Covered Entity Details

RRC450011-08 ST. JOSEPH REGIONAL HEALTH CENTER (Terminated) - information as of 4/26/2025 11:43:33 PM

Main Details

Name

ST. JOSEPH REGIONAL HEALTH CENTER

Subdivision Name

CHI St Joseph Health Urology Associates - CHI St Joseph Health Urology Associates

Type

Rural Referral Center

Rural

340B ID

RRC450011-08

Medicare Provider Number

450011

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/4/2018

Participating Start Date

10/1/2018

Participating Approval Date

8/20/2018

Last Recertification Date

8/17/2023

Termination Date
Termination Reason

1/1/2024
Business decision by the Covered Entity

Contacts

Authorizing Official

St. Joseph Regional Health Center
Erin Marietta, VP Operations
(443) 956-3099

Primary Contact

St. Joseph Regional Health Center
Kimberly Feese, Market Director Pharmacy
(979) 776-2506

Addresses

Street Address

2700 E. 29th Street
100
Bryan, TX 77802

Billing Address

St. Josph Reg HLT CTR
PO Box 636000
Littleton,, CO 80163-6000

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
TX	081951801	1669557179

Shipping Addresses

Shipping Address 1

CHI St. Joseph Health Regional Hospital
2801 Franciscan Drive
Bryan, TX 77802

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
RRC450011-01	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Primary Care	4421 Hwy 6 South	College Station	TX	Terminated
RRC450011-02	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Orthopaedic Associates - CHI St Joseph Health Orthopaedic Associates	2803 Earl Rudder Fwy.	College Station	TX	Terminated
RRC450011-03	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Pain & Spine Associates - CHI St Joseph Health Pain & Spine Associates	2801 Franciscan Drive	Bryan	TX	Active
RRC450011-04	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St. Joseph Health Trauma Clinic - CHI St. Joseph Health Trauma Clinic	2700 E. 29th Street, Ste 305	Bryan	TX	Terminated
RRC450011-05	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Primary Care Bryan - CHI St Joseph Health Primary Care Bryan	2210 E. 29th Street	Bryan	TX	Terminated
RRC450011-06	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Pediatrics College Station - CHI St Joseph Health Pediatrics College Station	4401 Texas 6 Frontage Rd	College Station	TX	Terminated
RRC450011-07	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Express Care College Station - CHI St Joseph Health Express Care College Station	4421 Texas 6 Frontage Rd	College Station	TX	Terminated
RRC450011-08	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Urology Associates - CHI St Joseph Health Urology Associates	2700 E. 29th Street	Bryan	TX	Terminated
RRC450011-09	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health ENT - CHI St Joseph Health ENT	2805 Earl Rudder Fwy	College Station	TX	Terminated
RRC450011-10	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	Neurology Associates - St. Joseph Health - College Station	1602 Rock Prairie Rd	College Station	TX	Terminated
RRC450011-11	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Primary Care Austin's Colony - CHI St Joseph Health Primary Care Austin's Colony	2410 Boonville Road	Bryan	TX	Terminated
RRC450011-12	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health General Surgery Associates - BSG - CHI St Joseph Health General Surgery Associates - BSG	2700 E. 29th Street	Bryan	TX	Terminated
RRC450011-13	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Pediatrics Bryan - CHI St Joseph Health Pediatrics Bryan	2901 E. 29th Street	Bryan	TX	Terminated
RRC450011-14	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Primary Care College Station - CHI St Joseph Health Primary Care College Station	1512 Holleman	College Station	TX	Terminated
RRC450011-15	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Primary Care South College Station - CHI St Joseph Health Primary Care South College Station	4421 State Hwy 6 South	College Station	TX	Terminated
RRC450011-16	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Express Care - CHI St Joseph Health Express Care	2010 E. Villa Maria Road	Bryan	TX	Terminated
RRC450011-17	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St. Joseph Health Heart Failure Clinic - CHI St. Joseph Health Heart Failure Clinic	2700 E. 29th Street	Bryan	TX	Terminated
RRC450011-18	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Primary Care Barron Road - CHI St Joseph Health Primary Care Barron Road	4007 Victoria Avenue	College Station	TX	Terminated
