/01/202208/25/2022
Contract DetailOPTUM INFUSION SERVICES 101, INC.931 CONKLIN ST STE D
FARMINGDALENY11735-242904/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 203 INC9984 PREMIER PKWY
MIRAMARFL33025-320904/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 204, INC8509 BENJAMIN RD STE A
TAMPAFL33634-122404/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 204, INC4220 EXECUTIVE CIRCLE, SUITE 62
FORT MYERSFL3391604/15/202006/08/2020 07/01/202208/25/2022
Contract DetailOPTUM INFUSION SERVICES 204, INC.826 CREIGHTON RD, UNIT A-103
PENSACOLAFL3250404/15/202006/08/2020 07/01/202208/25/2022
Contract DetailOPTUM INFUSION SERVICES 302, LLC8720 S 114TH ST STE 106
LA VISTANE68128-558504/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/15/202006/08/2020  06/08/2020
Contract DetailOPTUM INFUSION SERVICES 305, LLC11211 INDUSTRIPLEX BLVD STE 900
BATON ROUGELA70809-417804/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC4000 CHEMICAL RD STE 100
PLYMOUTH MEETINGPA1946204/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 308, LLC485 N JUNIPER DR STE 2
CHANDLERAZ8522604/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 308, LLC2420 COMANCHE RD NE STE A5
ALBUQUERQUENM87107-475404/15/202006/08/2020 07/01/202208/25/2022
Contract DetailOPTUM INFUSION SERVICES 308, LLC6547 S RACINE CIR STE 300
CENTENNIALCO8011104/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 401, LLC4610 NORTHGATE BLVD. STE. 130
SACRAMENTOCA95834-115404/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 500, INC8400 ESTERS BLVD STE 185
IRVINGTX75063-286404/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 500, INC5627 UNIVERSITY HTS STE 105
SAN ANTONIOTX78249-358304/15/202006/08/2020 07/01/202208/25/2022
Contract DetailOPTUM INFUSION SERVICES 500, INC2182 DIVIDEND DR
COLUMBUSOH43228-380604/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 500, INC.4620 S SAM HOUSTON PKWY W STE 440
HOUSTONTX7705304/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM INFUSION SERVICES 500, INC.4900 RIVERGRADE RD STE E120
IRWINDALECA91706-141904/15/202006/08/2020 07/01/202208/25/2022
Contract DetailOPTUM INFUSION SERVICES 550, LLC1819 ASTON AVE STE 104
CARLSBADCA9200810/05/202201/01/2023  01/01/2023
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/06/202204/13/2022 07/23/202408/07/2024
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520410/04/202401/01/2025  01/01/2025
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/15/202006/08/2020  06/08/2020
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824904/15/202006/08/2020  06/08/2020
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/15/202006/08/2020  06/08/2020
Contract DetailOPTUM PHARMACY 705, LLC11142 RENNER BLVD
LENEXAKS6621904/15/202006/08/2020 07/01/202208/25/2022
Contract DetailOPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970504/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265504/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110104/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140104/15/202006/08/2020 07/23/202408/07/2024
Contract DetailOPTUM PHARMACY 800, INC.3016 GUADALUPE ST STE A
AUSTINTX78705-286101/15/201604/01/2016 07/01/202209/09/2022
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508505/20/202006/08/2020  06/08/2020
Contract DetailOPTUM PHARMACY 806, INC.2288 AUBURN BLVD STE. 102
SACRAMENTOCA95821-161804/15/202006/08/2020 07/01/202209/09/2022
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660804/15/202006/08/2020 07/01/202208/25/2022
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983804/15/202006/08/2020  06/08/2020
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/14/202201/01/2023  02/01/2023
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255005/02/202305/05/2023 08/14/202410/04/2024
Contract DetailRANDALLS FOOD AND DRUGS LPRANDALLS PHARMACY #3067 5161 SAN FELIPE
HOUSTONTX7705601/12/201804/01/2018  01/12/2018
Contract DetailRANDALLS FOOD AND DRUGS LPRANDALLS PHARMACY #2483 715 S. EXPOSITION
AUSTINTX7870301/12/201804/01/2018  01/12/2018
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500205/02/202305/05/2023 08/14/202410/04/2024
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1930 8071 GUIDE MERIDIAN ROAD
LYNDENWA9826401/12/201804/01/2018  01/12/2018
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1681 1301 MAIN STREET
