Covered Entity Details

DSH100075AG ST JOSEPH'S HOSPITAL (Active) - information as of 4/25/2025 5:40:33 PM

Main Details

Name

ST JOSEPH'S HOSPITAL

Subdivision Name

ST. JOSEPHS HOSPITAL South Ultrasound

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH100075AG

Medicare Provider Number

100075

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/13/2016

Participating Start Date

10/1/2016

Participating Approval Date

8/22/2016

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

Baycare Health System
Carl Tremonti, Chief Financial Officer
(813) 870-4020

Primary Contact

BayCare Health System
Kyle J Brauer, Manager, BayCare Pharmacy Supply Chain
(813) 901-6376

Addresses

Street Address

6901 SIMMONS LOOP
RIVERVIEW, FL 33578-9498

Billing Address
Same as Street Address

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
FL	0100978-06	1881632818

Shipping Addresses

Shipping Address 1

ST. JOSEPHS HOSPITAL South Ultrasound
6901 SIMMONS LOOP
RIVERVIEW, FL 33578

Shipping Address 2

BayCare Integrated Service Center, LLC
Dba/ BayCare Central Pharmacy
7802 E. Telecom Parkway
Temple Terrace, FL 33637

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
DSH100075A	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL- NORTH	4211 VAN DYKE ROAD	LUTZ	FL	Terminated
DSH100075AA	Child	DSH	ST JOSEPH'S HOSPITAL	ST. JOSEPHS HOSPITAL SOUTH Respiratory Care Services	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AB	Child	DSH	ST JOSEPH'S HOSPITAL	St Josephs Hospital South MRI	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AC	Child	DSH	ST JOSEPH'S HOSPITAL	St. Josephs Hospital South CT Scan	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AD	Child	DSH	ST JOSEPH'S HOSPITAL	St. Josephs Hospital South Nuclear Medicine	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AE	Child	DSH	ST JOSEPH'S HOSPITAL	St. Josephs Hospital South Interventional Services	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AF	Child	DSH	ST JOSEPH'S HOSPITAL	St. Josephs Hosptial South Diagnostic Imagining	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AG	Child	DSH	ST JOSEPH'S HOSPITAL	ST. JOSEPHS HOSPITAL South Ultrasound	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AH	Child	DSH	ST JOSEPH'S HOSPITAL	Rehab Services Main	4211 VAN DYKE RD	LUTZ	FL	Active
DSH100075AJ	Child	DSH	ST JOSEPH'S HOSPITAL	ST. JOSEPHS HOSPITAL SOUTH Breast Center	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AK	Child	DSH	ST JOSEPH'S HOSPITAL	ST. JOSEPHS HOSPITAL SOUTH Anesthesiology	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AL	Child	DSH	ST JOSEPH'S HOSPITAL	ST. JOSEPHS HOSPITAL SOUTH Labor and Delivery	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AM	Child	DSH	ST JOSEPH'S HOSPITAL	ST. JOSEPHS HOSPITAL SOUTH Post Anesthesia Care Unit	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AN	Child	DSH	ST JOSEPH'S HOSPITAL	ST. JOSEPHS HOSPITAL SOUTH Endoscopy	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AP	Child	DSH	ST JOSEPH'S HOSPITAL	ST. JOSEPHS HOSPITAL SOUTH Surgery	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075AQ	Child	DSH	ST JOSEPH'S HOSPITAL	Outpatient Infusion Center	4211 VAN DYKE RD	LUTZ	FL	Active
DSH100075AR	Child	DSH	ST JOSEPH'S HOSPITAL	Hemodialysis	4211 VAN DYKE RD	LUTZ	FL	Active
DSH100075AS	Child	DSH	ST JOSEPH'S HOSPITAL	Non-Invasive Cardiology	4211 VAN DYKE RD	LUTZ	FL	Active
DSH100075AT	Child	DSH	ST JOSEPH'S HOSPITAL	Endoscopy	4211 VAN DYKE RD	LUTZ	FL	Active
DSH100075AU	Child	DSH	ST JOSEPH'S HOSPITAL	Respiratory Care Services	4211 VAN DYKE RD	LUTZ	FL	Active
DSH100075AV	Child	DSH	ST JOSEPH'S HOSPITAL	Nuclear Medicine	4211 VAN DYKE RD	LUTZ	FL	Active
DSH100075AW	Child	DSH	ST JOSEPH'S HOSPITAL	Diagnostic Imaging	4211 VAN DYKE RD	LUTZ	FL	Active
DSH100075AX	Child	DSH	ST JOSEPH'S HOSPITAL	Ultrasound	4211 VAN DYKE RD	LUTZ	FL	Active
DSH100075AY	Child	DSH	ST JOSEPH'S HOSPITAL	BREAST CENTER	4211 VAN DYKE RD	LUTZ	FL	Active
DSH100075AZ	Child	DSH	ST. JOSEPHS HOSPITAL	ST. JOSEPHS HOSPITAL SOUTH Surgery	4211 VAN DYKE RD	LUTZ	FL	Terminated
DSH100075B	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital - North / EMERGENCY SERVICE	4211 VAN DYKE ROAD	Lutz	FL	Active
