Covered Entity Details

DSH370091 Saint Francis Hospital (Active) - information as of 5/26/2025 12:58:39 AM

Main Details

Name

Saint Francis Hospital

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH370091

Medicare Provider Number

370091

Additional Details

Current Program Status

Active

Registration Date

2/2/2012

Participating Start Date

4/1/2012

Participating Approval Date

3/30/2012

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Saint Francis Health System
Deborah D Dage, SRVP/Chief Financial Officer
(918) 494-8418

Primary Contact

Saint Francis Health System
Theodore Houston, Manager Pharmacy Financials and 340B Program
(918) 494-1862

Addresses

Street Address

6161 South Yale Avenue
Tulsa, OK 74136

Billing Address

Saint Francis Health System
Att: Accounts Payable
PO BOX 707004
Tulsa, OK 74170-7004

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
OK	100699570A	1144228487

Shipping Addresses

Shipping Address 1

SAINT FRANCIS ONCOLOGY PHARMACY
11212 E 48TH ST
Suite A
Tulsa, OK 74146

Shipping Address 2

SAINT FRANCIS OUTPATIENT PHARMACY
6161 S YALE AVE
B LEVEL BLUE NORTH
TULSA, OK 74136

Shipping Address 3

SAINT FRANCIS WARREN CLINIC TOWER PHARMACY
6600 S YALE AVE
SUITE 110
TULSA, OK 74136

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/07/2024	01/01/2025		01/01/2025
Contract Detail	ACCREDO HEALTH GROUP INC	2410 WARDLOW RD	STE 101	CORONA	CA	92878	10/07/2024	01/01/2025		01/01/2025
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/07/2024	01/01/2025		01/01/2025
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/07/2024	01/01/2025		01/01/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/07/2024	01/01/2025		01/01/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/07/2024	01/01/2025		01/01/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	11411 STRANG LINE RD	STE A	LENEXA	KS	66215	10/07/2024	01/01/2025		01/01/2025
Contract Detail	ACRO PHARMACEUTICAL SERVICES LLC	ACRO PHARMACEUTICAL SERVICES LLC	313 HENDERSON DR	SHARON HILL	PA	19079	10/17/2016	01/01/2017	02/01/2017	01/26/2017
Contract Detail	ALL SAINTS CANCER PHARMACY		11212 E 48TH STREET	TULSA	OK	74146	10/14/2014	01/01/2015	12/31/2016	02/12/2017
Contract Detail	ALL SAINTS HOME MEDICAL, LLC	6600 SOUTH YALE, SUITE 110		TULSA	OK	74136	10/15/2013	01/01/2014	12/31/2016	02/12/2017
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/14/2023	07/01/2023		07/01/2023
Contract Detail	COMMCARE PHARMACY-FTL, LLC	855 SW 78TH AVE STE C100		PLANTATION	FL	33324-3223	10/14/2016	01/01/2017	02/01/2017	01/26/2017
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/14/2023	07/01/2023		07/01/2023
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/14/2020	01/01/2021		01/01/2021
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	01/17/2017	04/01/2017	12/31/2017	01/26/2018
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	G3320 BEECHER RD		FLINT	MI	48532-3614	01/17/2017	04/01/2017	12/31/2017	01/26/2018
Contract Detail	ECONOMY PHARMACY EXPRESS	10120 E 91ST ST		TULSA	OK	74133	10/14/2019	01/01/2020		01/01/2020
Contract Detail	ECONOMY PHARMACY ST. FRANCIS	6585 S YALE AVE STE 102		TULSA	OK	74136-8384	10/14/2019	01/01/2020	03/31/2022	04/25/2022
Contract Detail	HOOK-SUPERX, L.L.C.	CVS/PHARMACY #11114	2800 ENTERPRISE ST STE 5	INDIANAPOLIS	IN	46219-1106	04/14/2023	07/01/2023	05/15/2023	06/23/2023
Contract Detail	MAY'S DRUG STORE'S, INC.	WALGREENS #15764	651 E CHARLES PAGE BLVD	SAND SPRINGS	OK	74063	07/14/2015	10/01/2015	10/01/2015	01/13/2016
Contract Detail	MAY'S DRUG STORES, INC.	DBA: WALGREENS #15756	14003 SOUTH HIGHWAY 51	COWETA	OK	74429	07/14/2015	10/01/2015	11/25/2024	12/06/2024
Contract Detail	MAY'S DRUG STORES, INC.	DBA: WALGREENS #15762	11650 EAST 86TH ST NORTH	OWASSO	OK	74055	07/14/2015	10/01/2015		10/26/2015
Contract Detail	MAY'S DRUG STORES, INC.	DBA: WALGREENS #15770	1150 SOUTH GARNETT ROAD	TULSA	OK	74128-1822	07/14/2015	10/01/2015	03/17/2025	03/18/2025
Contract Detail	MAY'S DRUG STORES, INC.	DBA: WALGREENS #15772	2323 WEST EDISON	TULSA	OK	74127	07/14/2015	10/01/2015		10/26/2015
Contract Detail	MAY'S DRUG STORES, INC.	DBA: WALGREENS #15773	3063 SOUTH SHERIDAN	TULSA	OK	74129-1017	07/14/2015	10/01/2015		10/26/2015
Contract Detail	MAY'S DRUG STORES, INC.	DBA: WALGREENS #15778	6336 E 4TH PLACE	TULSA	OK	74112	07/14/2015	10/01/2015	11/09/2021	12/17/2021
