Covered Entity Details

DSH370091P Saint Francis Hospital (Active) - information as of 5/13/2025 11:05:23 PM

Main Details

Name

Saint Francis Hospital

Subdivision Name

SFCC / Radiation Oncology - Radiation Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH370091P

Medicare Provider Number

370091

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/15/2019

Participating Start Date

10/1/2019

Participating Approval Date

7/26/2019

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Saint Francis Health System
Deborah D Dage, SRVP/Chief Financial Officer
(918) 494-8418

Primary Contact

Saint Francis Health System
Theodore Houston, Manager Pharmacy Financials and 340B Program
(918) 494-1862

Addresses

Street Address

11212 East 48th Street
Tulsa, OK 74146

Billing Address

Saint Francis Health System
Att: Accounts Payable
PO BOX 707004
Tulsa, OK 74170-7004

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
OK	100699570A	1144228487

Shipping Addresses

Shipping Address 1

Saint Francis Hospital
6161 South Yale Avenue
Tulsa, OK 74136

Shipping Address 2

SAINT FRANCIS ONCOLOGY PHARMACY
11212 E 48TH ST
Suite A
Tulsa, OK 74146

Shipping Address 3

SAINT FRANCIS OUTPATIENT PHARMACY
6161 S YALE AVE
B LEVEL BLUE NORTH
TULSA, OK 74136

Shipping Address 4

SAINT FRANCIS WARREN CLINIC TOWER PHARMACY
6600 S YALE AVE
SUITE 110
TULSA, OK 74136

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
DSH370091A	Child	DSH	Saint Francis Hospital	Natalie ASC	6475 South Yale Avenue	Tulsa	OK	Active
DSH370091B	Child	DSH	Saint Francis Hospital	Outpatient Imaging	6605 South Yale Avenue	Tulsa	OK	Active
DSH370091C	Child	DSH	Saint Francis Hospital	Pulmonary Rehab	6585 South Yale Avenue	Tulsa	OK	Active
DSH370091D	Child	DSH	Saint Francis Hospital	Broken Arrow Rehab	2950 South Elm Place Suite 230	Broken Arrow	OK	Active
DSH370091E	Child	DSH	Saint Francis Hospital	Outpatient Imaging	6160 South Yale Avenue	Tulsa	OK	Terminated
DSH370091F	Child	DSH	Saint Francis Hospital	Sleep Lab	6585 South Yale Ave	Tulsa	OK	Active
DSH370091G	Child	DSH	Saint Francis Hospital	SFCC / Radiology	11212 East 48th Street	Tulsa	OK	Active
DSH370091H	Child	DSH	Saint Francis Hospital	SFCC / Outpatient Infusion	11212 East 48th Street	Tulsa	OK	Active
DSH370091J	Child	DSH	Saint Francis Hospital	SAINT FRANCIS HOSPITAL, INC. / Breast Center	6475 S YALE AVE	TULSA	OK	Active
DSH370091K	Child	DSH	Saint Francis Hospital	SFCC - Outpatient Rehab	11212 E 48th Street	TULSA	OK	Active
DSH370091L	Child	DSH	Saint Francis Hospital	SAINT FRANCIS HOSPITAL, INC. - IC CT	6605 S YALE AVE	TULSA	OK	Active
DSH370091M	Child	DSH	Saint Francis Hospital	SAINT FRANCIS HOSPITAL, INC. - IC MRI	6605 S YALE AVE	TULSA	OK	Active
DSH370091N	Child	DSH	Saint Francis Hospital	SAINT FRANCIS HOSPITAL, INC. - Nuclear Medicine	6605 S YALE AVE	TULSA	OK	Terminated
DSH370091P	Child	DSH	Saint Francis Hospital	SFCC / Radiation Oncology - Radiation Oncology	11212 East 48th Street	Tulsa	OK	Active
DSH370091Q	Child	DSH	Saint Francis Hospital	SAINT FRANCIS HOSPITAL, INC. - Radiology - Ultrasound	6605 S YALE AVE	TULSA	OK	Terminated
DSH370091R	Child	DSH	Saint Francis Hospital	Springer - Endoscopy	6160 South Yale Avenue	Tulsa	OK	Active
DSH370091S	Child	DSH	Saint Francis Hospital	SAINT FRANCIS CANCER CENTER PHYSICIAN CLINIC - YALE CAMPUS - Oncology Services	11212 East 48th Street	Tulsa	OK	Active
DSH370091T	Child	DSH	Saint Francis Hospital	SAINT FRANCIS OWASSO - RADIOLOGY	11610 NORTH 137TH EAST AVE	COLLINSVILLE	OK	Active
DSH370091U	Child	DSH	Saint Francis Hospital	Hospice - Hospice	6600 South Yale Avenue	Tulsa	OK	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Insert	Group Change Request		SAINT FRANCIS ONCOLOGY PHARMACY 11212 E 48TH ST Suite A Tulsa, OK 74146	3/3/2025 4:36 PM
Addresses	Shipping Address	Insert	Group Change Request		SAINT FRANCIS OUTPATIENT PHARMACY 6161 S YALE AVE B LEVEL BLUE NORTH TULSA, OK 74136	3/3/2025 4:36 PM
Addresses	Shipping Address	Insert	Group Change Request		SAINT FRANCIS WARREN CLINIC TOWER PHARMACY 6600 S YALE AVE SUITE 110 TULSA, OK 74136	3/3/2025 4:36 PM
Contacts	Primary Contact	Update	PC Change Request	Walker, Robert Douglas Manager, Pharmacy Saint Francis Health System 9184941059	Houston, Theodore Manager Pharmacy Financials and 340B Program Saint Francis Health System 9184941862	10/15/2024 8:31 PM
Addresses	Shipping Address	Insert	Recertification		Saint Francis Hospital 6161 South Yale Avenue Tulsa, OK 74136	