DSH100075BA	Child	DSH	ST JOSEPH'S HOSPITAL	Specialty Pharmacy Clinic - Specialty Pharmacy Clinic	3030 W Martin Luther King Jr Blvd	Tampa	FL	Active
DSH100075BB	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL - SOUTH - St. Joseph's Hospital South Rehab Services	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075BC	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL - SOUTH - St. Joseph's Hospital South Non-invasive Cardiology	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075BD	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital Infusion Center - Outpatient Infusion Adult	4510 N Habana Ave	Tampa	FL	Active
DSH100075BE	Child	DSH	ST JOSEPH'S HOSPITAL	SJH HEMATOLOGY & ONCOLOGY - SJH Hem Onc Habana	4620 N HABANA AVE	TAMPA	FL	Active
DSH100075BF	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL RHEUMATOLOGY - SJH Rheum St Petersburg	620 10TH ST N	ST PETERSBURG	FL	Approved
DSH100075BG	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL NEUROLOGY - SJH Neuro St Petersburg	1201 5TH AVE N	ST PETERSBURG	FL	Approved
DSH100075C	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital - North / ANESTHESIOLOGY	4211 Van Dyke Road	Lutz	FL	Active
DSH100075D	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital - North / BLOOD SERVICES	4211 VAN DYKE ROAD	Lutz	FL	Terminated
DSH100075E	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital - North / CT SCAN	4211 VAN DYKE ROAD	Lutz	FL	Active
DSH100075F	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital - North / INTERVENTIONAL SERVICES	4211 VAN DYKE ROAD	Lutz	FL	Active
DSH100075G	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital - North / MRI	4211 VAN DYKE ROAD	Lutz	FL	Active
DSH100075H	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital - North / Surgery	4211 VAN DYKE ROAD	Lutz	FL	Active
DSH100075J	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital - North / INTENSIVE CARE UNIT I	4211 VAN DYKE ROAD	Lutz	FL	Terminated
DSH100075K	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital - North / LABOR & DELIVERY	4211 VAN DYKE ROAD	Lutz	FL	Active
DSH100075L	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital - North / PACU	4211 VAN DYKE ROAD	Lutz	FL	Active
DSH100075M	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL INC / SURGERY WOMENS	3030 W DR MARTIN LUTHER KING JR BLVD	TAMPA	FL	Active
DSH100075N	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL INC / PACU Women's	3030 W DR MARTIN LUTHER KING JR BLVD	TAMPA	FL	Active
DSH100075P	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL INC / MRI Womens	3030 W DR MARTIN LUTHER KING JR BLVD	TAMPA	FL	Active
DSH100075Q	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL INC / ULTRASOUND WOMENS	3030 W DR MARTIN LUTHER KING JR BLVD	TAMPA	FL	Active
DSH100075R	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL INC / CT SCAN WOMENS	3030 W DR MARTIN LUTHER KING JR BLVD	TAMPA	FL	Active
DSH100075S	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL INC / DIAGNOSTIC IMAGING WOMENS	3030 W DR MARTIN LUTHER KING JR BLVD	TAMPA	FL	Active
DSH100075T	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL INC / RESPIRATORY CARE SVCS WOMENS	3030 W DR MARTIN LUTHER KING JR BLVD	TAMPA	FL	Active
DSH100075U	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL INC / WOMENS MATERNAL FETAL MED CTR	3030 W DR MARTIN LUTHER KING JR BLVD	TAMPA	FL	Terminated
DSH100075V	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL INC / WOMENS URGENT CARE	3030 W DR MARTIN LUTHER KING JR BLVD	TAMPA	FL	Active
DSH100075W	Child	DSH	ST JOSEPH'S HOSPITAL	ST JOSEPH'S HOSPITAL INC / BREAST CENTER WOMENS	3030 W DR MARTIN LUTHER KING JR BLVD	TAMPA	FL	Active
DSH100075X	Child	DSH	ST JOSEPH'S HOSPITAL	St. Joseph's Hospital South Emergency Services	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075Y	Child	DSH	ST JOSEPH'S HOSPITAL	ST. JOSEPHS HOSPITAL South Outpatient Infusion	6901 SIMMONS LOOP	RIVERVIEW	FL	Active
DSH100075Z	Child	DSH	ST JOSEPH'S HOSPITAL	St. Josephs Hosptial South Hemodialysis	6901 SIMMONS LOOP	RIVERVIEW	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/6/2023 7:45:05 AM	8/26/2024 6:37:34 AM	8/26/2024 6:37 AM
Details	Last Recertification Date	Update	Recertification	9/12/2022 8:12:44 AM	9/6/2023 7:45:05 AM	9/6/2023 7:45 AM