Contract Detail	MAY'S DRUG STORES, INC.	DBA: WALGREENS #15780	5115 S PEORIA AVE	TULSA	OK	74105	07/14/2015	10/01/2015	11/25/2024	12/06/2024
Contract Detail	MAY'S DRUG STORES, INC.	DBA: WALGREENS #15810	950 E TAFT AVE	SAPULPA	OK	74066	07/14/2015	10/01/2015	11/25/2024	12/06/2024
Contract Detail	MAY'S DRUG STORES, INC.	DBA: WALGREENS #15811	5046 S. SHERIDAN	TULSA	OK	74145	07/14/2015	10/01/2015	12/16/2024	12/16/2024
Contract Detail	MAY'S DRUG STORES, INC.	DBA: WALGREENS #15812	6505 E. 71ST STREET	TULSA	OK	74133	07/14/2015	10/01/2015	01/24/2024	12/14/2024
Contract Detail	MED-X CORPORATION	DBA: WALGREENS #15776	4423 SOUTHWEST BLVD	TULSA	OK	74107	07/14/2015	10/01/2015		10/26/2015
Contract Detail	MED-X CORPORATION	DBA: WALGREENS #15777	6040 SOUTH YALE AVENUE	TULSA	OK	74135	07/14/2015	10/01/2015		10/26/2015
Contract Detail	MED-X CORPORATION	DBA: WALGREENS #15782	1714 UTICA SQUARE	TULSA	OK	74114	07/14/2015	10/01/2015		10/26/2015
Contract Detail	MED-X CORPORATION	DBA: WALGREENS #15809	4016 S HWY 97	SAND SPRINGS	OK	74063	07/14/2015	10/01/2015		10/26/2015
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07972	4107 S HARVARD AVE	TULSA	OK	74135	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10437	304 NORTH YORK ST.	MUSKOGEE	OK	74403	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10214	511 SOUTH ELM ST.	JENKS	OK	74037	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10976	1701 E. 15TH ST.	TULSA	OK	74104	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY #02324	12902 E. 96TH ST.	OWASSO	OK	74055	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07971	10101 S. MEMORIAL DR.	TULSA	OK	74133	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10273	8010 EAST. 51ST STREET	TULSA	OK	74145	04/14/2023	07/01/2023	05/23/2023	06/23/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10491	3711 E. FRANK PHILLIPS BLVD.	BARTLESVILLE	OK	74006	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10272	100 NORTH JM DAVIS BLVD	CLAREMORE	OK	74017	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17421	7437 S OLYMPIA AVE W	TULSA	OK	74132	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16004	1701 S YALE AVE	TULSA	OK	74112	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10561	6116 SOUTH LEWIS AVE.	TULSA	OK	74136	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01145	751 W. TUCSON ST (121ST)	BROKEN ARROW	OK	74011	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16906	10711 E 71ST ST	TULSA	OK	74133	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 4896	1853 S. ASPEN AVE.	BROKEN ARROW	OK	74012	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08986	7041 S. YALE AVE.	TULSA	OK	74136	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 8263	2110 S. HARVARD AVE.	TULSA	OK	74114	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08279	2351 N. 9TH ST.	BROKEN ARROW	OK	74012	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10012	11223 EAST 31ST ST. SOUTH	TULSA	OK	74146	04/14/2023	07/01/2023	09/07/2022	06/23/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10065	251 S. HIGHWAY 97	SAND SPRINGS	OK	74063	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17479	1150 E HILLSIDE DR	BROKEN ARROW	OK	74012	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17567	10019 S MEMORIAL DR	TULSA	OK	74133	04/14/2023	07/01/2023		07/01/2023
Contract Detail	OKLAHOMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10175	9122 S YALE AVE.	TULSA	OK	74137	04/14/2023	07/01/2023		07/01/2023
Contract Detail	ONCO360	SINA DRUG, LLC	4700 W SAM HOUSTON PKWY N STE 150	HOUSTON	TX	77041	10/16/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	10/16/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM FRONTIER THERAPIES, LLC	325 W ATHERTON RD	SUITE 1	FLINT	MI	48507-2601	10/16/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	10/16/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	10/16/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	10/16/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/16/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	10/16/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	10/16/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/16/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/16/2023	01/01/2024		01/01/2024
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/14/2020	01/01/2021		01/01/2021
