Covered Entity Details

DSH450431A ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER (Terminated) - information as of 6/22/2025 12:06:36 AM

Main Details

Name

ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER

Subdivision Name

HEART HOSPITAL OF AUSTIN A CAMPUS OF ST DAVID'S MEDICAL CENTER

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450431A

Medicare Provider Number

450431

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

3/11/2011

Participating Start Date

7/1/2011

Participating Approval Date

6/14/2011

Last Recertification Date

12/4/2017

Termination Date
Termination Reason

4/1/2018
Other

Contacts

Authorizing Official

St Davids Medical Center
Todd Steward, CEO
(512) 544-4215

Primary Contact

Heart Hospital of Austin
MIKE MATTHEWS, DIRECTOR OF PHARMACY
(512) 407-7555

Addresses

Street Address

3801 N LAMAR
AUSTIN, TX 78756

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
TX	094160103
		1720033947

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
DSH450431A	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	HEART HOSPITAL OF AUSTIN A CAMPUS OF ST DAVID'S MEDICAL CENTER	3801 N LAMAR	AUSTIN	TX	Terminated
DSH450431AA	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Ultrasound	3801 N Lamar Blvd	Austin	TX	Active
DSH450431AB	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - MRI	3801 N Lamar Blvd	Austin	TX	Active
DSH450431AC	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Labor/Delivery	2000 Scenic Dr.	Georgetown	TX	Active
DSH450431AD	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Nuclear Medicine	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AE	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Mammography	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AF	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St. Davids Georgetown Hospital - Anesthesia	2000 Scenic Dr.	Georgetown	TX	Active
DSH450431AG	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - CT Scan	2000 Scenic Dr.	Georgetown	TX	Active
DSH450431AH	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Hemodialysis	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AJ	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Surgery	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AK	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Speech Pathology	2000 Scenic Dr.	Georgetown	TX	Active
DSH450431AL	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St. Davids Georgetown Hospital - Recovery Room	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AM	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Emergency Department	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AN	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Pathology	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AP	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Rehabilitation - Sun City	400 Del Webb Blvd	Georgetown	TX	Active
DSH450431AQ	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Endoscopy	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AR	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Occupational Therapy	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AS	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Ultrasound	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AT	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - ECHO	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AU	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St. Davids Georgetown Hospital - Cardiac Rehabilitation	2000 Scenic Dr.	Georgetown	TX	Active
DSH450431AV	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Physical Therapy	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AW	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St. David's Georgetown Hospital - Operating Room	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AX	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - EKG	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AY	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - MRI	2000 Scenic Dr	Georgetown	TX	Active
DSH450431AZ	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Respiratory Therapy	2000 Scenic Dr	Georgetown	TX	Active
DSH450431B	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	CARDIOVASCULAR IMAGING CENTER	2200 PARK BEND DRIVE	AUSTIN	TX	Active
DSH450431BA	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Rehabilitation - Lake Air	2423 Williams Dr	Georgetown	TX	Active
DSH450431BB	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St Davids Georgetown Hospital - Radiology Diagnostic	2000 Scenic Dr	Georgetown	TX	Active
DSH450431BC	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Pathology	3801 N Lamar Blvd	Austin	TX	Active
DSH450431BD	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Physical	3801 N Lamar Blvd	Austin	TX	Active
DSH450431BE	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - EP	3801 N Lamar Blvd	Austin	TX	Active
DSH450431BF	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Laboratory	3801 N Lamar Blvd	Austin	TX	Active
DSH450431BG	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - EKG	3801 N Lamar Blvd	Austin	TX	Active
DSH450431BH	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St. David's Georgetown Hospital - Laboratory	2000 Scenic Drive	Georgetown	TX	Active
DSH450431BJ	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St. David's - Spine and Sports Therapy	3000 N IH 35	Austin	TX	Active
DSH450431C	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	CARDIOVASCULAR IMAGING CENTER	4316 JAMES CASEY STREET	AUSTIN	TX	Active
DSH450431D	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	CARDIOVASCULAR IMAGING CENTER	1015 EAST 32ND STREET	AUSTIN	TX	Active
DSH450431E	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	CARDIOVASCULAR IMAGING CENTER	1330 WONDER WORLD DRIVE	SAN MARCOS	TX	Active
DSH450431F	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	CARDIOVASCULAR IMAGING CENTER	2559 WESTERN TRAILS BLVD.	AUSTIN	TX	Active