Details	Last Recertification Date	Update	Recertification	9/1/2021 7:55:14 AM	9/12/2022 8:12:44 AM	9/12/2022 8:12 AM
Details	Last Recertification Date	Update	Recertification	9/8/2020 8:01:36 AM	9/1/2021 7:55:14 AM	9/1/2021 7:55 AM
Medicaid Billing	NPI: State	Update	Recertification		FL	9/8/2020 8:01 AM
Details	Last Recertification Date	Update	Recertification	8/20/2019 9:06:29 AM	9/8/2020 8:01:36 AM	9/8/2020 8:01 AM
Contacts	Primary Contact	Update	Change Request	Magee, Michael Vice President of Pharmacy BayCare Health System 8138704020	Brauer, Kyle J Manager, BayCare Pharmacy Supply Chain BayCare Health System 8139016376	6/5/2020 7:19 AM
Details	Last Recertification Date	Update	Recertification	8/20/2018 2:26:53 PM	8/20/2019 9:06:29 AM	8/20/2019 9:06 AM
Details	Last Recertification Date	Update	Recertification	11/9/2017 8:50:50 AM	8/20/2018 2:26:53 PM	8/20/2018 2:26 PM
Addresses	Shipping Address	Insert	Change Request		ST. JOSEPHS HOSPITAL South Ultrasound 6901 SIMMONS LOOP RIVERVIEW, FL 33578	8/10/2018 7:09 AM
Addresses	Shipping Address	Insert	Change Request		BayCare Integrated Service Center, LLC Dba/ BayCare Central Pharmacy 7802 E. Telecom Parkway Temple Terrace, FL 33637	8/10/2018 7:09 AM
Details	Last Recertification Date	Update	Recertification		11/9/2017 8:50:50 AM	11/9/2017 8:50 AM
Details	Entity Name	Update	Recertification	ST. JOSEPHS HOSPITAL	ST JOSEPH'S HOSPITAL	11/9/2017 8:42 AM
Contacts	Authorizing Official	Update		Tremonti, Carl Chief Financial Officer 8138704020	Tremonti, Carl Chief Financial Officer Baycare Health System 8138704020	10/2/2017 2:52 PM
Contacts	Signed By	Update		Tremonti, Carl Chief Financial Officer 8138704020	Tremonti, Carl Chief Financial Officer Baycare Health System 8138704020	10/2/2017 2:52 PM
Contacts	Primary Contact	Update		Magee, Michael Vice President of Pharmacy 8138704020	Magee, Michael Vice President of Pharmacy BayCare Health System 8138704020	10/1/2017 6:33 PM
Contacts	Authorizing Official	Insert			Tremonti, Carl Chief Financial Officer 8138704020	8/9/2017 10:58 AM
Contacts	Signed By	Insert			Tremonti, Carl Chief Financial Officer 8138704020	8/9/2017 10:58 AM
Contacts	Primary Contact	Insert			Magee, Michael Vice President of Pharmacy 8138704020	8/4/2017 1:11 PM
Addresses	Main Address	Insert			6901 SIMMONS LOOP RIVERVIEW, FL 33578-9498	9/7/2016 2:35 PM
Details	340B ID	Update		DSH100075BG	DSH100075AG	8/22/2016 11:52 AM
Dates	Participating Approval Date	Update			8/22/2016 12:00:00 AM	8/22/2016 11:52 AM
Details	State	Update		Pending	Active	8/22/2016 11:52 AM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	8/22/2016 11:52 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_71629	DSH100075BG	7/26/2016 11:20 AM
Details	Entity Subname	Update		ST JOSEPH'S HOSPITAL INC / SJHS Ultrasound	ST. JOSEPHS HOSPITAL South Ultrasound	7/26/2016 11:20 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_71629	7/13/2016 4:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/13/2016 4:59 PM
Medicaid Billing	Medicaid: Number	Insert			0100978-06	7/13/2016 4:59 PM
Medicaid Billing	Medicaid: State	Insert			FL	7/13/2016 4:59 PM
Medicaid Billing	NPI: Number	Insert			1881632818	7/13/2016 4:59 PM
Details	Last Recertification Date	Insert				7/13/2016 4:59 PM
Details	Grant Number	Insert				7/13/2016 4:59 PM
Details	340B ID	Insert				7/13/2016 4:59 PM
Details	Is Authorizing Official EHB Data	Insert				7/13/2016 4:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/13/2016 4:59 PM
Details	Medicare Provider Number	Insert			100075	7/13/2016 4:59 PM
Details	Entity Name	Insert			ST. JOSEPHS HOSPITAL	7/13/2016 4:59 PM
Details	Program Code	Insert			DSH	7/13/2016 4:59 PM
Details	Entity Subname	Insert			ST JOSEPH'S HOSPITAL INC / SJHS Ultrasound	7/13/2016 4:59 PM
Dates	Participating Approval Date	Insert				7/13/2016 4:59 PM
Details	State	Insert			Pending	7/13/2016 4:59 PM
Dates	Registration Date	Insert			7/13/2016 12:00:00 AM	7/13/2016 4:59 PM
Dates	Signed By Date	Insert			7/13/2016 12:00:00 AM	7/13/2016 4:59 PM
Dates	Start Date	Insert				7/13/2016 4:59 PM
Terminations	Termination Comments	Insert				7/13/2016 4:59 PM
Terminations	Termination Date	Insert				7/13/2016 4:59 PM
Terminations	Termination Effective Date	Insert				7/13/2016 4:59 PM
Terminations	Termination Reason	Insert				7/13/2016 4:59 PM