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/14/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/14/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/14/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2751	426 S. HENDERSON STREET	FORT WORTH	TX	76104	04/14/2023	07/01/2023		07/01/2023
Contract Detail	SAINT FRANCIS ONCOLOGY PHARMACY	SAINT FRANCIS HOSPITAL, INC	11212 E 48TH ST SUITE A	TULSA	OK	74146	03/03/2017	03/07/2017	05/26/2022	05/26/2022
Contract Detail	SAINT FRANCIS ONCOLOGY PHARMACY	SAINT FRANCIS HOSPITAL, INC	11212 E 48TH ST SUITE A	TULSA	OK	74146	10/08/2023	01/01/2024	03/01/2025	03/03/2025
Contract Detail	SAINT FRANCIS OUTPATIENT PHARMACY	SAINT FRANCIS HOSPITAL, INC	6161 S YALE AVE B LEVEL BLUE NORTH	TULSA	OK	74136	10/14/2019	01/01/2020	03/01/2025	03/03/2025
Contract Detail	SAINT FRANCIS WARREN CLINIC TOWER PHARMA	SAINT FRANCIS PHARMACY SERVICES, INC	6600 S YALE AVE STE 110	TULSA	OK	74136	02/22/2017	03/03/2017	03/01/2025	03/03/2025
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	10/16/2023	01/01/2024		01/01/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS #12160	3751 N ASPEN AVE	BROKEN ARROW	OK	74012	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02361	12802 E 96TH ST NORTH	OWASSO	OK	74055-5371	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03018	3112 S. HARVARD AVE.	TULSA	OK	74135	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03037	11332 EAST 31ST	TULSA	OK	74146	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03038	1440 SOUTH LEWIS	TULSA	OK	74104	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03039	6415 EAST PINE	TULSA	OK	74115	07/10/2015	10/01/2015	03/19/2024	03/19/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03040	701 WEST HOUSTON ST.	BROKEN ARROW	OK	74012	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03051	9106 SOUTH SHERIDAN	TULSA	OK	74133	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03052	2115 S. MEMORIAL DR.	TULSA	OK	74129	07/10/2015	10/01/2015	09/29/2022	06/16/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03258	4971 S. MEMORIAL DR.	TULSA	OK	74145	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03534	4704 SOUTH ELM PLACE	BROKEN ARROW	OK	74011	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03771	7111 S. LEWIS AVE.	TULSA	OK	74136	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04723	11 W TAFT AVE	SAPULPA	OK	74066	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05421	1438 N. LEWIS AVE.	TULSA	OK	74110	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06268	4561 N PEORIA	TULSA	OK	74106	07/10/2015	10/01/2015	03/19/2024	03/19/2024
Contract Detail	WALGREEN CO.	WALGREENS # 06551	4901 W KENOSHA ST	BROKEN ARROW	OK	74012	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06839	11118 S MEMORIAL	BIXBY	OK	74008	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06973	8102 S YALE	TULSA	OK	74137	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07135	10018 S YALE AVENUE	TULSA	OK	74137-6016	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07503	1424 S YALE AVE	TULSA	OK	74112-6216	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07547	3600 W WASHINGTON ST	BROKEN ARROW	OK	74012	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07821	950 E KENOSHA STREET	BROKEN ARROW	OK	74012	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07857	405 E 2ND STREET	SAND SPRINGS	OK	74063-7948	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07858	5104 S LEWIS AVE	TULSA	OK	74105-6542	07/10/2015	10/01/2015	03/28/2023	06/16/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09595	210 S ELM ST	JENKS	OK	74037	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12161	11605 N. 135TH E AVE.	COLLINSVILLE	OK	74021	07/10/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12714	315 N. 193RD EAST AVE.	CATOOSA	OK	74015	07/14/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13059	15111 S. MEMORIAL DR.	BIXBY	OK	74008	07/14/2015	10/01/2015		10/26/2015
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16556	1611 E. 15TH ST.	TULSA	OK	74120	04/12/2018	07/01/2018	01/13/2020	01/16/2020
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16556	1611 E. 15TH ST.	TULSA	OK	74120	01/12/2024	04/01/2024		04/01/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/14/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/14/2020	01/01/2021		01/01/2021

