Covered Entity Details

DSH500141C ST FRANCIS HOSPITAL (Active) - information as of 5/13/2025 11:01:47 PM

Main Details

Name

ST FRANCIS HOSPITAL

Subdivision Name

Outpatient Oncology Care Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500141C

Medicare Provider Number

500141

Outpatient Facility Provider Number

500141

Additional Details

Current Program Status

Active

Registration Date

1/15/2014

Participating Start Date

4/1/2014

Participating Approval Date

1/31/2014

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Virginia Mason Franciscan Health
David Nosacka, SVP and CFO
(253) 680-4005

Primary Contact

St. Francis Hospital
Nicholas William Larned, Director of Pharmacy
(253) 944-4142

Addresses

Street Address

34509 9th Avenue South
Suite 301
Federal Way, WA 98003

Billing Address

St. Francis Hospital
PO Box 636000
Littleton, CO 80163

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
WA		1093713091

Shipping Addresses

Shipping Address 1

St. Francis Hospital
34515 Ninth Avenue South
Federal Way, WA 98003

Shipping Address 2

St. Joseph Medical Center
1717 South J Street
Tacoma, WA 98405

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
DSH500141A	Child	DSH	ST FRANCIS HOSPITAL	Harbor Endoscopy Center (FECGH GI Surgery SVCS)	4700 Pt Fosdick Drive NW	Gig Harbor	WA	Active
DSH500141B	Child	DSH	ST FRANCIS HOSPITAL	Tacoma Endoscopy Center (FECTGI Surgery SVCS)	1112 6th Avenue	Tacoma	WA	Active
DSH500141C	Child	DSH	ST FRANCIS HOSPITAL	Outpatient Oncology Care Clinic	34509 9th Avenue South	Federal Way	WA	Active
DSH500141D	Child	DSH	ST FRANCIS HOSPITAL	St. Francis Anticoagulation Clinic (Coumadin Clinic)	34509 9th Ave. S., Suite 308	Federal Way	WA	Terminated
DSH500141E	Child	DSH	ST FRANCIS HOSPITAL	Franciscan Endoscopy Center - Federal Way - Endoscopy Center - Federal Way	34503 9th Avenue South	Federal Way	WA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/30/2023 2:11:08 PM	8/20/2024 5:58:22 PM	8/20/2024 5:58 PM
Contacts	Primary Contact	Update	Recertification	Bonck, Michael Joseph Manager, Pharmaceutical Services St. Joseph Medical Center 2534266234	Larned, Nicholas William Director of Pharmacy St. Francis Hospital 2539444142	8/30/2023 2:11 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 4:27:05 PM	8/30/2023 2:11:08 PM	8/30/2023 2:11 PM
Addresses	Billing Address	Update	Change Request	St. Francis Hospital 34515 Ninth Avenue S Federal Way, WA 98003	St. Francis Hospital PO Box 636000 Littleton, CO 80163	4/14/2023 2:09 PM
Contacts	Primary Contact	Update	Group Change Request	Michaels, Ben Director of Pharmacy St Francis Hospital 2539444142	Bonck, Michael Joseph Manager, Pharmaceutical Services St. Joseph Medical Center 2534266234	9/20/2022 2:58 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 2:39:06 PM	9/14/2022 4:27:05 PM	9/14/2022 4:27 PM
Details	Last Recertification Date	Update	Recertification	8/28/2020 4:02:30 PM	8/23/2021 2:39:06 PM	8/23/2021 2:39 PM
Contacts	Authorizing Official	Update	Change Request	Butcherite, David CFO CHI Franciscan Health 2536804031	Nosacka, David SVP and CFO Virginia Mason Franciscan Health 2536804005	8/19/2021 1:53 PM
Contacts	Authorizing Official	Update	Change Request	Fitzgerald, Mike CFO CHI Franciscan Health 2536804005	Butcherite, David CFO CHI Franciscan Health 2536804031	3/18/2021 7:58 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1093713091	8/28/2020 4:02 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/28/2020 4:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1093713091 ( )		8/28/2020 4:02 PM
Details	Last Recertification Date	Update	Recertification	8/27/2019 2:08:12 PM	8/28/2020 4:02:30 PM	8/28/2020 4:02 PM