RRC450011-19	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health General Surgery - GBSA - CHI St Joseph Health General Surgery - GBSA	2700 E. 29th Street	Bryan	TX	Terminated
RRC450011-20	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Primary Care West Villa Maria	1612 West Villa Maria Road	Bryan	TX	Terminated
RRC450011-21	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St. Joseph Health Fracture Clinic - CHI St. Joseph Health Fracture Clinic	2010 E. Villa Maria Road	Bryan	TX	Terminated
RRC450011-22	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health MatureWell Lifestyle Center - CHI St Joseph Health MatureWell Lifestyle Center	3989 N Shore Drive	Bryan	TX	Terminated
RRC450011-23	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI St Joseph Health Primary Care Brenham - CHI St Joseph Health Primary Care Brenham	110 Hwy 290 West	Brenham	TX	Terminated
RRC450011-24	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	CHI ST JOSEPH HEALTH CS EMERGENCY - Emergency room	4411 HIGHWAY 6 S	COLLEGE STATION	TX	Terminated
RRC450011-25	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH-COLLEGE STATION ANESTHESIA - ANESTHESIA	1604 ROCK PRAIRIE ROAD	COLLEGE STATION	TX	Active
RRC450011-26	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION RECOVERY ROOM - RECOVERY ROOM	1604 ROCK PRAIRIE ROAD	COLLEGE STATION	TX	Active
RRC450011-27	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION EMERGENCY SERVICES - EMERGENCY SERVICES	1604 ROCK PRAIRIE ROAD	COLLEGE STATION	TX	Active
RRC450011-28	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION LDR - LDR	1604 ROCK PRAIRIE ROAD	COLLEGE STATION	TX	Active
RRC450011-29	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION CARDIAC CATH LAB - CARDIAC CATH LAB	1604 ROCK PRAIRIE ROAD	COLLEGE STATION	TX	Active
RRC450011-30	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION WOUND SERVICES - WOUND SERVICES	1604 ROCK PRAIRIE ROAD	COLLEGE STATION	TX	Active
RRC450011-31	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION OR - OR	1604 ROCK PRAIRIE ROAD	COLLEGE STATION	TX	Active
RRC450011-32	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION RESPIRATORY CARE - RESPIRATORY CARE	1604 ROCK PRAIRIE ROAD	COLLEGE STATION	TX	Active
RRC450011-33	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION DIALYSIS - DIALYSIS	1604 ROCK PRAIRIE RD	COLLEGE STATION	TX	Active
RRC450011-34	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION Radiology - Diagnostic - Special Procedures	1604 ROCK PRAIRIE ROAD	COLLEGE STATION	TX	Active
RRC450011-35	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION Radiology - Diagnostic - Nuclear Medicine	1604 ROCK PRAIRIE ROAD	COLLEGE STATION	TX	Active
RRC450011-36	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION Radiology - Diagnostic - Radiology	1604 Rock Prairie Rd	College Station	TX	Active
RRC450011-37	Child	RRC	ST. JOSEPH REGIONAL HEALTH CENTER	SJH - COLLEGE STATION Day Services/Day Stay - CSHSDC CS DAY STAY	1604 Rock Prairie Road	College Station	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		9/30/2023 12:00:00 AM	12/4/2023 7:03 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/4/2023 7:03 AM
Terminations	Termination Date	Update	Termination Request		1/1/2024 12:00:00 AM	12/4/2023 7:03 AM
Terminations	Termination Effective Date	Update	Termination Request		10/1/2023 12:00:00 AM	12/4/2023 7:03 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	12/4/2023 7:03 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 12:59:04 PM	8/17/2023 8:12:49 PM	8/17/2023 8:12 PM
Contacts	Primary Contact	Update	Group Change Request	Feese, Kimberly Director of Pharmacy CHI St. Joseph Regional Health Center 9797762506	Feese, Kimberly Market Director Pharmacy St. Joseph Regional Health Center 9797762506	7/26/2023 10:35 AM
Contacts	Authorizing Official	Update	Change Request	Diaz, Ricardo Chief Operating Officer CHI St. Joseph Regional Health Center 9797762580	Marietta, Erin VP Operations St. Joseph Regional Health Center 4439563099	7/24/2023 1:56 PM
Addresses	Billing Address	Update	Change Request	CHI St. Joseph Health Regional Hospital 2801 Franciscan Drive Bryan, TX 77802	St. Josph Reg HLT CTR PO Box 636000 Littleton,, CO 80163-6000	12/7/2022 3:52 PM
Details	Last Recertification Date	Update	Recertification	9/8/2021 2:49:59 PM	9/1/2022 12:59:04 PM	9/1/2022 12:59 PM
Details	Last Recertification Date	Update	Recertification	8/21/2020 4:16:01 PM	9/8/2021 2:49:59 PM	9/8/2021 2:49 PM
