Covered Entity Details

DSH030024F ST JOSEPH'S HOSPITAL AND MEDICAL CENTER (Active) - information as of 4/25/2025 8:34:27 PM

Main Details

Name

ST JOSEPH'S HOSPITAL AND MEDICAL CENTER

Subdivision Name

OP Infusion

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH030024F

Medicare Provider Number

030024

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/14/2015

Participating Start Date

10/1/2015

Participating Approval Date

7/23/2015

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

St.Joseph's Hospital and Medical Center
Jeffrey Jackson, Chief Financial Officer
(602) 406-4618

Primary Contact

CommonSpirit Health - Central Region
Mitchell Schultz, RPh, 340b Regional Manager
(701) 928-0620

Addresses

Street Address

500 West Thomas Road
Suite 650
Phoenix, AZ 85013

Billing Address

Dignity Health AP
3033 N. 3rd Ave
Phoenix, AZ 85013

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
AZ	691974	1982733655,1326084872,1952775298

Shipping Addresses

Shipping Address 1

St. Joseph's Hospital and Medical Center
350 W. Thomas Rd
Phoenix, AZ 85013

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
DSH030024C	Child	DSH	ST JOSEPH'S HOSPITAL AND MEDICAL CENTER	Trauma Clinic	500 West Thomas Rd	Phoenix	AZ	Terminated
DSH030024D	Child	DSH	ST JOSEPH'S HOSPITAL AND MEDICAL CENTER	Dignity Health Cancer Institute at St Joseph	625 N. 6th Street	PHOENIX	AZ	Active
DSH030024E	Child	DSH	ST JOSEPH'S HOSPITAL AND MEDICAL CENTER	Neuro Muscular Outpatient Infusion Services	240 West Thomas Road	Phoenix	AZ	Terminated
DSH030024F	Child	DSH	ST JOSEPH'S HOSPITAL AND MEDICAL CENTER	OP Infusion	500 West Thomas Road	Phoenix	AZ	Active
DSH030024G	Child	DSH	ST JOSEPH'S HOSPITAL AND MEDICAL CENTER	Oncology Clinic - Gynecologic - Oncology Clinic - Gynecologic	500 W. Thomas Rd.	Phoenix	AZ	Terminated
DSH030024H	Child	DSH	ST JOSEPH'S HOSPITAL AND MEDICAL CENTER	Cancer/Oncology Clinic 3 - Cancer/Oncology Clinic 3	500 W Thomas Rd	Phoenix	AZ	Terminated
DSH030024J	Child	DSH	ST JOSEPH'S HOSPITAL AND MEDICAL CENTER	Liver Disease and Transplantation - Liver Disease and Transplantation	500 W Thomas Rd	Phoenix	AZ	Terminated
DSH030024K	Child	DSH	ST JOSEPH'S HOSPITAL AND MEDICAL CENTER	Rehab Neuro - Rehab Neuro	222 W Thomas Rd	Phoenix	AZ	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/16/2023 1:32:30 PM	8/16/2024 4:38:57 PM	8/16/2024 4:38 PM
Contacts	Primary Contact	Update	Profile Change Request	Schultz, Mitchell RPh, 340b Division Manager CommonSpirit Health - Midwest Division 7019280620	Schultz, Mitchell RPh, 340b Regional Manager CommonSpirit Health - Central Region 7019280620	8/6/2024 1:57 PM
Contacts	Primary Contact	Update	Group Change Request	Pearcy, Ryan 340B Division Manager CommonSpirit Health 8592295654	Schultz, Mitchell RPh, 340b Division Manager CommonSpirit Health - Midwest Division 7019280620	7/10/2024 3:31 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 4:09:09 PM	8/16/2023 1:32:30 PM	8/16/2023 1:32 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 9:46:56 AM	9/7/2022 4:09:09 PM	9/7/2022 4:09 PM
Contacts	Primary Contact	Update	Change Request	Mesdaghi, Mike Senior Director of Pharmacy Dignity Health 6024064744	Pearcy, Ryan 340B Division Manager CommonSpirit Health 8592295654	1/31/2022 10:32 AM
Details	Last Recertification Date	Update	Recertification	8/28/2020 9:32:28 AM	8/23/2021 9:46:56 AM	8/23/2021 9:46 AM
Contacts	Authorizing Official	Update	Profile Change Request	Jackson, Jeffrey VP Finance St.Joseph's Hospital and Medical Center 6024064618	Jackson, Jeffrey Chief Financial Officer St.Joseph's Hospital and Medical Center 6024064618	3/23/2021 8:08 AM
Contacts	Signed By	Update	Profile Change Request	Jackson, Jeffrey VP Finance St.Joseph's Hospital and Medical Center 6024064618	Jackson, Jeffrey Chief Financial Officer St.Joseph's Hospital and Medical Center 6024064618	3/23/2021 8:08 AM
Contacts	Primary Contact	Update	Profile Change Request	Mesdaghi, Pooyan Senior Director of Pharmacy Dignity Health 6024064744	Mesdaghi, Mike Senior Director of Pharmacy Dignity Health 6024064744	3/22/2021 7:10 AM
Contacts	Primary Contact	Update	Change Request	Blank, Greg Director of Pharmacy St. Joseph's Hospital and Medical Center 6024064744	Mesdaghi, Pooyan Senior Director of Pharmacy Dignity Health 6024064744	9/9/2020 12:05 PM
Medicaid Billing	NPI: State	Update	Recertification		AZ	8/28/2020 9:32 AM
