Covered Entity Details

CAH281322-06 ST. FRANCIS MEMORIAL HOSPITAL (Terminated) - information as of 5/29/2025 2:01:12 AM

Main Details

Name

ST. FRANCIS MEMORIAL HOSPITAL

Subdivision Name

FRANCISCAN CARE SERVICES INC - HOOPER MEDICAL CLINIC

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH281322-06

Medicare Provider Number

281322

Outpatient Facility Provider Number

288537

Additional Details

Current Program Status

Terminated

Registration Date

1/10/2017

Participating Start Date

4/1/2017

Participating Approval Date

2/16/2017

Last Recertification Date

8/22/2019

Termination Date
Termination Reason

1/1/2020
Site closure

Contacts

Authorizing Official

St. Francis Memorial Hospital
Alisa Ann Brunsing, CFO
(402) 372-6717

Primary Contact

St. Francis Memorial Hospital
MICHELLE EINFALT, PHARMACY DIRECTOR
(402) 372-6730

Addresses

Street Address

600 E FULTON ST STE A
HOOPER MEDICAL CLINIC
HOOPER, NE 68031-3074

Billing Address

DINKLAGE MEDICAL CLINIC
500 E DECATUR ST
WEST POINT, NE 68788-1566

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?
No

Shipping Addresses

Shipping Address 1

ST FRANCIS MEMORIAL HOSPITAL
430 N MONITOR ST
WEST POINT, NE 68788-1595

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
CAH281322-01	Child	CAH	FRANCISCAN CARE SERVICES INC DBA FRANCISCAN HEALTHCARE	FRANCISCAN HEALTHCARE WEST POINT CLINIC	500 EAST DECATUR	WEST POINT	NE	Active
CAH281322-02	Child	CAH	FRANCISCAN CARE SERVICES INC DBA FRANCISCAN HEALTHCARE	FRANCISCAN HEALTHCARE HOWELLS CLINIC	119 S 3RD STREET	HOWELLS	NE	Active
CAH281322-03	Child	CAH	FRANCISCAN CARE SERVICES INC DBA FRANCISCAN HEALTHCARE	FRANCISCAN HEALTHCARE WISNER CLINIC	2100 21ST CIRCLE	WISNER	NE	Active
CAH281322-04	Child	CAH	FRANCISCAN CARE SERVICES INC DBA FRANCISCAN HEALTHCARE	OAKLAND FAMILY PRACTICE	100 WEST 9TH STREET	OAKLAND	NE	Terminated
CAH281322-05	Child	CAH	FRANCISCAN CARE SERVICES INC DBA FRANCISCAN HEALTHCARE	FRANCISCAN HEALTHCARE SCRIBNER CLINIC	429 MAIN STREET	SCRIBNER	NE	Active
CAH281322-06	Child	CAH	ST. FRANCIS MEMORIAL HOSPITAL	FRANCISCAN CARE SERVICES INC - HOOPER MEDICAL CLINIC	600 E FULTON ST STE A	HOOPER	NE	Terminated
CAH281322-07	Child	CAH	FRANCISCAN CARE SERVICES INC DBA FRANCISCAN HEALTHCARE	Franciscan Healthcare Oakland Clinic - Family Practice	211 N Engdahl Ave	Oakland	NE	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/20/2019 12:00:00 AM	12/4/2019 3:41 PM
Details	State	Update	Termination Request	Active	To Be Terminated	12/4/2019 3:41 PM
Terminations	Termination Date	Update	Termination Request		1/1/2020 12:00:00 AM	12/4/2019 3:41 PM
Terminations	Termination Effective Date	Update	Termination Request		11/20/2019 12:00:00 AM	12/4/2019 3:41 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	12/4/2019 3:41 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 1:04:50 PM	8/22/2019 2:52:02 PM	8/22/2019 2:52 PM
Contacts	Authorizing Official	Update	Change Request	Wordekemper, Jerry CEO/PRESIDENT St. Francis Memorial Hospital 4023722404-2101	Brunsing, Alisa Ann CFO St. Francis Memorial Hospital 4023726717	7/11/2019 8:05 AM
