| Contacts | Authorizing Official | Update | Change Request | Stoehr, Troy
VP of Finance
Platte Valley Medical Center
3034981606 | Denton, Ashley
VP Finance
SCL Health Lutheran Medical Center
3034252410 | 9/4/2024 2:04 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2023 3:03:26 PM | 8/20/2024 11:19:05 AM | 8/20/2024 11:19 AM |
| Details | Entity Name | Update | Change Request | SAINT JOSEPH HOSPITAL | Saint Joseph Hospital, Inc. DBA Intermountain Health Saint Joseph Hospital | 5/6/2024 7:17 AM |
| Contacts | Primary Contact | Update | Group Change Request | Stubbs, Charles B.
340B Pharmacist
Intermountain Healthcare
8012841113 | Landry, Ben
340B Pharmacist
Intermountain Health
2072005264 | 5/3/2024 1:58 PM |
| Addresses | Main Address | Update | Change Request |
1825 MARION ST
DENVER, CO 80218-1122 |
1825 MARION ST - 2nd Floor
DENVER, CO 80218-1122 | 9/11/2023 10:26 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2022 10:52:02 AM | 8/23/2023 3:03:26 PM | 8/23/2023 3:03 PM |
| Contacts | Authorizing Official | Update | Change Request | Fadden, Sean
Vice President Finance
Intermountain Health - Peaks Region
3032720416 | Stoehr, Troy
VP of Finance
Platte Valley Medical Center
3034981606 | 6/28/2023 1:51 PM |
| Contacts | Primary Contact | Update | PC Change Request | Tillman, Don
Director of Pharmacy
Saint Joseph Hospital
3038122304 | Stubbs, Charles B.
340B Pharmacist
Intermountain Healthcare
8012841113 | 6/20/2023 7:28 AM |
| Contacts | Authorizing Official | Update | Change Request | Membel, Brad
VP Finance, CFO
Saint Joseph Hospital
3038124936 | Fadden, Sean
Vice President Finance
Intermountain Health - Peaks Region
3032720416 | 4/12/2023 4:05 PM |
| Contacts | Primary Contact | Update | Group Change Request | Tillman, Don
Pharmacy Director
SCL Health Saint Joseph Hospital
3038122304 | Tillman, Don
Director of Pharmacy
Saint Joseph Hospital
3038122304 | 1/30/2023 11:13 AM |
| Addresses | Billing Address | Update | Change Request | EXEMPLA SAINT JOSEPH HOSPITAL
P.O. Box 1010
Lafayette, CO 80026 | SAINT JOSEPH HOSPITAL
Attn: Accounts Payable
P.O. Box 1010
Lafayette, CO 80026 | 10/7/2022 7:39 AM |
| Addresses | Main Address | Update | Change Request |
1825 MARION ST
SJH COMPREHENSIVE CANCER CENTER
DENVER, CO 80218-1122 |
1825 MARION ST
DENVER, CO 80218-1122 | 10/7/2022 7:39 AM |
| Details | Entity Subname | Update | Change Request | SAINT JOSEPH HOSPITAL INC / Medical Oncology | Saint Joseph Hospital Cancer Centers of Colorado - Medical Oncology | 10/7/2022 7:39 AM |
| Details | Entity Name | Update | Recertification | EXEMPLA SAINT JOSEPH HOSPITAL | SAINT JOSEPH HOSPITAL | 9/14/2022 12:37 PM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2021 4:43:44 PM | 8/24/2022 10:52:02 AM | 8/24/2022 10:52 AM |
| Contacts | Primary Contact | Update | PC Change Request | Mains, Ashley
System Pharmacy Manager
SCL Health
3038135016 | Tillman, Don
Pharmacy Director
SCL Health Saint Joseph Hospital
3038122304 | 6/21/2022 11:20 AM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2020 2:19:43 PM | 9/2/2021 4:43:44 PM | 9/2/2021 4:43 PM |
| Contacts | Authorizing Official | Update | Change Request | Scremin, Karen
Interim CFO
SCL Health
3038135255 | Membel, Brad
VP Finance, CFO
Saint Joseph Hospital
3038124936 | 12/23/2020 10:19 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | CO | 9/2/2020 2:19 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2019 3:10:20 PM | 9/2/2020 2:19:43 PM | 9/2/2020 2:19 PM |
| Contacts | Authorizing Official | Update | Change Request | Rigdon, Alice
VP Finance
Saint Joseph Hospital
3038124926 | Scremin, Karen