DSH450431G	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	CARDIOVASCULAR IMAGING CENTER	3801 N. LAMAR BOULEVARD	AUSTIN	TX	Active
DSH450431H	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Hemodialysis	3801 N Lamar Blvd	Austin	TX	Active
DSH450431J	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - GI Lab	3801 N Lamar Blvd	Austin	TX	Active
DSH450431K	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Cat Scan	3801 N Lamar Blvd	Austin	TX	Active
DSH450431L	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Day Patient	3801 N Lamar Blvd	Austin	TX	Active
DSH450431M	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Sleep Lab	3801 N Lamar Blvd	Austin	TX	Active
DSH450431N	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - ICU	3801 N Lamar Blvd	Austin	TX	Active
DSH450431P	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Emergency Department	3801 N Lamar Blvd	Austin	TX	Active
DSH450431Q	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Cath Lab	3801 N Lamar Blvd	Austin	TX	Active
DSH450431R	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Surgery	3801 N Lamar Blvd	Austin	TX	Active
DSH450431S	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Executive Wellness	3801 N Lamar Blvd	Austin	TX	Active
DSH450431T	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Nuclear Medicine	3801 N Lamar Blvd	Austin	TX	Active
DSH450431U	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Respiratory Therapy	3801 N Lamar Blvd	Austin	TX	Active
DSH450431V	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Anesthesia	3801 N Lamar Blvd	Austin	TX	Active
DSH450431W	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - Radiology	3801 N Lamar Blvd	Austin	TX	Active
DSH450431X	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - PCU	3801 N Lamar Blvd	Austin	TX	Active
DSH450431Y	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	St. David's Wound Care/HBO - Wound Care/HBO	900 E. 30th Street	Austin	TX	Terminated
DSH450431Z	Child	DSH	ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	Heart Hospital of Austin - PACU	3801 N Lamar Blvd	Austin	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Huffine, Daniel CFO St. David's Medical Center 5125445030	Steward, Todd CEO St Davids Medical Center 5125444215	5/29/2020 11:32 AM
Contacts	Authorizing Official	Update	Change Request	Perez, Julie CFO St. David's Medical Center 5125445030	Huffine, Daniel CFO St. David's Medical Center 5125445030	8/14/2018 12:32 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		3/31/2018 12:00:00 AM	2/21/2018 11:55 AM
Details	State	Update	Termination Request	Active	To Be Terminated	2/21/2018 11:55 AM
Terminations	Termination Comments	Update	Termination Request		Registered services separately effective 4/1/18; terminating original registration	2/21/2018 11:55 AM
Terminations	Termination Date	Update	Termination Request		4/1/2018 12:00:00 AM	2/21/2018 11:55 AM
Terminations	Termination Effective Date	Update	Termination Request		4/1/2018 12:00:00 AM	2/21/2018 11:55 AM
Terminations	Termination Reason	Update	Termination Request		Other	2/21/2018 11:55 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	H0454314	094160103	1/24/2018 2:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/12/2018 3:38 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		H0454314	1/12/2018 3:38 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	1/12/2018 3:38 PM
Medicaid Billing	NPI: Number	Update	Change Request	1184661217	1720033947	1/12/2018 3:38 PM
Details	Last Recertification Date	Update	Recertification	9/6/2016 12:00:00 AM	12/4/2017 4:19:50 PM	12/4/2017 4:19 PM
Contacts	Primary Contact	Update	Recertification	MATTHEWS, MIKE DIRECTOR OF PHARMACY 5124077555	MATTHEWS, MIKE DIRECTOR OF PHARMACY Heart Hospital of Austin 5124077555	12/4/2017 4:19 PM
Contacts	Authorizing Official	Update		Perez, Julie CFO 5125445030	Perez, Julie CFO St. David's Medical Center 5125445030	12/4/2017 2:13 PM
Contacts	Authorizing Official	Update		Perez, Julie CFO 5125444030	Perez, Julie CFO 5125445030	9/11/2017 3:29 PM
Addresses	Main Address	Insert			3801 N LAMAR AUSTIN, TX 78756	9/6/2016 12:47 PM
Contacts	Authorizing Official	Update		BROUILLETTE, CINDY CFO 5125444080-44080	Perez, Julie CFO 5125444030	9/6/2016 12:47 PM
Contacts	Primary Contact	Insert			MATTHEWS, MIKE DIRECTOR OF PHARMACY 5124077555	9/6/2016 12:47 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	9/6/2016 12:00:00 AM	9/6/2016 12:47 PM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 4:46 PM
Details	Last Recertification Date	Update		9/11/2013 12:00:00 AM	8/7/2014 12:00:00 AM	8/7/2014 2:47 PM
Details	Last Recertification Date	Update			9/11/2013 12:00:00 AM	9/11/2013 10:03 AM
Contacts	Authorizing Official	Insert			BROUILLETTE, CINDY CFO 5125444080-44080	6/14/2011 9:26 AM
Details	Last Recertification Date	Insert				6/14/2011 9:26 AM
Details	Grant Number	Insert				6/14/2011 9:26 AM
Details	340B ID	Insert			DSH450431A	6/14/2011 9:26 AM
Details	Is Authorizing Official EHB Data	Insert				6/14/2011 9:26 AM
Dates	Last Date That 340B Drugs Purchased	Insert				6/14/2011 9:26 AM
Details	Medicare Provider Number	Insert			450431	6/14/2011 9:26 AM
Details	Entity Name	Insert			ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP, DBA ST. DAVID'S MEDICAL CENTER	6/14/2011 9:26 AM
Details	Program Code	Insert			DSH	6/14/2011 9:26 AM
Details	Entity Subname	Insert			HEART HOSPITAL OF AUSTIN A CAMPUS OF ST DAVID'S MEDICAL CENTER	6/14/2011 9:26 AM
Dates	Participating Approval Date	Insert			6/14/2011 12:00:00 AM	6/14/2011 9:26 AM
Details	State	Insert			Active	6/14/2011 9:26 AM
Dates	Registration Date	Insert			3/11/2011 12:00:00 AM	6/14/2011 9:26 AM
Dates	Signed By Date	Insert			3/11/2011 12:00:00 AM	6/14/2011 9:26 AM
Dates	Start Date	Insert			7/1/2011 12:00:00 AM	6/14/2011 9:26 AM
Terminations	Termination Comments	Insert				6/14/2011 9:26 AM
Terminations	Termination Date	Insert				6/14/2011 9:26 AM
Terminations	Termination Effective Date	Insert				6/14/2011 9:26 AM
Terminations	Termination Reason	Insert				6/14/2011 9:26 AM
Medicaid Billing	NPI: Number	Insert			1184661217	3/11/2011 1:10 PM