ALAMOSACO8110101/12/201804/01/2018  01/12/2018
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #0722 457 W MAIN ST
TRINIDADCO8108201/12/201804/01/2018  01/12/2018
Contract DetailSANTA BARBARA SPECIALTY PHARMACYSANTA BARBARA SPECIALTY PHARMACY LLC DBA 4690 CARPINTERIA AVE STE B
CARPINTERIACA93013-187505/02/202307/01/2023 05/02/202305/02/2023
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301305/02/202305/05/2023 08/14/202410/04/2024
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104207/14/201410/01/2014  08/08/2017
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022304/14/201507/01/2015  08/08/2017
Contract DetailSMITH'S FOOD & DRUG CTRSSMITH'S PHARMACY #467 751 TRINITY DRIVE
SUITE 100 		LOS ALAMOSNM8754401/02/201404/01/2014 11/18/201608/08/2017
Contract DetailSMITH'S FOOD & DRUG CTRSSMITH'S PHARMACY #467 751 TRINITY DRIVE
SUITE 100 		LOS ALAMOSNM8754410/14/202201/01/2023 01/25/202501/30/2025
Contract DetailSMITH'S FOOD & DRUG CTRS INCSMITH'S PHARMACY #491 2110 S PACHECO ST
SANTA FENM8750501/02/201404/01/2014 11/18/201608/08/2017
Contract DetailSMITH'S FOOD & DRUG CTRS INCSMITH'S PHARMACY #491 2110 S PACHECO ST
SANTA FENM8750510/14/202201/01/2023 01/25/202501/30/2025
Contract DetailSMITHS FOOD & DRUG CENTERSSMITH'S PHARMACY #461 2308 CERRILLOS ROAD
SANTA FENM8750501/02/201404/01/2014 11/18/201608/08/2017
Contract DetailSMITHS PHARMACY #43231 SHERWOOD BLVD
WHITE ROCKNM8754701/02/201404/01/2014 11/18/201608/08/2017
Contract DetailSORKIN'S RX LTDD/B/A CAREMED PHARMACEUTICAL SERVICES 1985 MARCUS AVE STE 130
NEW HYDE PARKNY11042-202404/12/201807/01/2018  04/12/2018
Contract DetailTURQUOISE LTDDEL NORTE PHARMACY 1691 GALISTEO ST
SANTA FENM8750501/02/201404/01/2014 11/18/201608/08/2017
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #987 3001 S SAINT FRANCIS DR
SANTA FENM8750501/12/201804/01/2018 02/03/202502/12/2025
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #922 6600 CENTRAL AVENUE SW
ALBUQUERQUENM8712101/12/201804/01/2018  01/12/2018
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #905 2910 JUAN TABO BLVD NE
ALBUQUERQUENM8711201/12/201804/01/2018  01/12/2018
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #938 7101 WYOMING BLVD. N.E.
ALBUQUERQUENM8710901/12/201804/01/2018  01/12/2018
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #915 6200 COORS BLVD NW
ALBUQUERQUENM8712001/12/201804/01/2018  01/12/2018
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #911 2801 A EUBANK BLVD
ALBUQUERQUENM8711201/12/201804/01/2018  01/12/2018
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #928 11825 LOMAS BLVD. N.E
ALBUQUERQUENM8711201/12/201804/01/2018  01/12/2018
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #917 1625 RIO BRAVO BLVD SW
ALBUQUERQUENM8710501/12/201804/01/2018  01/12/2018
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #937 10131 COORS BLVD NW
ALBUQUERQUENM8711401/12/201804/01/2018  01/12/2018
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #939 12201 ACADEMY RD N E
ALBUQUERQUENM8711101/12/201804/01/2018  01/12/2018
Contract DetailUNITED SUPERMARKETS, LLCALBERTSONS MARKET PHARMACY #920 710A PASEO DEL PUEBLO SUR
TAOSNM8757101/12/201804/01/2018 02/03/202502/12/2025
Contract DetailUNITED SUPERMARKETS, LLCMARKET STREET PHARMACY #927 600 N GUADALUPE ST
SANTA FENM8750101/12/201804/01/2018  01/12/2018
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/09/201701/01/2018  10/09/2017
Contract DetailWAL-MART PHARMACY 10-08293251 CERRILLOS ROAD
SANTA FENM8750701/02/201404/01/2014  08/08/2017
Contract DetailWAL-MART PHARMACY 10-13802609 7TH ST
LAS VEGASNM8770110/09/201701/01/2018  10/09/2017
Contract DetailWAL-MART PHARMACY 10-26561610 N RIVERSIDE DRIVE
ESPANOLANM8753201/02/201404/01/2014 11/18/201608/08/2017
Contract DetailWAL-MART PHARMACY 10-34235701 HERRERA DRIVE
SANTA FENM8750701/02/201404/01/2014  08/08/2017
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/09/201701/01/2018  10/09/2017
Contract DetailWALGREEN ARIZONA DRUG CO.WALGREENS CENTRAL FILL #21372 120 N 83RD AVE
STE 200 		TOLLESONAZ8535307/08/202110/01/2021  10/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 03934 3298 CERRILLOS RD
SANTA FENM8750701/07/201404/01/2014  08/08/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05157 1115 N. RIVERSIDE DR.
