Covered Entity Details

DSH060103F AdventHealth Avista (Active) - information as of 6/21/2025 10:38:31 PM

Main Details

Name

AdventHealth Avista

Subdivision Name

AdventHealth Hematology and Oncology at Parker

Type

Disproportionate Share Hospital

Rural

340B ID

DSH060103F

Medicare Provider Number

060103

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/11/2018

Participating Start Date

7/1/2018

Participating Approval Date

4/20/2018

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

AdventHealth
Jonathan Erickson, Avista CFO
(303) 673-1000

Primary Contact

AdventHealth
Dustin Lott Jones, 340B Coordinator
(254) 833-1495

Addresses

Street Address

9403 Crown Crest Blvd.
Suite 115
Parker, CO 80138

Billing Address

AdventHealth Avista
c/o AdventHealth
902 Inspiration Avenue
Suite 9100
Altamonte Springs, FL 32714

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
CO	05010301	1891709192,1760022297

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
DSH060103A	Child	DSH	AdventHealth Avista	AdventHealth Surgery Center Boulder	2525 4th Street	Boulder	CO	Active
DSH060103B	Child	DSH	Centura Health-Avista Adventist Hospital	Church Ranch Neighborhood Health Center / Emergency Department	7233 Church Ranch Boulevard	Westminster	CO	Terminated
DSH060103C	Child	DSH	AdventHealth Avista	AdventHealth Avista Infusion Center	100 Health Park Drive	LOUISVILLE	CO	Active
DSH060103D	Child	DSH	AdventHealth Avista	AdventHealth Hematology and Oncology at Denver	2555 S Downing St	Denver	CO	Active
DSH060103E	Child	DSH	AdventHealth Avista	AdventHealth Hematology and Oncology at Littleton	7750 S. Broadway	Littleton	CO	Active
DSH060103F	Child	DSH	AdventHealth Avista	AdventHealth Hematology and Oncology at Parker	9403 Crown Crest Blvd.	Parker	CO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	PC Change Request	Becker, Jody 340B Program Director AdventHealth 3524344284	Jones, Dustin Lott 340B Coordinator AdventHealth 2548331495	3/19/2025 8:24 AM
Addresses	Main Address	Update	Recertification	9403 Crown Crest Blvd. 115 Parker, CO 80138	9403 Crown Crest Blvd. Suite 115 Parker, CO 80138	9/3/2024 2:57 PM
Details	Last Recertification Date	Update	Recertification	8/14/2023 10:37:50 AM	9/3/2024 2:57:29 PM	9/3/2024 2:57 PM
Addresses	Billing Address	Update	Change Request	Centura Health PO Box 372660 Denver, CO 80237	AdventHealth Avista c/o AdventHealth 902 Inspiration Avenue Suite 9100 Altamonte Springs, FL 32714	3/19/2024 12:39 PM
Details	Entity Subname	Update	Change Request	CYPRESS HEMATOLOGY & ONCOLOGY PARKER - CYPRESS HEMATOLOGY & ONCOLOGY PARKER	AdventHealth Hematology and Oncology at Parker	3/19/2024 12:39 PM
Details	Entity Name	Update	Change Request	Centura Avista Adventist Hospital	AdventHealth Avista	2/9/2024 8:44 AM
Contacts	Primary Contact	Update	PC Change Request	Morgan, Samantha Director, Enterprise 340B Program Centura Health 3036737380	Becker, Jody 340B Program Director AdventHealth 3524344284	11/29/2023 11:15 AM
Contacts	Authorizing Official	Update	AO Change Request	Travis, Carol CFO Avista Adventist Hospital 3036731288	Erickson, Jonathan Avista CFO AdventHealth 3036731000	11/27/2023 8:04 AM
Contacts	Authorizing Official	Update	AO Change Request	Travis, Carol CFO Avista Adventist Hospital 3036731288	Travis, Carol CFO Avista Adventist Hospital 3036731288	10/17/2023 7:49 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 11:48:06 AM	8/14/2023 10:37:50 AM	8/14/2023 10:37 AM
Contacts	Authorizing Official	Update	Profile Change Request	Travis, Carol CFO St. Anthony North Health Campus 7206271230	Travis, Carol CFO Avista Adventist Hospital 3036731288	6/15/2023 2:53 PM
Contacts	Primary Contact	Update	Profile Change Request	Morgan, Samantha 340B Program Manager Centura Health 3036737380	Morgan, Samantha Director, Enterprise 340B Program Centura Health 3036737380	5/25/2023 12:41 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1760022297	4/10/2023 4:16 PM
Medicaid Billing	NPI: State	Insert	Change Request		CO	4/10/2023 4:16 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 8:30:26 AM	9/7/2022 11:48:06 AM	9/7/2022 11:48 AM
Details	Entity Name	Update	Change Request	Centura Health-Avista Adventist Hospital	Centura Avista Adventist Hospital	4/5/2022 1:31 PM
