Covered Entity Details

DSH320002U ST. VINCENT HOSPITAL (Active) - information as of 5/5/2025 12:07:00 AM

Main Details

Name

ST. VINCENT HOSPITAL

Subdivision Name

CHRISTUS St. Vincent Heart & Vascular Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH320002U

Medicare Provider Number

320002

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/7/2017

Participating Start Date

10/1/2017

Participating Approval Date

8/8/2017

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

St. Vincent Hospital
Lillian Montoya, President and CEO
(505) 913-5258

Primary Contact

St. Vincent Hospital
Christine Atwell, Director of Pharmacy
(505) 913-5522

Addresses

Street Address

1631 Hospital Drive
Suite 110
SANTA FE, NM 87505

Billing Address

St. Vincent Hospital
455 St. Michaels Drive
Santa Fe, NM 87505

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
NM	00547	1578587150

Shipping Addresses

Same as Street Address

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
DSH320002AA	Child	DSH	ST. VINCENT HOSPITAL	CHRISTUS ST. VINCENT ORTHOPEDIC SPE - Clinic	2968 RODEO PARK DR W	SANTA FE	NM	Active
DSH320002AB	Child	DSH	ST. VINCENT HOSPITAL	NM Heart - Cardiology Services	2237 Trinity Dr.	Los Alamos	NM	Active
DSH320002AC	Child	DSH	ST. VINCENT HOSPITAL	CHRISTUS ST VINCENT LOS ALAMOS - Outpatient Procedures	2237 TRINITY DR	LOS ALAMOS	NM	Active
DSH320002AD	Child	DSH	ST. VINCENT HOSPITAL	CHRISTUS ST VINCENT NEUROLOGY SPEC - Neurology	1631 HOSPITAL DR	SANTA FE	NM	Active
DSH320002B	Child	DSH	ST. VINCENT HOSPITAL	Physicians Medical Center - Surgical Services	2990 Rodeo Park Drive East	Santa Fe	NM	Active
DSH320002C	Child	DSH	ST. VINCENT HOSPITAL	Physicians Medical Center - OR Recovery	2990 Rodeo Park Drive East	Santa Fe	NM	Active
DSH320002D	Child	DSH	ST. VINCENT HOSPITAL	Physicians Medical Center - OR Anesthesia	2990 Rodeo Park Drive East	Santa Fe	NM	Active
DSH320002J	Child	DSH	ST. VINCENT HOSPITAL	Regional Cancer Center - Radiation Oncology	490 A West Zia Road	Santa Fe	NM	Active
DSH320002K	Child	DSH	ST. VINCENT HOSPITAL	Regional Cancer Center - Medical Oncology	490 A West Zia Road	Santa Fe	NM	Active
DSH320002L	Child	DSH	St. Vincent Hospital	Hyperbaric Oxygen Therapy	465 St. Michael's Drive	Santa Fe	NM	Terminated
DSH320002M	Child	DSH	St. Vincent Hospital	Wound Care Center	465 St. Michael's Drive	Santa Fe	NM	Terminated
DSH320002N	Child	DSH	St. Vincent Hospital	Anticoagulation Management Service	465 St. Michael's Drive	Santa Fe	NM	Terminated
DSH320002P	Child	DSH	ST. VINCENT HOSPITAL	NM Heart and Vascular Institute - Radiology	2085 S. Pacheco St.	Santa Fe	NM	Terminated
DSH320002Q	Child	DSH	ST. VINCENT HOSPITAL	NM Heart and Vascular Institute - Cardiology	2085 S. Pacheco St.	SANTA FE	NM	Terminated
DSH320002R	Child	DSH	ST. VINCENT HOSPITAL	NM Heart and Vascular Institute - Administration	2085 S. Pacheco St.	Santa Fe	NM	Terminated
DSH320002S	Child	DSH	ST. VINCENT HOSPITAL	CHRISTUS ST VINCENT MEDICATION MANAGEMENT SERVICES CLINIC	465 ST MICHAELS DRIVE SUITE 114	SANTA FE	NM	Active
DSH320002T	Child	DSH	ST. VINCENT HOSPITAL	CHRISTUS ST VINCENT WOUND AND HYPER	465 ST MICHAELS DRIVE SUITE 101	SANTA FE	NM	Active
DSH320002U	Child	DSH	ST. VINCENT HOSPITAL	CHRISTUS St. Vincent Heart & Vascular Center	1631 Hospital Drive	SANTA FE	NM	Active
DSH320002V	Child	DSH	ST. VINCENT HOSPITAL	ST VINCENT Entrada Contenta Emergency Services - Free Standing Emergency Department	5501 Herrera Drive	Santa Fe	NM	Terminated
DSH320002W	Child	DSH	ST. VINCENT HOSPITAL	CHRISTUS ST VINCENT MEDICATION MANAGEMENT SERVICES CLINIC - MEDICATION MANAGEMENT SERVICES CLINIC	465 SAINT MICHAELS DR	Santa Fe	NM	Terminated
DSH320002X	Child	DSH	ST. VINCENT HOSPITAL	CHRISTUS ST VINCENT PAIN & SPINE SP - Pain and Spine	2990 Rodeo Park Dr. E	Santa Fe	NM	Active
DSH320002Y	Child	DSH	ST. VINCENT HOSPITAL	CHRISTUS ST VINCENT ENT SPECIALISTS - ENT	1631 HOSPITAL DR	SANTA FE	NM	Active
DSH320002Z	Child	DSH	ST. VINCENT HOSPITAL	CHRISTUS St. Vincent Urology - Clinic	465 SAINT MICHAELS DR	SANTA FE	NM	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/18/2023 10:31:42 AM	8/23/2024 2:06:17 PM	8/23/2024 2:06 PM