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH370091A	Child	DSH	Saint Francis Hospital	Natalie ASC	6475 South Yale Avenue	Tulsa	OK	Active
DSH370091B	Child	DSH	Saint Francis Hospital	Outpatient Imaging	6605 South Yale Avenue	Tulsa	OK	Active
DSH370091C	Child	DSH	Saint Francis Hospital	Pulmonary Rehab	6585 South Yale Avenue	Tulsa	OK	Active
DSH370091D	Child	DSH	Saint Francis Hospital	Broken Arrow Rehab	2950 South Elm Place Suite 230	Broken Arrow	OK	Active
DSH370091E	Child	DSH	Saint Francis Hospital	Outpatient Imaging	6160 South Yale Avenue	Tulsa	OK	Terminated
DSH370091F	Child	DSH	Saint Francis Hospital	Sleep Lab	6585 South Yale Ave	Tulsa	OK	Active
DSH370091G	Child	DSH	Saint Francis Hospital	SFCC / Radiology	11212 East 48th Street	Tulsa	OK	Active
DSH370091H	Child	DSH	Saint Francis Hospital	SFCC / Outpatient Infusion	11212 East 48th Street	Tulsa	OK	Active
DSH370091J	Child	DSH	Saint Francis Hospital	SAINT FRANCIS HOSPITAL, INC. / Breast Center	6475 S YALE AVE	TULSA	OK	Active
DSH370091K	Child	DSH	Saint Francis Hospital	SFCC - Outpatient Rehab	11212 E 48th Street	TULSA	OK	Active
DSH370091L	Child	DSH	Saint Francis Hospital	SAINT FRANCIS HOSPITAL, INC. - IC CT	6605 S YALE AVE	TULSA	OK	Active
DSH370091M	Child	DSH	Saint Francis Hospital	SAINT FRANCIS HOSPITAL, INC. - IC MRI	6605 S YALE AVE	TULSA	OK	Active
DSH370091N	Child	DSH	Saint Francis Hospital	SAINT FRANCIS HOSPITAL, INC. - Nuclear Medicine	6605 S YALE AVE	TULSA	OK	Terminated
DSH370091P	Child	DSH	Saint Francis Hospital	SFCC / Radiation Oncology - Radiation Oncology	11212 East 48th Street	Tulsa	OK	Active
DSH370091Q	Child	DSH	Saint Francis Hospital	SAINT FRANCIS HOSPITAL, INC. - Radiology - Ultrasound	6605 S YALE AVE	TULSA	OK	Terminated
DSH370091R	Child	DSH	Saint Francis Hospital	Springer - Endoscopy	6160 South Yale Avenue	Tulsa	OK	Active
DSH370091S	Child	DSH	Saint Francis Hospital	SAINT FRANCIS CANCER CENTER PHYSICIAN CLINIC - YALE CAMPUS - Oncology Services	11212 East 48th Street	Tulsa	OK	Active
DSH370091T	Child	DSH	Saint Francis Hospital	SAINT FRANCIS OWASSO - RADIOLOGY	11610 NORTH 137TH EAST AVE	COLLINSVILLE	OK	Active
DSH370091U	Child	DSH	Saint Francis Hospital	Hospice - Hospice	6600 South Yale Avenue	Tulsa	OK	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Insert	Group Change Request		SAINT FRANCIS ONCOLOGY PHARMACY 11212 E 48TH ST Suite A Tulsa, OK 74146	3/3/2025 4:36 PM
Addresses	Shipping Address	Insert	Group Change Request		SAINT FRANCIS OUTPATIENT PHARMACY 6161 S YALE AVE B LEVEL BLUE NORTH TULSA, OK 74136	3/3/2025 4:36 PM
Addresses	Shipping Address	Insert	Group Change Request		SAINT FRANCIS WARREN CLINIC TOWER PHARMACY 6600 S YALE AVE SUITE 110 TULSA, OK 74136	3/3/2025 4:36 PM
Contacts	Primary Contact	Update	PC Change Request	Walker, Robert Douglas Manager, Pharmacy Saint Francis Health System 9184941059	Houston, Theodore Manager Pharmacy Financials and 340B Program Saint Francis Health System 9184941862	10/15/2024 8:31 PM
Details	Last Recertification Date	Update	Recertification	8/23/2023 11:43:54 AM	8/15/2024 1:29:29 PM	8/15/2024 1:29 PM
Addresses	Billing Address	Insert	Group Change Request		Saint Francis Health System Att: Accounts Payable PO BOX 707004 Tulsa, OK 74170-7004	12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1008245105 (AR)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	XHSP31145 (CA)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	XHSP41145 (CA)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	95007951 (CO)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0918540 (IA)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	730700090001 (IL)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	100099860A (KS)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1791148 (LA)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	010853406 (MO)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	73070009000 (NE)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	000A7657 (NM)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0333660 (OH)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	072674701 (TX)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	2062863 (WA)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	126294 (AZ)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	80491800 (WI)		11/17/2023 5:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1790220952 (ME)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (NM)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (MO)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (OH)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (TX)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (IA)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (KS)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (AR)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (AZ)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (LA)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (WA)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (NE)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (IL)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (CO)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (CA)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (WI)		11/17/2023 5:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (ME)		11/17/2023 5:17 PM
