| Details | Last Recertification Date | Update | Recertification | | 8/15/2024 10:16:31 AM | 8/15/2024 10:16 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Gardner, John Robert
CEO
St Vincent General Hospital District, dba St. Vincent Health
9709881559 | Dreesen, Andrew
CEO
St. Vincent Health
7194867161 | 10/6/2023 7:48 AM |
| Details | State | Update | | Approved | Active | 10/1/2023 12:01 AM |
| Addresses | Billing Address | Insert | Reinstatement | | 822 West 4th St
822 W 4th St
Leadville, CO 80461 | 7/12/2023 7:26 AM |
| Addresses | Main Address | Update | Reinstatement |
822 West 4th St
Leadville, CO 80461 |
822 WEST 4TH ST.
LEADVILLE, CO 80461 | 7/12/2023 7:26 AM |
| Contacts | Authorizing Official | Update | Reinstatement | Campbell, Gary
CEO
St Vincent General Hospital
7194867161 | Gardner, John Robert
CEO
St Vincent General Hospital District, dba St. Vincent Health
9709881559 | 7/12/2023 7:26 AM |
| Contacts | Signed By | Update | Reinstatement | Campbell, Gary
CEO
St Vincent General Hospital
7194867161 | Gardner, John Robert
CEO
St Vincent General Hospital District, dba St. Vincent Health
9709881559 | 7/12/2023 7:26 AM |
| Contacts | Primary Contact | Update | Reinstatement | Coffin, Megan
Pharmacy Tech
St Vincent General Hospital District
7194867124 | Johnston, Kelly
Interim CFO
St Vincent General Hospital District, dba St. Vincent Health
9702102588 | 7/12/2023 7:26 AM |
| Details | Last Recertification Date | Update | Reinstatement | 8/26/2020 6:12:01 AM | | 7/12/2023 7:26 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 9/30/2021 12:00:00 AM | | 7/12/2023 7:26 AM |
| Details | Entity Name | Update | Reinstatement | Saint Vincent General Hospital District | ST. VINCENT GENERAL HOSPITAL | 7/12/2023 7:26 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 11/24/2017 9:57:43 AM | 7/12/2023 7:26:08 AM | 7/12/2023 7:26 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 7/12/2023 7:26 AM |
| Dates | Registration Date | Update | Reinstatement | 10/4/2017 2:44:10 PM | 7/3/2023 1:04:22 PM | 7/12/2023 7:26 AM |
| Dates | Signed By Date | Update | Reinstatement | 11/22/2017 11:59:30 AM | 7/11/2023 1:15:35 PM | 7/12/2023 7:26 AM |
| Dates | Start Date | Update | Reinstatement | 1/1/2018 12:00:00 AM | 10/1/2023 12:00:00 AM | 7/12/2023 7:26 AM |
| Terminations | Termination Date | Update | Reinstatement | 10/1/2021 12:00:00 AM | | 7/12/2023 7:26 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 10/1/2021 12:00:00 AM | | 7/12/2023 7:26 AM |
| Terminations | Termination Reason | Update | Reinstatement | Failure to recertify | | 7/12/2023 7:26 AM |
| Details | Comments Public | Insert | Reinstatement | | Participating Start Date 1/1/2018,Termination Date
10/1/2021, Reinstatement 10/1/2023 | 7/12/2023 7:17 AM |
| Details | State | Update | | To Be Terminated | Terminated | 10/1/2021 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 9/30/2021 12:00:00 AM | 9/17/2021 7:37 AM |
| Details | State | Update | Recertification | Active | To Be Terminated | 9/17/2021 7:37 AM |
| Terminations | Termination Date | Update | Recertification | | 10/1/2021 12:00:00 AM | 9/17/2021 7:37 AM |
| Terminations | Termination Effective Date | Update | Recertification | | 10/1/2021 12:00:00 AM | 9/17/2021 7:37 AM |
| Terminations | Termination Reason | Update | Recertification | | Failure to recertify | 9/17/2021 7:37 AM |
| Details | Last Recertification Date | Update | Recertification | 9/5/2019 11:34:32 AM | 8/26/2020 6:12:01 AM | 8/26/2020 6:12 AM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2018 1:29:52 PM | 9/5/2019 11:34:32 AM | 9/5/2019 11:34 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Campbell, Gary
Administrative Director of Operations
St Vincent General Hospital
7194867161 | Campbell, Gary
CEO
St Vincent General Hospital
7194867161 | 7/23/2019 3:00 PM |
| Contacts | Signed By | Update | Profile Change Request | Campbell, Gary
Administrative Director of Operations