Details	Last Recertification Date	Update	Recertification	8/25/2022 12:17:02 PM	8/18/2023 10:31:42 AM	8/18/2023 10:31 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 2:02:31 PM	8/25/2022 12:17:02 PM	8/25/2022 12:17 PM
Details	Last Recertification Date	Update	Recertification	8/26/2020 3:38:54 PM	8/16/2021 2:02:31 PM	8/16/2021 2:02 PM
Addresses	Main Address	Update	Change Request	2085 SOUTH PACHECO STREET SANTA FE, NM 87505-6103	1631 Hospital Drive Suite 110 SANTA FE, NM 87505	2/5/2021 10:57 AM
Details	Entity Subname	Update	Change Request	CHRISTUS ST VINCENT HEART AND VASCU	CHRISTUS St. Vincent Heart & Vascular Center	2/5/2021 10:57 AM
Medicaid Billing	NPI: State	Update	Recertification		NM	8/26/2020 3:38 PM
Details	Last Recertification Date	Update	Recertification	8/29/2019 1:37:29 PM	8/26/2020 3:38:54 PM	8/26/2020 3:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/1/2020 2:02 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00547	6/1/2020 2:02 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NM	6/1/2020 2:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578587150	6/1/2020 2:02 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 1:55:42 PM	8/29/2019 1:37:29 PM	8/29/2019 1:37 PM
Details	Last Recertification Date	Update	Recertification	11/8/2017 4:12:02 PM	8/20/2018 1:55:42 PM	8/20/2018 1:55 PM
Contacts	Authorizing Official	Update	AO Change Request	Carrier, Patrick B. President & CEO St. Vincent Hospital 5059135202	Montoya, Lillian President and CEO St. Vincent Hospital 5059135258	7/16/2018 3:24 PM
Details	Last Recertification Date	Update	Recertification		11/8/2017 4:12:02 PM	11/8/2017 4:12 PM
Contacts	Primary Contact	Update	Recertification	Atwell, Christine Director of Pharmacy 5059135522	Atwell, Christine Director of Pharmacy St. Vincent Hospital 5059135522	11/8/2017 3:52 PM
Contacts	Authorizing Official	Update		Carrier, Patrick B. President & CEO 5059135202	Carrier, Patrick B. President & CEO St. Vincent Hospital 5059135202	9/25/2017 11:35 AM
Contacts	Signed By	Update		Carrier, Patrick B. President & CEO 5059135202	Carrier, Patrick B. President & CEO St. Vincent Hospital 5059135202	9/25/2017 11:35 AM
Contacts	Authorizing Official	Insert			Carrier, Patrick B. President & CEO 5059135202	8/9/2017 4:01 PM
Contacts	Signed By	Insert			Carrier, Patrick B. President & CEO 5059135202	8/9/2017 4:01 PM
Contacts	Primary Contact	Insert			Atwell, Christine Director of Pharmacy 5059135522	8/9/2017 4:01 PM
Addresses	Main Address	Insert			2085 SOUTH PACHECO STREET SANTA FE, NM 87505-6103	8/8/2017 9:58 AM
Addresses	Billing Address	Insert			St. Vincent Hospital 455 St. Michaels Drive Santa Fe, NM 87505	8/8/2017 9:58 AM
Details	State	Update		Approved	Active	8/8/2017 9:58 AM
Dates	Participating Approval Date	Update			8/8/2017 12:00:00 AM	8/8/2017 9:57 AM
Details	State	Update		Pending	Approved	8/8/2017 9:57 AM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	8/8/2017 9:57 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_77974	DSH320002U	7/10/2017 4:05 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_77974	7/7/2017 2:19 PM
Details	Last Recertification Date	Insert				7/7/2017 2:19 PM
Details	Grant Number	Insert				7/7/2017 2:19 PM
Details	340B ID	Insert				7/7/2017 2:19 PM
Details	Is Authorizing Official EHB Data	Insert				7/7/2017 2:19 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/7/2017 2:19 PM
Details	Medicare Provider Number	Insert			320002	7/7/2017 2:19 PM
Details	Entity Name	Insert			ST. VINCENT HOSPITAL	7/7/2017 2:19 PM
Details	Program Code	Insert			DSH	7/7/2017 2:19 PM
Details	Entity Subname	Insert			CHRISTUS ST VINCENT HEART AND VASCU	7/7/2017 2:19 PM
Dates	Participating Approval Date	Insert				7/7/2017 2:19 PM
Details	State	Insert			Pending	7/7/2017 2:19 PM
Dates	Registration Date	Insert			7/7/2017 12:00:00 AM	7/7/2017 2:19 PM
Dates	Signed By Date	Insert			7/7/2017 12:00:00 AM	7/7/2017 2:19 PM
Dates	Start Date	Insert				7/7/2017 2:19 PM
Terminations	Termination Comments	Insert				7/7/2017 2:19 PM
Terminations	Termination Date	Insert				7/7/2017 2:19 PM
Terminations	Termination Effective Date	Insert				7/7/2017 2:19 PM
Terminations	Termination Reason	Insert				7/7/2017 2:19 PM