| 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 |
| 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 | 8/17/2023 7:12:42 PM | 8/19/2024 12:07:35 PM | 8/19/2024 12:07 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 | 8/26/2022 12:49:57 PM | 8/17/2023 7:12:42 PM | 8/17/2023 7:12 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 | 10/18/2022 10:09 AM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2021 12:53:02 PM | 8/26/2022 12:49:57 PM | 8/26/2022 12:49 PM |
| 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 10:37:44 AM | 8/16/2021 12:53:02 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 10:37 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | CA | 8/21/2020 10:37 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1316061997 ( ) | | 8/21/2020 10:37 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2019 11:12:08 AM | 8/21/2020 10:37:44 AM | 8/21/2020 10:37 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2018 8:36:57 AM | 8/21/2019 11:12:08 AM | 8/21/2019 11:12 AM |
| 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 4:29 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 |
| Addresses | Shipping Address | Insert | Recertification | | Saint Francis Memorial Hospital
900 Hyde Street
San Francisco, CA 94109 | 8/22/2018 8:36 AM |
| Addresses | Shipping Address | Insert | Recertification | | Safecor Health, LLC
4060 Business Park Drive, Suite B
Columbus, OH 43204 | 8/22/2018 8:36 AM |
| Details | Last Recertification Date | Update | Recertification | 11/9/2017 1:35:06 PM | 8/22/2018 8:36:57 AM | 8/22/2018 8:36 AM |
| 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 1:35:06 PM | 11/9/2017 1:35 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 |
| Contacts | Authorizing Official | Insert | | | Welton, Jill
VP COO, CNO
4153536173 | 3/14/2017 9:24 AM |
| Contacts | Primary Contact | Insert | | | MILLER, RAY
DIRECTOR OF PHARMACY
4153536451 | 3/14/2017 9:24 AM |
| Addresses | Main Address | Insert | | |
1199 Bush Street, Ste 160
Industrial Medicine / Franciscan Treatment Room
San Francisco, CA 94109 | 2/23/2017 10:50 PM |
| Addresses | Billing Address | Insert | | | Dignity Health Accounts Payable
3400 Data Drive
3rd floor
Rancho Cordova, CA 95670 | 2/23/2017 10:50 PM |
| Contacts | Signed By | Insert | | | Fox, Alan
CFO
4153536600 | 2/23/2017 10:50 PM |
| 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 | | 1417089350 | 1316061997 | 9/18/2015 8:58 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 | | | HSC30116 | 7/14/2015 4:46 PM |
| Medicaid Billing | Medicaid: State | Insert | | | CA | 7/14/2015 4:46 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1417089350 | 7/14/2015 4:46 PM |
| Details | Last Recertification Date | Update | | 8/26/2013 6:32:43 AM | 8/18/2014 12:00:00 AM | 8/18/2014 8:38 AM |
| Details | Last Recertification Date | Update | | | 8/26/2013 6:32:43 AM | 8/26/2013 6:32 AM |
| Details | 340B ID | Update | | IS-AP-DSH050152D | DSH050152D | 10/25/2012 3:18 PM |
| Dates | Participating Approval Date | Update | | | 10/25/2012 12:00:00 AM | 10/25/2012 3:18 PM |
| Details | State | Update | | Pending | Active | 10/25/2012 3:18 PM |
| Dates | Start Date | Update | | | 1/1/2013 12:00:00 AM | 10/25/2012 3:18 PM |
| Details | 340B ID | Update | | AP1018122 | IS-AP-DSH050152D | 10/25/2012 9:18 AM |
| Details | Entity Subname | Update | | | Industrial Medicine | 10/18/2012 9:26 AM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | AP1018122 | 10/18/2012 9:21 AM |
| Details | Last Recertification Date | Insert | | | | 10/15/2012 6:25 PM |
| Details | Grant Number | Insert | | | | 10/15/2012 6:25 PM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 10/15/2012 6:25 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/15/2012 6:25 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/15/2012 6:25 PM |
| Details | Medicare Provider Number | Insert | | | 050152 | 10/15/2012 6:25 PM |
| Details | Entity Name | Insert | | | ST FRANCIS MEMORIAL HOSPITAL | 10/15/2012 6:25 PM |
| Details | Program Code | Insert | | | DSH | 10/15/2012 6:25 PM |
| Details | Entity Subname | Insert | | | | 10/15/2012 6:25 PM |
| Dates | Participating Approval Date | Insert | | | | 10/15/2012 6:25 PM |
| Details | State | Insert | | | Pending | 10/15/2012 6:25 PM |
| Dates | Registration Date | Insert | | | 10/15/2012 12:00:00 AM | 10/15/2012 6:25 PM |
| Dates | Signed By Date | Insert | | | 10/15/2012 12:00:00 AM | 10/15/2012 6:25 PM |
| Dates | Start Date | Insert | | | | 10/15/2012 6:25 PM |
| Terminations | Termination Comments | Insert | | | | 10/15/2012 6:25 PM |
| Terminations | Termination Date | Insert | | | | 10/15/2012 6:25 PM |
| Terminations | Termination Effective Date | Insert | | | | 10/15/2012 6:25 PM |
| Terminations | Termination Reason | Insert | | | | 10/15/2012 6:25 PM |