St Vincent General Hospital
7194867161 | Campbell, Gary
CEO
St Vincent General Hospital
7194867161 | 7/23/2019 3:00 PM |
| Contacts | Primary Contact | Update | Recertification | Schafer, Craig W
Pharmacy Tech
St Vincent General Hospital
7194867124 | Coffin, Megan
Pharmacy Tech
St Vincent General Hospital District
7194867124 | 8/28/2018 1:29 PM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2016 12:00:00 AM | 8/28/2018 1:29:52 PM | 8/28/2018 1:29 PM |
| Details | Entity Name | Update | Recertification | Saint Vincent General Hospital | Saint Vincent General Hospital District | 8/28/2018 1:29 PM |
| Terminations | Termination Reason | Update | | Loss of qualifying grant/support | | 7/21/2018 12:21 PM |
| Details | State | Update | | Approved | Active | 1/1/2018 12:00 AM |
| Medicaid Billing | Medicaid: Number | Delete | Reinstatement | 05029004 (CO) | | 11/24/2017 9:57 AM |
| Medicaid Billing | NPI: Number | Delete | Reinstatement | 1457315152 ( ) | | 11/24/2017 9:57 AM |
| Contacts | Signed By | Update | Reinstatement | duncan, rhonda
ceo
7194867124 | Campbell, Gary
Administrative Director of Operations
St Vincent General Hospital
7194867161 | 11/24/2017 9:57 AM |
| Contacts | Primary Contact | Update | Reinstatement | Campbell, Gary
Administrative Director of Operations
7194867161 | Schafer, Craig W
Pharmacy Tech
St Vincent General Hospital
7194867124 | 11/24/2017 9:57 AM |
| Dates | Participating Approval Date | Update | Reinstatement | | 11/24/2017 9:57:43 AM | 11/24/2017 9:57 AM |
| Details | State | Update | Reinstatement | Pending | Approved | 11/24/2017 9:57 AM |
| Dates | Signed By Date | Update | Reinstatement | 1/15/2013 12:00:00 AM | 11/22/2017 11:59:30 AM | 11/24/2017 9:57 AM |
| Dates | Start Date | Update | Reinstatement | | 1/1/2018 12:00:00 AM | 11/24/2017 9:57 AM |
| Terminations | Termination Reason | Update | Reinstatement | | Loss of qualifying grant/support | 11/24/2017 9:57 AM |
| Details | Comments Public | Insert | Reinstatement | | Participated starting 4/1/2013, terminated 4/1/2017. Reinstated 1/1/2018. | 11/24/2017 8:22 AM |
| Contacts | Authorizing Official | Update | Reinstatement | Campbell, Gary
Administrative Director of Operations
7194867161 | Campbell, Gary
Administrative Director of Operations
St Vincent General Hospital
7194867161 | 10/4/2017 2:44 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 9/14/2016 12:00:00 AM | | 10/4/2017 2:44 PM |
| Dates | Participating Approval Date | Update | Reinstatement | 1/22/2013 12:00:00 AM | | 10/4/2017 2:44 PM |
| Details | State | Update | Reinstatement | Terminated | Pending | 10/4/2017 2:44 PM |
| Dates | Registration Date | Update | Reinstatement | 1/15/2013 12:00:00 AM | 10/4/2017 2:44:10 PM | 10/4/2017 2:44 PM |
| Dates | Start Date | Update | Reinstatement | 4/1/2013 12:00:00 AM | | 10/4/2017 2:44 PM |
| Terminations | Termination Comments | Update | Reinstatement | The facility does not have the resources necessary to support the program. We are still eligible as a critical access hospital, but are voluntarily terminating with 340b. We will evaluate re-enrolling when the infrastructure and resources are in place to support the program. | | 10/4/2017 2:44 PM |
| Terminations | Termination Date | Update | Reinstatement | 4/1/2017 12:00:00 AM | | 10/4/2017 2:44 PM |
| Terminations | Termination Effective Date | Update | Reinstatement | 12/22/2017 12:00:00 AM | | 10/4/2017 2:44 PM |
| Terminations | Termination Reason | Update | Reinstatement | Loss of qualifying grant/support | | 10/4/2017 2:44 PM |
| Addresses | Main Address | Insert | | |
822 west 4th st
leadville, CO 80461 | 1/24/2017 6:55 AM |
| Contacts | Authorizing Official | Update | | Boyle, Jill
Interim Administrative Director of Operations
7194867161 | Campbell, Gary
Administrative Director of Operations
7194867161 | 1/24/2017 6:55 AM |
| Contacts | Primary Contact | Update | | emmonds, todd