Details	Last Recertification Date	Update	Recertification	11/20/2017 11:34:43 AM	8/17/2018 1:04:50 PM	8/17/2018 1:04 PM
Contacts	Primary Contact	Insert	Recertification		EINFALT, MICHELLE PHARMACY DIRECTOR St. Francis Memorial Hospital 4023726730	11/20/2017 11:34 AM
Details	Last Recertification Date	Update	Recertification		11/20/2017 11:34:43 AM	11/20/2017 11:34 AM
Contacts	Authorizing Official	Update		Wordekemper, Jerry CEO/PRESIDENT 4023722404-2101	Wordekemper, Jerry CEO/PRESIDENT St. Francis Memorial Hospital 4023722404-2101	10/14/2017 8:44 AM
Contacts	Signed By	Update		Wordekemper, Jerry CEO/PRESIDENT 4023722404-2101	Wordekemper, Jerry CEO/PRESIDENT St. Francis Memorial Hospital 4023722404-2101	10/14/2017 8:44 AM
Contacts	Authorizing Official	Insert			Wordekemper, Jerry CEO/PRESIDENT 4023722404-2101	2/16/2017 4:43 PM
Contacts	Signed By	Insert			Wordekemper, Jerry CEO/PRESIDENT 4023722404-2101	2/16/2017 4:43 PM
Addresses	Main Address	Insert			600 E FULTON ST STE A HOOPER MEDICAL CLINIC HOOPER, NE 68031-3074	2/16/2017 4:43 PM
Addresses	Billing Address	Insert			DINKLAGE MEDICAL CLINIC 500 E DECATUR ST WEST POINT, NE 68788-1566	2/16/2017 4:43 PM
Addresses	Shipping Address	Insert			ST FRANCIS MEMORIAL HOSPITAL 430 N MONITOR ST WEST POINT, NE 68788-1595	2/16/2017 4:43 PM
Dates	Participating Approval Date	Update			2/16/2017 12:00:00 AM	2/16/2017 4:43 PM
Details	State	Update		Pending	Active	2/16/2017 4:43 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	2/16/2017 4:43 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_74309	CAH281322-06	2/1/2017 2:40 PM
Details	Entity Subname	Update		FRANCISCAN CARE SERVICES INC	FRANCISCAN CARE SERVICES INC - HOOPER MEDICAL CLINIC	2/1/2017 2:40 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_74309	1/10/2017 11:59 AM
Details	Last Recertification Date	Insert				1/10/2017 11:59 AM
Details	Grant Number	Insert				1/10/2017 11:59 AM
Details	340B ID	Insert				1/10/2017 11:59 AM
Details	Is Authorizing Official EHB Data	Insert				1/10/2017 11:59 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/10/2017 11:59 AM
Details	Medicare Provider Number	Insert			281322	1/10/2017 11:59 AM
Details	Entity Name	Insert			ST. FRANCIS MEMORIAL HOSPITAL	1/10/2017 11:59 AM
Details	Program Code	Insert			CAH	1/10/2017 11:59 AM
Details	Entity Subname	Insert			FRANCISCAN CARE SERVICES INC	1/10/2017 11:59 AM
Dates	Participating Approval Date	Insert				1/10/2017 11:59 AM
Details	State	Insert			Pending	1/10/2017 11:59 AM
Dates	Registration Date	Insert			1/10/2017 12:00:00 AM	1/10/2017 11:59 AM
Dates	Signed By Date	Insert			1/10/2017 12:00:00 AM	1/10/2017 11:59 AM
Dates	Start Date	Insert				1/10/2017 11:59 AM
Terminations	Termination Comments	Insert				1/10/2017 11:59 AM
Terminations	Termination Date	Insert				1/10/2017 11:59 AM
Terminations	Termination Effective Date	Insert				1/10/2017 11:59 AM
Terminations	Termination Reason	Insert				1/10/2017 11:59 AM