Details	Last Recertification Date	Update	Recertification	9/1/2022 6:56:01 AM	8/23/2023 11:43:54 AM	8/23/2023 11:43 AM
Details	Last Recertification Date	Update	Recertification	8/20/2021 7:27:26 AM	9/1/2022 6:56:01 AM	9/1/2022 6:56 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	187686 (AL)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	094564100 (FL)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	100038950A (IN)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	651075200 (MD)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	30-4924037 (MI)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	40-4924046 (MI)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	871555600 (MN)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	00981255 (NY)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	000873548-000 (PA)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	10648B (SC)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0370091 (TN)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	010386322 (VA)		8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1790220952	8/10/2022 9:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ME	8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (PA)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (NY)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (VA)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (TN)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (FL)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (IN)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (SC)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (AL)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (MI)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (MD)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144228487 (MN)		8/10/2022 9:35 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	8/10/2022 9:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		ME	8/10/2022 9:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/8/2022 8:16 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		80491800	7/8/2022 8:16 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	7/8/2022 8:16 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	7/8/2022 8:16 AM
Medicaid Billing	NPI: State	Insert	Change Request		WI	7/8/2022 8:16 AM
Contacts	Authorizing Official	Update	Profile Change Request	Dage, Deborah D Vice President, Finance Saint Francis Hospital, Inc. 9185028119	Dage, Deborah D SRVP/Chief Financial Officer Saint Francis Health System 9184948418	5/30/2022 8:45 AM
Contacts	Authorizing Official	Update	Change Request	Schick, Eric Senior Vice President - Chief Financial Officer Saint Francis Hospital 9184948430	Dage, Deborah D Vice President, Finance Saint Francis Hospital, Inc. 9185028119	10/8/2021 8:46 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 4:47:30 PM	8/20/2021 7:27:26 AM	8/20/2021 7:27 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	9/10/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/10/2020 4:47 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 ( )		9/10/2020 4:47 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 7:20:24 PM	9/10/2020 4:47:30 PM	9/10/2020 4:47 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 12:12:27 AM	8/20/2019 7:20:24 PM	8/20/2019 7:20 PM
Contacts	Primary Contact	Update	Change Request	Hoss, Deborah VP - Finance Saint Francis Hospital 9185028120	Walker, Robert Douglas Manager, Pharmacy Saint Francis Health System 9184941059	6/6/2019 9:50 AM