ESPANOLANM8753201/07/201404/01/2014  08/08/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06346 525 W ZIA ROAD
SANTA FENM8750501/07/201404/01/2014  08/08/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #12005 5721 AIRPORT RD.
SANTA FENM8750701/07/201404/01/2014  08/08/2017
Contract DetailWALGREEN HASTINGS CO.DBA: WALGREENS # 02425 620 MILLS AVE
LAS VEGASNM8770101/07/201404/01/2014 11/18/201608/08/2017
Contract DetailWALGREEN HASTINGS CO.DBA: WALGREENS # 02900 1096 S. ST FRANCIS DR
SANTA FENM8750501/07/201404/01/2014  08/08/2017
Contract DetailWALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528401/07/201404/01/2014 11/18/201608/08/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700810/16/201701/01/2018 11/23/202111/23/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/08/202110/01/2021  10/01/2021
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/13/202307/01/2023  07/01/2023
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/16/202301/01/2024  01/01/2024
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH320002AAChildDSHST. VINCENT HOSPITALCHRISTUS ST. VINCENT ORTHOPEDIC SPE - Clinic2968 RODEO PARK DR WSANTA FENMActive
DSH320002ABChildDSHST. VINCENT HOSPITALNM Heart - Cardiology Services2237 Trinity Dr.Los AlamosNMActive
DSH320002ACChildDSHST. VINCENT HOSPITALCHRISTUS ST VINCENT LOS ALAMOS - Outpatient Procedures2237 TRINITY DRLOS ALAMOSNMActive
DSH320002ADChildDSHST. VINCENT HOSPITALCHRISTUS ST VINCENT NEUROLOGY SPEC - Neurology1631 HOSPITAL DRSANTA FENMActive
DSH320002BChildDSHST. VINCENT HOSPITALPhysicians Medical Center - Surgical Services2990 Rodeo Park Drive EastSanta FeNMActive
DSH320002CChildDSHST. VINCENT HOSPITALPhysicians Medical Center - OR Recovery2990 Rodeo Park Drive EastSanta FeNMActive
DSH320002DChildDSHST. VINCENT HOSPITALPhysicians Medical Center - OR Anesthesia2990 Rodeo Park Drive EastSanta FeNMActive
DSH320002JChildDSHST. VINCENT HOSPITALRegional Cancer Center - Radiation Oncology490 A West Zia RoadSanta FeNMActive
DSH320002KChildDSHST. VINCENT HOSPITALRegional Cancer Center - Medical Oncology490 A West Zia RoadSanta FeNMActive
DSH320002LChildDSHSt. Vincent HospitalHyperbaric Oxygen Therapy465 St. Michael's DriveSanta FeNMTerminated
DSH320002MChildDSHSt. Vincent HospitalWound Care Center465 St. Michael's DriveSanta FeNMTerminated
DSH320002NChildDSHSt. Vincent HospitalAnticoagulation Management Service465 St. Michael's DriveSanta FeNMTerminated
DSH320002PChildDSHST. VINCENT HOSPITALNM Heart and Vascular Institute - Radiology2085 S. Pacheco St.Santa FeNMTerminated
DSH320002QChildDSHST. VINCENT HOSPITALNM Heart and Vascular Institute - Cardiology2085 S. Pacheco St.SANTA FENMTerminated
DSH320002RChildDSHST. VINCENT HOSPITALNM Heart and Vascular Institute - Administration2085 S. Pacheco St.Santa FeNMTerminated
DSH320002SChildDSHST. VINCENT HOSPITALCHRISTUS ST VINCENT MEDICATION MANAGEMENT SERVICES CLINIC465 ST MICHAELS DRIVE SUITE 114SANTA FENMActive
DSH320002TChildDSHST. VINCENT HOSPITALCHRISTUS ST VINCENT WOUND AND HYPER465 ST MICHAELS DRIVE SUITE 101SANTA FENMActive