8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (MO)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (SC)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (WA)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (IN)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (MD)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (AL)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (MN)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (NM)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (AZ)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (NE)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (VA)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (CA)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (IL)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (OH)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (IA)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (MI)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (NY)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (KS)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (LA)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (AR)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (CO)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (FL)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (PA)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (TN)		8/15/2024 1:36 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 (TX)		8/15/2024 1:36 PM
Details	Last Recertification Date	Update	Recertification	8/22/2023 7:47:19 PM	8/15/2024 1:36:42 PM	8/15/2024 1:36 PM
Addresses	Billing Address	Insert	Group Change Request		Saint Francis Health System Att: Accounts Payable PO BOX 707004 Tulsa, OK 74170-7004	12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	010853406 (MO)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	10648B (SC)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	2062863 (WA)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	100038950A (IN)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	651075200 (MD)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	187686 (AL)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	871555600 (MN)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000A7657 (NM)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	126294 (AZ)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	73070009000 (NE)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	010386322 (VA)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	XHSP31145 (CA)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	XHSP41145 (CA)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	730700090001 (IL)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0333660 (OH)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0918540 (IA)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	30-4924037 (MI)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	40-4924046 (MI)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	00981255 (NY)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	100099860A (KS)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1791148 (LA)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1008245105 (AR)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	95007951 (CO)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	094564100 (FL)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	000873548-000 (PA)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0370091 (TN)		12/14/2023 6:22 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	072674701 (TX)		12/14/2023 6:22 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 5:01:39 PM	8/22/2023 7:47:19 PM	8/22/2023 7:47 PM
Details	Last Recertification Date	Update	Recertification	8/19/2021 10:49:41 PM	8/31/2022 5:01:39 PM	8/31/2022 5:01 PM
Contacts	Authorizing Official	Update	Profile Change Request	Dage, Deborah D Vice President, Finance Saint Francis Hospital, Inc. 9185028119	Dage, Deborah D SRVP/Chief Financial Officer Saint Francis Health System 9184948418	5/30/2022 8:45 AM
Contacts	Authorizing Official	Update	Change Request	Schick, Eric Senior Vice President - Chief Financial Officer Saint Francis Hospital 9184948430	Dage, Deborah D Vice President, Finance Saint Francis Hospital, Inc. 9185028119	10/8/2021 8:46 AM
Details	Last Recertification Date	Update	Recertification	8/18/2020 7:48:26 PM	8/19/2021 10:49:41 PM	8/19/2021 10:49 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010853406	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10648B	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2062863	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100038950A	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		651075200	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		187686	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		871555600	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000A7657	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NM	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		126294	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		73070009000	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010386322	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		XHSP31145	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		XHSP41145	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		730700090001	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0333660	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0918540	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		30-4924037	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		40-4924046	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MI	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00981255	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100099860A	