Covered Entity Details

DSH370091Q Saint Francis Hospital (Terminated) - information as of 6/14/2025 10:09:36 AM

Main Details

Name

Saint Francis Hospital

Subdivision Name

SAINT FRANCIS HOSPITAL, INC. - Radiology - Ultrasound

Type

Disproportionate Share Hospital

Rural

340B ID

DSH370091Q

Medicare Provider Number

370091

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/14/2019

Participating Start Date

1/1/2020

Participating Approval Date

10/31/2019

Last Recertification Date

Termination Date
Termination Reason

4/1/2020
Outpatient facility moved within the 4 walls of the parent hospital

Contacts

Authorizing Official

Saint Francis Hospital
Eric Schick, Senior Vice President - Chief Financial Officer
(918) 494-8430

Primary Contact

Saint Francis Health System
Robert Douglas Walker, Manager, Pharmacy
(918) 494-1059

Addresses

Street Address

6605 S YALE AVE
DIAGNOSTIC IMAGING CENTER
TULSA, OK 74136-3326

Billing Address
Same as Street Address

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

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
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
Details	State	Update		To Be Terminated	Terminated	4/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/31/2019 12:00:00 AM	1/28/2020 2:52 PM
Details	State	Update	Termination Request	Active	To Be Terminated	1/28/2020 2:52 PM
Terminations	Termination Date	Update	Termination Request		4/1/2020 12:00:00 AM	1/28/2020 2:52 PM
Terminations	Termination Effective Date	Update	Termination Request		1/1/2020 12:00:00 AM	1/28/2020 2:52 PM
Terminations	Termination Reason	Update	Termination Request		Outpatient facility moved within the 4 walls of the parent hospital	1/28/2020 2:52 PM
Details	State	Update		Approved	Active	1/1/2020 12:04 AM
Contacts	Signed By	Insert	New Registration		Schick, Eric Senior Vice President - Chief Financial Officer Saint Francis Hospital 9184948430	10/31/2019 9:39 AM
Details	340B ID	Update	New Registration		DSH370091Q	10/31/2019 9:39 AM
Details	Entity Name	Update	New Registration	SAINT FRANCIS HOSPITAL	Saint Francis Hospital	10/31/2019 9:39 AM
Details	Entity Subname	Update	New Registration	SAINT FRANCIS HOSPITAL, INC.	SAINT FRANCIS HOSPITAL, INC. - Radiology - Ultrasound	10/31/2019 9:39 AM
Dates	Participating Approval Date	Update	New Registration		10/31/2019 9:39:25 AM	10/31/2019 9:39 AM
Details	State	Update	New Registration	Pending	Approved	10/31/2019 9:39 AM
Dates	Signed By Date	Update	New Registration		10/14/2019 9:43:39 PM	10/31/2019 9:39 AM
Dates	Start Date	Update	New Registration		1/1/2020 12:00:00 AM	10/31/2019 9:39 AM
Addresses	Main Address	Insert	New Registration		6605 S YALE AVE DIAGNOSTIC IMAGING CENTER TULSA, OK 74136-3326	10/14/2019 5:34 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/14/2019 5:34 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100699570A	10/14/2019 5:34 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OK	10/14/2019 5:34 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1144228487	10/14/2019 5:34 PM
Contacts	Authorizing Official	Insert	New Registration		Schick, Eric Senior Vice President - Chief Financial Officer Saint Francis Hospital 9184948430	10/14/2019 5:34 PM
Contacts	Primary Contact	Insert	New Registration		Walker, Robert Douglas Manager, Pharmacy Saint Francis Health System 9184941059	10/14/2019 5:34 PM
Details	Last Recertification Date	Insert	New Registration			10/14/2019 5:34 PM
Details	Grant Number	Insert	New Registration			10/14/2019 5:34 PM
Details	340B ID	Insert	New Registration			10/14/2019 5:34 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/14/2019 5:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/14/2019 5:34 PM
Details	Medicare Provider Number	Insert	New Registration		370091	10/14/2019 5:34 PM
Details	Entity Name	Insert	New Registration		SAINT FRANCIS HOSPITAL	10/14/2019 5:34 PM
Details	Program Code	Insert	New Registration		DSH	10/14/2019 5:34 PM
Details	Entity Subname	Insert	New Registration		SAINT FRANCIS HOSPITAL, INC.	10/14/2019 5:34 PM
Dates	Participating Approval Date	Insert	New Registration			10/14/2019 5:34 PM
Details	State	Insert	New Registration		Pending	10/14/2019 5:34 PM
Dates	Registration Date	Insert	New Registration		10/14/2019 5:34:02 PM	10/14/2019 5:34 PM
Dates	Signed By Date	Insert	New Registration			10/14/2019 5:34 PM
Dates	Start Date	Insert	New Registration			10/14/2019 5:34 PM
Terminations	Termination Comments	Insert	New Registration			10/14/2019 5:34 PM
Terminations	Termination Date	Insert	New Registration			10/14/2019 5:34 PM
Terminations	Termination Effective Date	Insert	New Registration			10/14/2019 5:34 PM
Terminations	Termination Reason	Insert	New Registration			10/14/2019 5:34 PM