Addresses	Main Address	Update	Change Request	2700 E. 29th Street, Ste. 100 Bryan, TX 77802	2700 E. 29th Street 100 Bryan, TX 77802	12/11/2020 8:34 AM
Addresses	Billing Address	Insert	Change Request		CHI St. Joseph Health Regional Hospital 2801 Franciscan Drive Bryan, TX 77802	12/11/2020 8:34 AM
Addresses	Shipping Address	Insert	Change Request		CHI St. Joseph Health Regional Hospital 2801 Franciscan Drive Bryan, TX 77802	12/11/2020 8:34 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1669557179	8/21/2020 4:16 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	8/21/2020 4:16 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1669557179 ( )		8/21/2020 4:16 PM
Details	Last Recertification Date	Update	Recertification	8/23/2019 7:49:44 AM	8/21/2020 4:16:01 PM	8/21/2020 4:16 PM
Details	Last Recertification Date	Update	Recertification		8/23/2019 7:49:44 AM	8/23/2019 7:49 AM
Contacts	Primary Contact	Update	Change Request	Gay, Chad E 340B Division Manager CHI St. Joseph Health System 2818047802	Feese, Kimberly Director of Pharmacy CHI St. Joseph Regional Health Center 9797762506	11/1/2018 2:21 PM
Details	State	Update		Approved	Active	10/1/2018 12:05 AM
Contacts	Signed By	Insert	New Registration		Diaz, Ricardo Chief Operating Officer CHI St. Joseph Regional Health Center 9797762580	8/20/2018 1:56 PM
Details	340B ID	Update	New Registration		RRC450011-08	8/20/2018 1:56 PM
Details	Entity Subname	Update	New Registration	CHI St Joseph Health Urology Associates	CHI St Joseph Health Urology Associates - CHI St Joseph Health Urology Associates	8/20/2018 1:56 PM
Dates	Participating Approval Date	Update	New Registration		8/20/2018 1:56:24 PM	8/20/2018 1:56 PM
Details	State	Update	New Registration	Pending	Approved	8/20/2018 1:56 PM
Dates	Signed By Date	Update	New Registration		7/4/2018 3:40:20 PM	8/20/2018 1:56 PM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	8/20/2018 1:56 PM
Contacts	Authorizing Official	Update	Profile Change Request	Diaz, Ricardo Chief Operating Officer CHI St. Joseph Health Care Center\ 9797762580	Diaz, Ricardo Chief Operating Officer CHI St. Joseph Regional Health Center 9797762580	7/6/2018 7:30 PM
Contacts	Authorizing Official	Update	Profile Change Request	Diaz, Ricardo Chief Operating Officer Madison St. Joseph Health Care Center 9797762580	Diaz, Ricardo Chief Operating Officer CHI St. Joseph Health Care Center\ 9797762580	7/6/2018 7:29 PM
Addresses	Main Address	Insert	New Registration		2700 E. 29th Street, Ste. 100 Bryan, TX 77802	7/4/2018 2:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/4/2018 2:30 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		081951801	7/4/2018 2:30 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	7/4/2018 2:30 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1669557179	7/4/2018 2:30 AM
Contacts	Authorizing Official	Insert	New Registration		Diaz, Ricardo Chief Operating Officer Madison St. Joseph Health Care Center 9797762580	7/4/2018 2:30 AM
Contacts	Primary Contact	Insert	New Registration		Gay, Chad E 340B Division Manager CHI St. Joseph Health System 2818047802	7/4/2018 2:30 AM
Details	Last Recertification Date	Insert	New Registration			7/4/2018 2:30 AM
Details	Grant Number	Insert	New Registration			7/4/2018 2:30 AM
Details	340B ID	Insert	New Registration			7/4/2018 2:30 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/4/2018 2:30 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/4/2018 2:30 AM
Details	Medicare Provider Number	Insert	New Registration		450011	7/4/2018 2:30 AM
Details	Entity Name	Insert	New Registration		ST. JOSEPH REGIONAL HEALTH CENTER	7/4/2018 2:30 AM
Details	Program Code	Insert	New Registration		RRC	7/4/2018 2:30 AM
Details	Entity Subname	Insert	New Registration		CHI St Joseph Health Urology Associates	7/4/2018 2:30 AM
Dates	Participating Approval Date	Insert	New Registration			7/4/2018 2:30 AM
Details	State	Insert	New Registration		Pending	7/4/2018 2:30 AM
Dates	Registration Date	Insert	New Registration		7/4/2018 2:30:13 AM	7/4/2018 2:30 AM
Dates	Signed By Date	Insert	New Registration			7/4/2018 2:30 AM
Dates	Start Date	Insert	New Registration			7/4/2018 2:30 AM
Terminations	Termination Comments	Insert	New Registration			7/4/2018 2:30 AM
Terminations	Termination Date	Insert	New Registration			7/4/2018 2:30 AM
Terminations	Termination Effective Date	Insert	New Registration			7/4/2018 2:30 AM
Terminations	Termination Reason	Insert	New Registration			7/4/2018 2:30 AM