Covered Entity Details

DSH500108J ST. JOSEPH MEDICAL CENTER (Active) - information as of 6/24/2025 12:03:48 AM

Main Details

Name

ST. JOSEPH MEDICAL CENTER

Subdivision Name

Gene & Mary Ann Walters Day Surgery Center (Walters Day Surgery)

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500108J

Medicare Provider Number

500108

Outpatient Facility Provider Number

500108

Additional Details

Current Program Status

Active

Registration Date

7/9/2014

Participating Start Date

10/1/2014

Participating Approval Date

9/16/2014

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

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

Primary Contact

CommonSpirit Health
Misty McCandless, 340B Program Coordinator NW Region
(757) 406-4583

Addresses

Street Address

1617 South J Street
Tacoma, WA 98405

Billing Address

St. Joseph Medical Center
PO Box 636000
Littleton, CO 80163-6000

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		1952309098

Shipping Addresses

Shipping Address 1

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
DSH500108A	Child	DSH	ST. JOSEPH MEDICAL CENTER	Gig Harbor Same Day Surgery	6401 Kimball Drive, Suite 100	Gig Harbor	WA	Active
DSH500108B	Child	DSH	ST. JOSEPH MEDICAL CENTER	Franciscan Hospice House	2901 Bridgeport Way West	University Place	WA	Active
DSH500108C	Child	DSH	ST. JOSEPH MEDICAL CENTER	St. Joseph Dialysis Center-Puyallup	702 South Hill Park Drive	Puyallup	WA	Terminated
DSH500108D	Child	DSH	ST. JOSEPH MEDICAL CENTER	St. Joseph Dialysis Center-Gig Harbor	4700 Point Fosdick Drive NW	Gig Harbor	WA	Terminated
DSH500108E	Child	DSH	ST. JOSEPH MEDICAL CENTER	Franciscan Dialysis Eastside	1415 E 72nd Street	Tacoma	WA	Terminated
DSH500108F	Child	DSH	ST. JOSEPH MEDICAL CENTER	Outpatient Oncology Infusion Clinic	1617 South J Street	Tacoma	WA	Active
DSH500108G	Child	DSH	ST. JOSEPH MEDICAL CENTER	St. Joseph Anticoagulation Clinic (Coumadin Clinic)	1708 S. Yakima Ave, Suite 20	Tacoma	WA	Active
DSH500108H	Child	DSH	ST. JOSEPH MEDICAL CENTER	Gene & Mary Ann Walters Day Surgery Center (Walters Short Stay)	1617 South J Street	Tacoma	WA	Active
DSH500108I	Child	DSH	ST. JOSEPH MEDICAL CENTER	St. Joseph Endoscopy Center (GI Lab)	1617 South J Street	Tacoma	WA	Active
DSH500108J	Child	DSH	ST. JOSEPH MEDICAL CENTER	Gene & Mary Ann Walters Day Surgery Center (Walters Day Surgery)	1617 South J Street	Tacoma	WA	Active
DSH500108K	Child	DSH	ST JOSEPH MEDICAL CENTER	ST JOSEPH MEDICAL RENAL - SOUTH TACOMA	5825 Tacoma Mall Blvd Suite 103	Tacoma	WA	Terminated
DSH500108L	Child	DSH	ST. JOSEPH MEDICAL CENTER	Franciscan Sports, Orthopedics & Spine Health Center (Spine Center)	1617 South J Street	Tacoma	WA	Active
DSH500108M	Child	DSH	ST. JOSEPH MEDICAL CENTER	Interventional Pain Care	1617 South J Street	Tacoma	WA	Active
DSH500108N	Child	DSH	ST. JOSEPH MEDICAL CENTER	Midwifery Birth Center at St. Joseph - Midwifery	1708 S. Yakima Avenue	Tacoma	WA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	Hren, Zachary Lee Director of Pharmacy St. Joseph Medical Center 2534266237	McCandless, Misty 340B Program Coordinator NW Region CommonSpirit Health 7574064583	9/17/2024 8:08 AM
Details	Last Recertification Date	Update	Recertification	9/5/2023 2:06:52 PM	8/20/2024 6:03:16 PM	8/20/2024 6:03 PM
Details	Last Recertification Date	Update	Recertification	9/5/2022 1:38:10 PM	9/5/2023 2:06:52 PM	9/5/2023 2:06 PM
Contacts	Primary Contact	Update	PC Change Request	Bonck, Michael Joseph Manager, Pharmaceutical Services St. Joseph Medical Center 2534266234	Hren, Zachary Lee Director of Pharmacy St. Joseph Medical Center 2534266237	8/31/2023 9:51 AM
Details	Last Recertification Date	Update	Recertification	8/19/2021 1:01:21 PM	9/5/2022 1:38:10 PM	9/5/2022 1:38 PM
Addresses	Billing Address	Update	Change Request	St. Joseph Medical Center 1717 South J Street Tacoma, WA 98405	St. Joseph Medical Center PO Box 636000 Littleton, CO 80163-6000	5/25/2022 8:55 PM
Details	Last Recertification Date	Update	Recertification	8/28/2020 4:17:39 PM	8/19/2021 1:01:21 PM	8/19/2021 1:01 PM