Details	Last Recertification Date	Update	Recertification	11/17/2017 6:57:48 AM	8/17/2018 12:12:27 AM	8/17/2018 12:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		187686	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1008245105	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		XHSP31145	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		XHSP41145	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		95007951	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		094564100	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0918540	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		730700090001	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100038950A	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100099860A	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1791148	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		651075200	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		30-4924037	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		40-4924046	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		871555600	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010853406	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		73070009000	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000A7657	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NM	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00981255	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0333660	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000873548-000	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10648B	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0370091	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		072674701	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010386322	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2062863	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		126294	8/3/2018 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	8/3/2018 1:54 PM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/17/2017 6:57:48 AM	11/17/2017 6:57 AM
Contacts	Authorizing Official	Update		Schick, Eric Senior Vice President - Chief Financial Officer 9185028118	Schick, Eric Senior Vice President - Chief Financial Officer Saint Francis Hospital 9184948430	10/13/2017 2:37 PM
Contacts	Primary Contact	Update		Hoss, Deborah VP - Finance 9185028120	Hoss, Deborah VP - Finance Saint Francis Hospital 9185028120	10/6/2017 3:18 PM
Contacts	Authorizing Official	Insert			Schick, Eric Senior Vice President - Chief Financial Officer 9185028118	3/7/2017 7:46 AM
Contacts	Signed By	Insert			Steichen, Barry L. Executive Vice President - Chief AdministrativeOfficer and CFO 9184941330	2/12/2017 6:49 PM
Contacts	Primary Contact	Insert			Hoss, Deborah VP - Finance 9185028120	9/5/2016 9:23 AM
Addresses	Main Address	Insert			6161 South Yale Avenue Tulsa, OK 74136	9/2/2016 10:59 AM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/2/2016 10:59 AM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 9:08 PM
Details	Last Recertification Date	Update		8/30/2013 12:00:00 AM	8/7/2014 12:00:00 AM	8/7/2014 2:34 PM
Details	Last Recertification Date	Update			8/30/2013 12:00:00 AM	8/30/2013 1:04 PM
Details	340B ID	Update		IS-DR-DSH370091	DSH370091	3/30/2012 11:02 AM
Dates	Participating Approval Date	Update			3/30/2012 12:00:00 AM	3/30/2012 11:02 AM
Details	State	Update		Pending	Active	3/30/2012 11:02 AM
Dates	Start Date	Update			4/1/2012 12:00:00 AM	3/30/2012 11:02 AM
Details	340B ID	Update		DSH370091	IS-DR-DSH370091	3/13/2012 4:29 PM
Details	340B ID	Update		DR013112DSH370091	DSH370091	3/13/2012 4:27 PM
Details	340B ID	Update		DEKETE-DR020612	DR013112DSH370091	3/13/2012 4:09 PM
Details	340B ID	Update		DR020612DSH370091	DEKETE-DR020612	3/13/2012 3:50 PM
Details	340B ID	Update		DR020212	DR020612DSH370091	2/15/2012 4:21 PM
Details	340B ID	Update		ONLINE_REG	DR020212	2/2/2012 3:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/2/2012 10:49 AM
Medicaid Billing	Medicaid: Number	Insert			100699570A	2/2/2012 10:49 AM
Medicaid Billing	Medicaid: State	Insert			OK	2/2/2012 10:49 AM
Medicaid Billing	NPI: Number	Insert			1144228487	2/2/2012 10:49 AM
Details	Last Recertification Date	Insert				2/2/2012 10:49 AM
Details	Grant Number	Insert				2/2/2012 10:49 AM
Details	340B ID	Insert			ONLINE_REG	2/2/2012 10:49 AM
Details	Is Authorizing Official EHB Data	Insert				2/2/2012 10:49 AM
Dates	Last Date That 340B Drugs Purchased	Insert				2/2/2012 10:49 AM
Details	Medicare Provider Number	Insert			370091	2/2/2012 10:49 AM
Details	Entity Name	Insert			Saint Francis Hospital	2/2/2012 10:49 AM
Details	Program Code	Insert			DSH	2/2/2012 10:49 AM
Details	Entity Subname	Insert				2/2/2012 10:49 AM
Dates	Participating Approval Date	Insert				2/2/2012 10:49 AM
Details	State	Insert			Pending	2/2/2012 10:49 AM
Dates	Registration Date	Insert			2/2/2012 12:00:00 AM	2/2/2012 10:49 AM
Dates	Signed By Date	Insert			2/2/2012 12:00:00 AM	2/2/2012 10:49 AM
Dates	Start Date	Insert				2/2/2012 10:49 AM
Terminations	Termination Comments	Insert				2/2/2012 10:49 AM
Terminations	Termination Date	Insert				2/2/2012 10:49 AM
Terminations	Termination Effective Date	Insert				2/2/2012 10:49 AM
Terminations	Termination Reason	Insert				2/2/2012 10:49 AM