pharmacy director
7194867124 | Campbell, Gary
Administrative Director of Operations
7194867161 | 1/24/2017 6:55 AM |
| Contacts | Signed By | Insert | | | duncan, rhonda
ceo
7194867124 | 1/24/2017 6:55 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 9/14/2016 12:00:00 AM | 1/24/2017 6:55 AM |
| Details | State | Update | | Active | Terminated | 1/24/2017 6:55 AM |
| Terminations | Termination Comments | Update | | | The facility does not have the resources necessary to support the program. We are still eligible as a critical access hospital, but are voluntarily terminating with 340b. We will evaluate re-enrolling when the infrastructure and resources are in place to support the program. | 1/24/2017 6:55 AM |
| Terminations | Termination Date | Update | | | 4/1/2017 12:00:00 AM | 1/24/2017 6:55 AM |
| Terminations | Termination Effective Date | Update | | | 12/22/2017 12:00:00 AM | 1/24/2017 6:55 AM |
| Terminations | Termination Reason | Update | | | Loss of qualifying grant/support | 1/24/2017 6:55 AM |
| Contacts | Authorizing Official | Update | | Radke, Sam
CEO
3038815411 | Boyle, Jill
Interim Administrative Director of Operations
7194867161 | 8/30/2016 7:16 PM |
| Details | Last Recertification Date | Update | | 9/8/2015 12:00:00 AM | 8/30/2016 12:00:00 AM | 8/30/2016 7:16 PM |
| Contacts | Authorizing Official | Insert | | | Radke, Sam
CEO
3038815411 | 9/8/2015 11:23 AM |
| Details | Last Recertification Date | Update | | 8/6/2014 12:00:00 AM | 9/8/2015 12:00:00 AM | 9/8/2015 11:23 AM |
| Contacts | Primary Contact | Insert | | | emmonds, todd
pharmacy director
7194867124 | 9/2/2015 11:31 AM |
| Details | Last Recertification Date | Update | | 9/13/2013 12:00:00 AM | 8/6/2014 12:00:00 AM | 8/6/2014 5:38 PM |
| Details | Last Recertification Date | Update | | | 9/13/2013 12:00:00 AM | 9/13/2013 2:16 PM |
| Details | 340B ID | Update | | ISAPCAH061319-00 | CAH061319-00 | 1/22/2013 10:32 AM |
| Dates | Participating Approval Date | Update | | | 1/22/2013 12:00:00 AM | 1/22/2013 10:32 AM |
| Details | State | Update | | Pending | Active | 1/22/2013 10:32 AM |
| Dates | Start Date | Update | | | 4/1/2013 12:00:00 AM | 1/22/2013 10:32 AM |
| Details | 340B ID | Update | | AP011513L | ISAPCAH061319-00 | 1/18/2013 1:37 PM |
| Details | 340B ID | Update | | ONLINE_REG | AP011513L | 1/15/2013 8:50 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 1/15/2013 7:22 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 05029004 | 1/15/2013 7:22 PM |
| Medicaid Billing | Medicaid: State | Insert | | | CO | 1/15/2013 7:22 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1457315152 | 1/15/2013 7:22 PM |
| Details | Last Recertification Date | Insert | | | | 1/15/2013 7:22 PM |
| Details | Grant Number | Insert | | | | 1/15/2013 7:22 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/15/2013 7:22 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/15/2013 7:22 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/15/2013 7:22 PM |
| Details | Medicare Provider Number | Insert | | | 061319 | 1/15/2013 7:22 PM |
| Details | Entity Name | Insert | | | Saint Vincent General Hospital | 1/15/2013 7:22 PM |
| Details | Program Code | Insert | | | CAH | 1/15/2013 7:22 PM |
| Details | Entity Subname | Insert | | | | 1/15/2013 7:22 PM |
| Dates | Participating Approval Date | Insert | | | | 1/15/2013 7:22 PM |
| Details | State | Insert | | | Pending | 1/15/2013 7:22 PM |
| Dates | Registration Date | Insert | | | 1/15/2013 12:00:00 AM | 1/15/2013 7:22 PM |
| Dates | Signed By Date | Insert | | | 1/15/2013 12:00:00 AM | 1/15/2013 7:22 PM |
| Dates | Start Date | Insert | | | | 1/15/2013 7:22 PM |
| Terminations | Termination Comments | Insert | | | | 1/15/2013 7:22 PM |
| Terminations | Termination Date | Insert | | | | 1/15/2013 7:22 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/15/2013 7:22 PM |
| Terminations | Termination Reason | Insert | | | | 1/15/2013 7:22 PM |