Contacts	Authorizing Official	Update	Change Request	Butcherite, David CFO CHI Franciscan Health 2536804031	Nosacka, David SVP and CFO Virginia Mason Franciscan Health 2536804005	8/13/2021 7:58 AM
Contacts	Authorizing Official	Update	Change Request	Fitzgerald, Mike CFO CHI Franciscan Health 2536804005	Butcherite, David CFO CHI Franciscan Health 2536804031	3/8/2021 8:15 AM
Medicaid Billing	NPI: State	Update	Recertification		WA	8/28/2020 4:17 PM
Details	Last Recertification Date	Update	Recertification	8/27/2019 2:03:11 PM	8/28/2020 4:17:39 PM	8/28/2020 4:17 PM
Details	Last Recertification Date	Update	Recertification	8/29/2018 11:39:20 AM	8/27/2019 2:03:11 PM	8/27/2019 2:03 PM
Contacts	Primary Contact	Update	Change Request	Wilson, Cindy 340B Program Manager CHI Franciscan Health 2534266692	Bonck, Michael Joseph Manager, Pharmaceutical Services St. Joseph Medical Center 2534266234	6/6/2019 7:25 AM
Addresses	Billing Address	Update	Change Request	St. Joseph Medical Center PO Box 63600 Littleton, CO 80163-6000	St. Joseph Medical Center 1717 South J Street Tacoma, WA 98405	5/22/2019 6:11 PM
Details	Last Recertification Date	Update	Recertification	11/10/2017 1:08:03 PM	8/29/2018 11:39:20 AM	8/29/2018 11:39 AM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/10/2017 1:08:03 PM	11/10/2017 1:08 PM
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	Insert			Wilson, Cindy 340B Program Manager 2534266692	6/15/2017 8:48 AM
Addresses	Main Address	Insert			1617 South J Street Tacoma, WA 98405	2/27/2017 3:03 PM
Addresses	Billing Address	Insert			St. Joseph Medical Center PO Box 63600 Littleton, CO 80163-6000	2/27/2017 3:03 PM
Addresses	Shipping Address	Insert			St Joseph Medical Center 1717 South J Street Tacoma, WA 98405	2/27/2017 3:03 PM
Medicaid Billing	NPI: Number	Insert			1952309098	9/2/2016 10:43 AM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 8:23 AM
Details	Last Recertification Date	Update			8/10/2015 12:00:00 AM	8/10/2015 6:42 PM
Details	Entity Subname	Update		Gene & Mary Ann Walters Day Surgery Center (Walters Day Surgery) / Gene & Mary Ann Walters Day Surgery Center (Walters Day Surgery)	Gene & Mary Ann Walters Day Surgery Center (Walters Day Surgery)	12/31/2014 3:51 PM
Details	Entity Subname	Update		Gene & Mary Ann Walters Day Surgery Center (Walters Day Surgery)	Gene & Mary Ann Walters Day Surgery Center (Walters Day Surgery) / Gene & Mary Ann Walters Day Surgery Center (Walters Day Surgery)	12/19/2014 2:16 PM
Dates	Participating Approval Date	Update			9/16/2014 12:00:00 AM	9/16/2014 5:01 AM
Details	State	Update		Pending	Active	9/16/2014 5:01 AM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	9/16/2014 5:01 AM
Details	340B ID	Update		DSH500108I	DSH500108J	9/11/2014 10:24 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_44860	DSH500108I	9/11/2014 10:11 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_44860	7/9/2014 7:45 PM
Details	Last Recertification Date	Insert				7/9/2014 7:45 PM
Details	Grant Number	Insert				7/9/2014 7:45 PM
Details	340B ID	Insert				7/9/2014 7:45 PM
Details	Is Authorizing Official EHB Data	Insert				7/9/2014 7:45 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/9/2014 7:45 PM
Details	Medicare Provider Number	Insert			500108	7/9/2014 7:45 PM
Details	Entity Name	Insert			ST. JOSEPH MEDICAL CENTER	7/9/2014 7:45 PM
Details	Program Code	Insert			DSH	7/9/2014 7:45 PM
Details	Entity Subname	Insert			Gene & Mary Ann Walters Day Surgery Center (Walters Day Surgery)	7/9/2014 7:45 PM
Dates	Participating Approval Date	Insert				7/9/2014 7:45 PM
Details	State	Insert			Pending	7/9/2014 7:45 PM
Dates	Registration Date	Insert			7/9/2014 12:00:00 AM	7/9/2014 7:45 PM
Dates	Signed By Date	Insert			7/9/2014 12:00:00 AM	7/9/2014 7:45 PM
Dates	Start Date	Insert				7/9/2014 7:45 PM
Terminations	Termination Comments	Insert				7/9/2014 7:45 PM
Terminations	Termination Date	Insert				7/9/2014 7:45 PM
Terminations	Termination Effective Date	Insert				7/9/2014 7:45 PM
Terminations	Termination Reason	Insert				7/9/2014 7:45 PM