Details	Last Recertification Date	Update	Recertification	8/29/2018 11:37:16 AM	8/27/2019 2:08:12 PM	8/27/2019 2:08 PM
Contacts	Primary Contact	Update	Change Request	Wilson, Cindy 340B Program Manager CHI Franciscan Health 2534266692	Michaels, Ben Director of Pharmacy St Francis Hospital 2539444142	6/10/2019 12:47 PM
Addresses	Billing Address	Update	Change Request	St. Francis Hospital PO Box 63600 Littleton, CO 80163-6000	St. Francis Hospital 34515 Ninth Avenue S Federal Way, WA 98003	5/22/2019 6:13 PM
Addresses	Shipping Address	Insert	Change Request		St. Joseph Medical Center 1717 South J Street Tacoma, WA 98405	2/4/2019 9:43 AM
Details	Last Recertification Date	Update	Recertification	11/16/2017 8:13:43 AM	8/29/2018 11:37:16 AM	8/29/2018 11:37 AM
Addresses	Shipping Address	Insert	Recertification		St. Francis Hospital 34515 Ninth Avenue South Federal Way, WA 98003	11/16/2017 8:13 AM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/16/2017 8:13:43 AM	11/16/2017 8:13 AM
Contacts	Authorizing Official	Update	New Registration	Fitzgerald, Mike CFO 2536804005	Fitzgerald, Mike CFO CHI Franciscan Health 2536804005	10/12/2017 12:33 PM
Contacts	Primary Contact	Update		Wilson, Cindy 340B Program Manager 2534266692	Wilson, Cindy 340B Program Manager CHI Franciscan Health 2534266692	9/20/2017 6:35 PM
Contacts	Authorizing Official	Insert			Fitzgerald, Mike CFO 2536804005	6/15/2017 8:48 AM
Contacts	Signed By	Insert			Fitzgerald, Mike CFO 2536804005	6/15/2017 8:48 AM
Contacts	Primary Contact	Update		LYNCH, TIM Associate VP of Pharmacy 2534266268	Wilson, Cindy 340B Program Manager 2534266692	6/15/2017 8:48 AM
Addresses	Main Address	Insert			34509 9th Avenue South Suite 301 Federal Way, WA 98003	9/1/2016 6:06 PM
Addresses	Billing Address	Insert			St. Francis Hospital PO Box 63600 Littleton, CO 80163-6000	9/1/2016 6:06 PM
Medicaid Billing	NPI: Number	Insert			1093713091	9/1/2016 6:06 PM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 4:16 PM
Details	Last Recertification Date	Update		8/26/2014 12:00:00 AM	8/10/2015 12:00:00 AM	8/10/2015 6:11 PM
Details	Last Recertification Date	Update			8/26/2014 12:00:00 AM	8/26/2014 1:40 PM
Contacts	Primary Contact	Insert			LYNCH, TIM Associate VP of Pharmacy 2534266268	7/3/2014 4:20 PM
Dates	Participating Approval Date	Update			1/31/2014 12:00:00 AM	1/31/2014 1:55 PM
Details	State	Update		Pending	Active	1/31/2014 1:55 PM
Dates	Start Date	Update			4/1/2014 12:00:00 AM	1/31/2014 1:55 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH500141C	1/21/2014 6:47 AM
Details	Last Recertification Date	Insert				1/15/2014 4:22 PM
Details	Grant Number	Insert				1/15/2014 4:22 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/15/2014 4:22 PM
Details	Is Authorizing Official EHB Data	Insert				1/15/2014 4:22 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/15/2014 4:22 PM
Details	Medicare Provider Number	Insert			500141	1/15/2014 4:22 PM
Details	Entity Name	Insert			ST FRANCIS HOSPITAL	1/15/2014 4:22 PM
Details	Program Code	Insert			DSH	1/15/2014 4:22 PM
Details	Entity Subname	Insert			Outpatient Oncology Care Clinic	1/15/2014 4:22 PM
Dates	Participating Approval Date	Insert				1/15/2014 4:22 PM
Details	State	Insert			Pending	1/15/2014 4:22 PM
Dates	Registration Date	Insert			1/15/2014 12:00:00 AM	1/15/2014 4:22 PM
Dates	Signed By Date	Insert			1/15/2014 12:00:00 AM	1/15/2014 4:22 PM
Dates	Start Date	Insert				1/15/2014 4:22 PM
Terminations	Termination Comments	Insert				1/15/2014 4:22 PM
Terminations	Termination Date	Insert				1/15/2014 4:22 PM
Terminations	Termination Effective Date	Insert				1/15/2014 4:22 PM
Terminations	Termination Reason	Insert				1/15/2014 4:22 PM