Medicaid Billing	NPI: State	Update	Recertification		AZ	8/28/2020 9:32 AM
Medicaid Billing	NPI: State	Update	Recertification		AZ	8/28/2020 9:32 AM
Details	Last Recertification Date	Update	Recertification	8/22/2019 6:10:40 PM	8/28/2020 9:32:28 AM	8/28/2020 9:32 AM
Details	Last Recertification Date	Update	Recertification	8/31/2018 11:18:01 AM	8/22/2019 6:10:40 PM	8/22/2019 6:10 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1952775298	10/11/2018 5:46 PM
Details	Last Recertification Date	Update	Recertification	11/6/2017 11:26:53 AM	8/31/2018 11:18:01 AM	8/31/2018 11:18 AM
Addresses	Shipping Address	Insert	Change Request		St. Joseph's Hospital and Medical Center 350 W. Thomas Rd Phoenix, AZ 85013	6/19/2018 7:12 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1326084872	6/19/2018 7:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/12/2017 8:50 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		691974	12/12/2017 8:50 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	12/12/2017 8:50 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1982733655	12/12/2017 8:50 AM
Details	Entity Name	Update	Recertification	ST. JOSEPHS HOSPITAL & MEDICAL CTR	ST JOSEPH'S HOSPITAL AND MEDICAL CENTER	11/9/2017 7:20 AM
Details	Last Recertification Date	Update	Recertification	8/17/2016 12:00:00 AM	11/6/2017 11:26:53 AM	11/6/2017 11:26 AM
Contacts	Authorizing Official	Update		Jackson, Jeffrey VP Finance 6024064618	Jackson, Jeffrey VP Finance St.Joseph's Hospital and Medical Center 6024064618	10/20/2017 11:25 AM
Contacts	Signed By	Update		Jackson, Jeffrey VP Finance 6024064618	Jackson, Jeffrey VP Finance St.Joseph's Hospital and Medical Center 6024064618	10/20/2017 11:25 AM
Contacts	Primary Contact	Update		Blank, Greg Director of Pharmacy 6024064744	Blank, Greg Director of Pharmacy St. Joseph's Hospital and Medical Center 6024064744	10/4/2017 2:49 PM
Contacts	Primary Contact	Update		Eslinger, Christian Pharmacy Manager 6024066480	Blank, Greg Director of Pharmacy 6024064744	7/17/2017 12:08 PM
Contacts	Authorizing Official	Insert			Jackson, Jeffrey VP Finance 6024064618	7/17/2017 12:08 PM
Contacts	Signed By	Insert			Jackson, Jeffrey VP Finance 6024064618	7/17/2017 12:08 PM
Addresses	Main Address	Insert			500 West Thomas Road Suite 650 Phoenix, AZ 85013	7/17/2017 12:07 PM
Addresses	Billing Address	Insert			Dignity Health AP 3033 N. 3rd Ave Phoenix, AZ 85013	7/17/2017 12:07 PM
Contacts	Primary Contact	Update		Kaimal, Girish Pharmacy Manager 6024064152	Eslinger, Christian Pharmacy Manager 6024066480	5/9/2017 9:30 AM
Contacts	Primary Contact	Update		Leach, Mark Pharmacy Director 6024060353	Kaimal, Girish Pharmacy Manager 6024064152	3/7/2017 8:59 AM
Contacts	Primary Contact	Insert			Leach, Mark Pharmacy Director 6024060353	8/17/2016 7:18 AM
Details	Last Recertification Date	Update			8/17/2016 12:00:00 AM	8/17/2016 7:18 AM
Dates	Participating Approval Date	Update			7/23/2015 12:00:00 AM	7/23/2015 2:03 PM
Details	State	Update		Pending	Active	7/23/2015 2:03 PM
Dates	Start Date	Update			10/1/2015 12:00:00 AM	7/23/2015 2:03 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_53700	DSH030024F	7/23/2015 9:33 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_53700	7/14/2015 5:35 PM
Details	Last Recertification Date	Insert				7/14/2015 5:35 PM
Details	Grant Number	Insert				7/14/2015 5:35 PM
Details	340B ID	Insert				7/14/2015 5:35 PM
Details	Is Authorizing Official EHB Data	Insert				7/14/2015 5:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/14/2015 5:35 PM
Details	Medicare Provider Number	Insert			030024	7/14/2015 5:35 PM
Details	Entity Name	Insert			ST. JOSEPHS HOSPITAL & MEDICAL CTR	7/14/2015 5:35 PM
Details	Program Code	Insert			DSH	7/14/2015 5:35 PM
Details	Entity Subname	Insert			OP Infusion	7/14/2015 5:35 PM
Dates	Participating Approval Date	Insert				7/14/2015 5:35 PM
Details	State	Insert			Pending	7/14/2015 5:35 PM
Dates	Registration Date	Insert			7/14/2015 12:00:00 AM	7/14/2015 5:35 PM
Dates	Signed By Date	Insert			7/14/2015 12:00:00 AM	7/14/2015 5:35 PM
Dates	Start Date	Insert				7/14/2015 5:35 PM
Terminations	Termination Comments	Insert				7/14/2015 5:35 PM
Terminations	Termination Date	Insert				7/14/2015 5:35 PM
Terminations	Termination Effective Date	Insert				7/14/2015 5:35 PM
Terminations	Termination Reason	Insert				7/14/2015 5:35 PM