DSH320002UChildDSHST. VINCENT HOSPITALCHRISTUS St. Vincent Heart & Vascular Center1631 Hospital DriveSANTA FENMActive
DSH320002VChildDSHST. VINCENT HOSPITALST VINCENT Entrada Contenta Emergency Services - Free Standing Emergency Department5501 Herrera DriveSanta FeNMTerminated
DSH320002WChildDSHST. VINCENT HOSPITALCHRISTUS ST VINCENT MEDICATION MANAGEMENT SERVICES CLINIC - MEDICATION MANAGEMENT SERVICES CLINIC465 SAINT MICHAELS DRSanta FeNMTerminated
DSH320002XChildDSHST. VINCENT HOSPITALCHRISTUS ST VINCENT PAIN & SPINE SP - Pain and Spine2990 Rodeo Park Dr. ESanta FeNMActive
DSH320002YChildDSHST. VINCENT HOSPITALCHRISTUS ST VINCENT ENT SPECIALISTS - ENT1631 HOSPITAL DRSANTA FENMActive
DSH320002ZChildDSHST. VINCENT HOSPITALCHRISTUS St. Vincent Urology - Clinic465 SAINT MICHAELS DRSANTA FENMActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/18/2023 10:25:59 AM8/23/2024 1:12:08 PM8/23/2024 1:12 PM
DetailsLast Recertification DateUpdateRecertification8/31/2022 4:22:34 PM8/18/2023 10:25:59 AM8/18/2023 10:25 AM
DetailsLast Recertification DateUpdateRecertification8/16/2021 1:55:22 PM8/31/2022 4:22:34 PM8/31/2022 4:22 PM
DetailsLast Recertification DateUpdateRecertification8/26/2020 3:20:06 PM8/16/2021 1:55:22 PM8/16/2021 1:55 PM
Medicaid BillingNPI: StateUpdateRecertification NM8/26/2020 3:20 PM
DetailsLast Recertification DateUpdateRecertification9/2/2019 3:52:17 PM8/26/2020 3:20:06 PM8/26/2020 3:20 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/1/2020 1:34 PM
Medicaid BillingMedicaid: NumberInsertChange Request 005476/1/2020 1:34 PM
Medicaid BillingMedicaid: StateInsertChange Request NM6/1/2020 1:34 PM
Medicaid BillingNPI: NumberInsertChange Request 15785871506/1/2020 1:34 PM
DetailsLast Recertification DateUpdateRecertification8/22/2018 2:04:21 PM9/2/2019 3:52:17 PM9/2/2019 3:52 PM
DetailsLast Recertification DateUpdateRecertification11/9/2017 7:57:30 AM8/22/2018 2:04:21 PM8/22/2018 2:04 PM
ContactsAuthorizing OfficialUpdateAO Change RequestCarrier, Patrick B. President & CEO St. Vincent Hospital 5059135202Montoya, Lillian President and CEO St. Vincent Hospital 50591352587/16/2018 3:24 PM
DetailsLast Recertification DateUpdateRecertification8/25/2016 12:00:00 AM11/9/2017 7:57:30 AM11/9/2017 7:57 AM
ContactsPrimary ContactUpdateRecertificationAtwell, Christine Director of Pharmacy 5059135522Atwell, Christine Director of Pharmacy St. Vincent Hospital 505913552211/8/2017 3:52 PM
ContactsAuthorizing OfficialUpdate Carrier, Patrick B. President & CEO 5059135202Carrier, Patrick B. President & CEO St. Vincent Hospital 50591352029/25/2017 11:35 AM
ContactsAuthorizing OfficialInsert  Carrier, Patrick B. President & CEO 50591352028/9/2017 4:01 PM
ContactsPrimary ContactInsert  Atwell, Christine Director of Pharmacy 50591355228/9/2017 4:01 PM
AddressesMain AddressInsert   455 ST. MICHAELS DRIVE SANTA FE, NM 875058/8/2017 9:58 AM
AddressesShipping AddressInsert  ST. VINCENT HOSPITAL 455 ST. MICHAELS DRIVE Santa Fe, NM 875058/8/2017 9:58 AM