Interim CFO
SCL Health
3038135255 | 1/7/2020 9:18 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2018 9:06:42 AM | 8/23/2019 3:10:20 PM | 8/23/2019 3:10 PM |
| Addresses | Billing Address | Insert | Recertification | | EXEMPLA SAINT JOSEPH HOSPITAL
P.O. Box 1010
Lafayette, CO 80026 | 8/22/2018 9:06 AM |
| Details | Last Recertification Date | Update | Recertification | 11/28/2017 4:52:46 PM | 8/22/2018 9:06:42 AM | 8/22/2018 9:06 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1417946021 | 3/13/2018 6:00 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Rigdon, Alice
Chief Financial Officer
Saint Joseph Hospital
3038124926 | Rigdon, Alice
VP Finance
Saint Joseph Hospital
3038124926 | 11/28/2017 4:54 PM |
| Contacts | Primary Contact | Insert | Recertification | | Mains, Ashley
System Pharmacy Manager
SCL Health
3038135016 | 11/28/2017 4:52 PM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2016 12:00:00 AM | 11/28/2017 4:52:46 PM | 11/28/2017 4:52 PM |
| Contacts | Authorizing Official | Update | | Rigdon, Alice
Chief Financial Officer
3038124926 | Rigdon, Alice
Chief Financial Officer
Saint Joseph Hospital
3038124926 | 10/16/2017 1:36 PM |
| Contacts | Authorizing Official | Update | | Binder, Forest C.
Chief Financial Officer
3038124926 | Rigdon, Alice
Chief Financial Officer
3038124926 | 9/11/2017 3:29 PM |
| Contacts | Authorizing Official | Insert | | | Binder, Forest C.
Chief Financial Officer
3038124926 | 6/15/2017 2:00 PM |
| Contacts | Signed By | Insert | | | Binder, Forest C.
Chief Financial Officer
3038124926 | 6/15/2017 2:00 PM |
| Addresses | Main Address | Insert | | |
1825 MARION ST
SJH COMPREHENSIVE CANCER CENTER
DENVER, CO 80218-1122 | 8/17/2016 12:14 PM |
| Details | Last Recertification Date | Update | | | 8/17/2016 12:00:00 AM | 8/17/2016 12:14 PM |
| Dates | Participating Approval Date | Update | | | 5/5/2016 12:00:00 AM | 5/5/2016 5:29 PM |
| Details | State | Update | | Pending | Active | 5/5/2016 5:29 PM |
| Dates | Start Date | Update | | | 7/1/2016 12:00:00 AM | 5/5/2016 5:29 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_59481 | DSH060028C | 5/3/2016 11:36 AM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_59481 | 4/11/2016 11:59 AM |
| Details | Last Recertification Date | Insert | | | | 4/11/2016 11:59 AM |
| Details | Grant Number | Insert | | | | 4/11/2016 11:59 AM |
| Details | 340B ID | Insert | | | | 4/11/2016 11:59 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/11/2016 11:59 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/11/2016 11:59 AM |
| Details | Medicare Provider Number | Insert | | | 060028 | 4/11/2016 11:59 AM |
| Details | Entity Name | Insert | | | EXEMPLA SAINT JOSEPH HOSPITAL | 4/11/2016 11:59 AM |
| Details | Program Code | Insert | | | DSH | 4/11/2016 11:59 AM |
| Details | Entity Subname | Insert | | | SAINT JOSEPH HOSPITAL INC / Medical Oncology | 4/11/2016 11:59 AM |
| Dates | Participating Approval Date | Insert | | | | 4/11/2016 11:59 AM |
| Details | State | Insert | | | Pending | 4/11/2016 11:59 AM |
| Dates | Registration Date | Insert | | | 4/11/2016 12:00:00 AM | 4/11/2016 11:59 AM |
| Dates | Signed By Date | Insert | | | 4/11/2016 12:00:00 AM | 4/11/2016 11:59 AM |
| Dates | Start Date | Insert | | | | 4/11/2016 11:59 AM |
| Terminations | Termination Comments | Insert | | | | 4/11/2016 11:59 AM |
| Terminations | Termination Date | Insert | | | | 4/11/2016 11:59 AM |
| Terminations | Termination Effective Date | Insert | | | | 4/11/2016 11:59 AM |
| Terminations | Termination Reason | Insert | | | | 4/11/2016 11:59 AM |