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1791148	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1008245105	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		95007951	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		094564100	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000873548-000	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0370091	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		072674701	3/15/2021 6:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		MO	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		SC	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		WA	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		IN	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		MN	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		NM	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		NE	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		VA	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		CA	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		IL	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		OH	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		IA	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		NY	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		KS	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		LA	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		AR	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		CO	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		FL	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		TN	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144228487	3/15/2021 6:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		TX	3/15/2021 6:46 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1144228487 ( )		8/18/2020 7:48 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144228487	8/18/2020 7:48 PM
Medicaid Billing	NPI: State	Insert	Recertification		OK	8/18/2020 7:48 PM
Details	Last Recertification Date	Update	Recertification		8/18/2020 7:48:26 PM	8/18/2020 7:48 PM
Addresses	Main Address	Update	Change Request	6161 South Yale Avenue Tulsa, OK 74136	11212 East 48th Street Tulsa, OK 74146	3/9/2020 9:05 AM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Contacts	Signed By	Insert	New Registration		Schick, Eric Senior Vice President - Chief Financial Officer Saint Francis Hospital 9184948430	7/26/2019 1:35 PM
Details	340B ID	Update	New Registration		DSH370091P	7/26/2019 1:35 PM
Details	Entity Name	Update	New Registration	SAINT FRANCIS HOSPITAL	Saint Francis Hospital	7/26/2019 1:35 PM
Details	Entity Subname	Update	New Registration	SFCC / Radiation Oncology	SFCC / Radiation Oncology - Radiation Oncology	7/26/2019 1:35 PM
Dates	Participating Approval Date	Update	New Registration		7/26/2019 1:35:50 PM	7/26/2019 1:35 PM
Details	State	Update	New Registration	Pending	Approved	7/26/2019 1:35 PM
Dates	Signed By Date	Update	New Registration		7/24/2019 4:34:13 PM	7/26/2019 1:35 PM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	7/26/2019 1:35 PM
Addresses	Main Address	Insert	New Registration		6161 South Yale Avenue Tulsa, OK 74136	7/15/2019 9:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/15/2019 9:47 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100699570A	7/15/2019 9:47 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OK	7/15/2019 9:47 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1144228487	7/15/2019 9:47 AM
Contacts	Authorizing Official	Insert	New Registration		Schick, Eric Senior Vice President - Chief Financial Officer Saint Francis Hospital 9184948430	7/15/2019 9:47 AM
Contacts	Primary Contact	Insert	New Registration		Walker, Robert Douglas Manager, Pharmacy Saint Francis Health System 9184941059	7/15/2019 9:47 AM
Details	Last Recertification Date	Insert	New Registration			7/15/2019 9:47 AM
Details	Grant Number	Insert	New Registration			7/15/2019 9:47 AM
Details	340B ID	Insert	New Registration			7/15/2019 9:47 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/15/2019 9:47 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/15/2019 9:47 AM
Details	Medicare Provider Number	Insert	New Registration		370091	7/15/2019 9:47 AM
Details	Entity Name	Insert	New Registration		SAINT FRANCIS HOSPITAL	7/15/2019 9:47 AM
Details	Program Code	Insert	New Registration		DSH	7/15/2019 9:47 AM
Details	Entity Subname	Insert	New Registration		SFCC / Radiation Oncology	7/15/2019 9:47 AM
Dates	Participating Approval Date	Insert	New Registration			7/15/2019 9:47 AM
Details	State	Insert	New Registration		Pending	7/15/2019 9:47 AM
Dates	Registration Date	Insert	New Registration		7/15/2019 9:47:40 AM	7/15/2019 9:47 AM
Dates	Signed By Date	Insert	New Registration			7/15/2019 9:47 AM
Dates	Start Date	Insert	New Registration			7/15/2019 9:47 AM
Terminations	Termination Comments	Insert	New Registration			7/15/2019 9:47 AM
Terminations	Termination Date	Insert	New Registration			7/15/2019 9:47 AM
Terminations	Termination Effective Date	Insert	New Registration			7/15/2019 9:47 AM
Terminations	Termination Reason	Insert	New Registration			7/15/2019 9:47 AM