Details	Last Recertification Date	Update	Recertification	8/20/2020 3:10:45 PM	8/24/2021 8:30:26 AM	8/24/2021 8:30 AM
Contacts	Primary Contact	Update	Change Request	POLITO, VINNY SYSTEM DIRECTOR AMB PHARMACY Centura Health 3036731014	Morgan, Samantha 340B Program Manager Centura Health 3036737380	7/15/2021 8:06 AM
Addresses	Main Address	Update	Change Request	9399 Crown Crest Blvd 215 Parker, CO 80138	9403 Crown Crest Blvd. 115 Parker, CO 80138	5/26/2021 8:06 AM
Medicaid Billing	NPI: State	Update	Recertification		CO	8/20/2020 3:10 PM
Details	Last Recertification Date	Update	Recertification	8/29/2019 1:10:26 PM	8/20/2020 3:10:45 PM	8/20/2020 3:10 PM
Addresses	Billing Address	Insert	Change Request		Centura Health PO Box 372660 Denver, CO 80237	9/13/2019 1:04 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 12:03:03 PM	8/29/2019 1:10:26 PM	8/29/2019 1:10 PM
Contacts	Authorizing Official	Update	Change Request	McKinney, Jillyan Chief Executive Officer CENTURA HEALTH - AVISTA ADVENTIST HOSPITAL 3036731280	Travis, Carol CFO St. Anthony North Health Campus 7206271230	6/5/2019 11:25 AM
Contacts	Primary Contact	Update	Profile Change Request	POLITO, VINNY PHARMACY MANAGER Centura Health 3036731235	POLITO, VINNY SYSTEM DIRECTOR AMB PHARMACY Centura Health 3036731014	10/4/2018 11:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1891709192	9/7/2018 6:24 PM
Details	Last Recertification Date	Update	Recertification		8/17/2018 12:03:03 PM	8/17/2018 12:03 PM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		McKinney, Jillyan Chief Executive Officer CENTURA HEALTH - AVISTA ADVENTIST HOSPITAL 3036731280	4/20/2018 2:01 PM
Details	340B ID	Update	New Registration		DSH060103F	4/20/2018 2:01 PM
Details	Entity Subname	Update	New Registration	CYPRESS HEMATOLOGY & ONCOLOGY PARKER	CYPRESS HEMATOLOGY & ONCOLOGY PARKER - CYPRESS HEMATOLOGY & ONCOLOGY PARKER	4/20/2018 2:01 PM
Dates	Participating Approval Date	Update	New Registration		4/20/2018 2:01:37 PM	4/20/2018 2:01 PM
Details	State	Update	New Registration	Pending	Approved	4/20/2018 2:01 PM
Dates	Signed By Date	Update	New Registration		4/12/2018 11:38:45 AM	4/20/2018 2:01 PM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	4/20/2018 2:01 PM
Addresses	Main Address	Insert	New Registration		9399 Crown Crest Blvd 215 Parker, CO 80138	4/11/2018 2:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/11/2018 2:06 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		05010301	4/11/2018 2:06 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	4/11/2018 2:06 PM
Contacts	Primary Contact	Insert	New Registration		POLITO, VINNY PHARMACY MANAGER Centura Health 3036731235	4/11/2018 2:06 PM
Contacts	Authorizing Official	Insert	New Registration		McKinney, Jillyan Chief Executive Officer CENTURA HEALTH - AVISTA ADVENTIST HOSPITAL 3036731280	4/11/2018 2:06 PM
Details	Last Recertification Date	Insert	New Registration			4/11/2018 2:06 PM
Details	Grant Number	Insert	New Registration			4/11/2018 2:06 PM
Details	340B ID	Insert	New Registration			4/11/2018 2:06 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2018 2:06 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2018 2:06 PM
Details	Medicare Provider Number	Insert	New Registration		060103	4/11/2018 2:06 PM
Details	Entity Name	Insert	New Registration		Centura Health-Avista Adventist Hospital	4/11/2018 2:06 PM
Details	Program Code	Insert	New Registration		DSH	4/11/2018 2:06 PM
Details	Entity Subname	Insert	New Registration		CYPRESS HEMATOLOGY & ONCOLOGY PARKER	4/11/2018 2:06 PM
Dates	Participating Approval Date	Insert	New Registration			4/11/2018 2:06 PM
Details	State	Insert	New Registration		Pending	4/11/2018 2:06 PM
Dates	Registration Date	Insert	New Registration		4/11/2018 2:06:11 PM	4/11/2018 2:06 PM
Dates	Signed By Date	Insert	New Registration			4/11/2018 2:06 PM
Dates	Start Date	Insert	New Registration			4/11/2018 2:06 PM
Terminations	Termination Comments	Insert	New Registration			4/11/2018 2:06 PM
Terminations	Termination Date	Insert	New Registration			4/11/2018 2:06 PM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2018 2:06 PM
Terminations	Termination Reason	Insert	New Registration			4/11/2018 2:06 PM