AddressesShipping AddressInsert  Christus St. Vincent Outpatient Pharmacy 465 St. Michaels Drive #112 Santa Fe, NM 875058/8/2017 9:58 AM
DetailsLast Recertification DateUpdate 8/14/2015 12:00:00 AM8/25/2016 12:00:00 AM8/26/2016 10:23 AM
DetailsLast Recertification DateUpdate 8/14/2014 12:00:00 AM8/14/2015 12:00:00 AM8/14/2015 3:45 PM
TerminationsTermination CommentsUpdate failure to recertify 3/23/2015 2:43 PM
DetailsLast Recertification DateUpdate 9/14/2013 12:00:00 AM8/14/2014 12:00:00 AM8/14/2014 2:48 PM
DatesLast Date That 340B Drugs PurchasedUpdate 10/1/2013 12:00:00 AM 11/19/2013 12:52 PM
DetailsStateUpdate TerminatedActive11/19/2013 12:52 PM
DatesStart DateUpdate 10/1/2004 12:00:00 AM1/1/2014 12:00:00 AM11/19/2013 12:52 PM
TerminationsTermination DateUpdate 10/1/2013 12:00:00 AM 11/19/2013 12:52 PM
TerminationsTermination Effective DateUpdate 10/1/2013 12:00:00 AM 11/19/2013 12:52 PM
TerminationsTermination ReasonUpdate Failure to recertify 11/19/2013 12:52 PM
DetailsComments PublicInsert  11/19/13 enrolled 10/1/2004 thru 9/30/13, not enrolled 10/1/13 thru 12/31/13 due to failure to recertify, reinstated based on on-line registration submitted in Oct. 2013; 6/27/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS11/19/2013 12:52 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/14/2013 12:00:00 AM9/14/2013 6:56 AM
DatesLast Date That 340B Drugs PurchasedUpdate  10/1/2013 12:00:00 AM9/14/2013 6:56 AM
DetailsStateUpdate ActiveTerminated9/14/2013 6:56 AM
TerminationsTermination CommentsUpdate  failure to recertify9/14/2013 6:56 AM
TerminationsTermination DateUpdate  10/1/2013 12:00:00 AM9/14/2013 6:56 AM
TerminationsTermination Effective DateUpdate  10/1/2013 12:00:00 AM9/14/2013 6:56 AM
TerminationsTermination ReasonUpdate  Failure to recertify9/14/2013 6:56 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/30/2012 7:50 AM
DetailsLast Recertification DateInsert   7/6/2011 4:27 PM
DetailsGrant NumberInsert   7/6/2011 4:27 PM
Details340B IDInsert  DSH3200027/6/2011 4:27 PM
DetailsIs Authorizing Official EHB DataInsert   7/6/2011 4:27 PM
DatesLast Date That 340B Drugs PurchasedInsert   7/6/2011 4:27 PM
DetailsMedicare Provider NumberInsert  3200027/6/2011 4:27 PM
DetailsEntity NameInsert  ST. VINCENT HOSPITAL7/6/2011 4:27 PM
DetailsProgram CodeInsert  DSH7/6/2011 4:27 PM
DetailsEntity SubnameInsert   7/6/2011 4:27 PM
DatesParticipating Approval DateInsert  7/16/2008 12:00:00 AM7/6/2011 4:27 PM
DetailsStateInsert  Active7/6/2011 4:27 PM
DatesRegistration DateInsert  7/16/2008 12:00:00 AM7/6/2011 4:27 PM
DatesSigned By DateInsert  8/13/2007 12:00:00 AM7/6/2011 4:27 PM
DatesStart DateInsert  10/1/2004 12:00:00 AM7/6/2011 4:27 PM
TerminationsTermination CommentsInsert   7/6/2011 4:27 PM
TerminationsTermination DateInsert   7/6/2011 4:27 PM
TerminationsTermination Effective DateInsert   7/6/2011 4:27 PM
TerminationsTermination ReasonInsert   7/6/2011 4:27 PM
DetailsComments PublicInsert  6/27/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS7/6/2011 4:27 PM
DetailsComments PublicInsert  6/27/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS7/6/2011 4:27 PM