Covered Entity Details

DSH040020S ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER (Active) - information as of 4/23/2025 10:51:01 PM

Main Details

Name

ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER

Subdivision Name

St. Bernards Gastroenterology Associates - Gastroenterology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH040020S

Medicare Provider Number

040020

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/8/2020

Participating Start Date

4/1/2020

Participating Approval Date

1/21/2020

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

St Bernards Healthcare
Benjamin F Barylske, VP of Finance / CFO
(870) 207-4565

Primary Contact

St. Bernards Medical Center
James Douglas Welborn, Assistant Vice President of Pharmacy Services
(870) 207-1800

Addresses

Street Address

1007 E Matthews Ave
Jonesboro, AR 72401

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
AR	101693105	1922043686,1255632568,1336150374
MO	010327302	1922043686,1255632568,1336150374

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
DSH040020A	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS BEHAVIORAL HEALTH CENTER	2712 E. JOHNSON AVENUE	JONESBORO	AR	Active
DSH040020AA	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS CLOPTON CLINIC - Pulmonology	300 CARSON ST	JONESBORO	AR	Active
DSH040020AB	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Infusion Center – Five Rivers - Infusion Center	2801 Medical Center Dr.	Pocahontas	AR	Active
DSH040020AC	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS SPECIALTY CLINIC- LMH - Pregnancy Clinic	1309 W MAIN ST	WALNUT RIDGE	AR	Active
DSH040020AD	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS CLOPTON CLINIC - Endocrinology	300 CARSON ST	JONESBORO	AR	Active
DSH040020AE	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS CLOPTON CLINIC - Internal Medicine	300 CARSON ST	JONESBORO	AR	Active
DSH040020B	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Infusion Center	300 Carson Street	Jonesboro	AR	Terminated
DSH040020C	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Imaging Center and PAT	1144 East Mathews Avenue	Jonesboro	AR	Active
DSH040020D	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Dialysis Center - Jonesboro	540 East Washington Avenue	Jonesboro	AR	Active
DSH040020E	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Dialysis Center - Wynne	310 South Falls Blvd	Wynne	AR	Active
DSH040020F	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Infusion Center - Paragould	4000 Linwood, Suite B & C	Paragould	AR	Active
DSH040020G	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Heart and Vascular	201 East Oak Street	Jonesboro	AR	Active
DSH040020H	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Heart and Vascular -Paragould	314 South 12th Street	Paragould	AR	Active
DSH040020J	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Wound Healing - Paragould	4000 Linwood, Suite J	Paragould	AR	Active
DSH040020K	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Wound Healing	505 East Mathews Ave., Suite 201	Jonesboro	AR	Active
DSH040020L	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Senior Health Clinic	303 East Mathews, Suite 202	Jonesboro	AR	Active
DSH040020M	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Specialty Clinic I -Behaviorial Health and PAT- Paragould	4000 Linwood Drive Suite B	Paragould	AR	Terminated
DSH040020N	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Internal Medical Residency Clinic and Infectious Disease Clinic	300 Carson Street	Jonesboro	AR	Active
DSH040020P	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Pregnancy Clinic - Obstetrics	4334 East Highland Drive, Suite B	Jonesboro	AR	Active
DSH040020Q	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST. Bernards Dialysis Center- Osceola - Dialysis	1420 W. Keiser Ave.	Osceola	AR	Active
DSH040020R	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST. BERNARDS HOSPITAL INC - Psychiatric/Psychological Services	615 E MATTHEWS AVE	JONESBORO	AR	Active
DSH040020S	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Gastroenterology Associates - Gastroenterology	1007 E Matthews Ave	Jonesboro	AR	Active
DSH040020T	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Urology - Urology	303 E Matthews Ave Suite 100	Jonesboro	AR	Active
DSH040020U	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	Dermatology Clinic - Dermatology	800 S. Church St. Suite 202	Jonesboro	AR	Active
DSH040020V	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	Dermatology Procedure Center - Dermatology	800 S. Church St. Suite 103	Jonesboro	AR	Active
DSH040020W	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS CLOPTON CLINIC - Nephrology	300 CARSON ST	JONESBORO	AR	Active
DSH040020X	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS CLOPTON CLINIC - Rheumatology	300 CARSON ST	JONESBORO	AR	Active
DSH040020Y	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	ST BERNARDS SPECIALTY CLINIC- LMH - Wound Healing	1309 W MAIN ST	WALNUT RIDGE	AR	Active
DSH040020Z	Child	DSH	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	St. Bernards Dialysis- Walnut Ridge - Dialysis	1051 W Free St	Walnut Ridge	AR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Recertification		1336150374	9/4/2024 1:39 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/4/2024 1:39 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336150374	9/4/2024 1:39 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/4/2024 1:39 PM
Details	Last Recertification Date	Update	Recertification	8/30/2023 11:27:44 AM	9/4/2024 1:39:08 PM	9/4/2024 1:39 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 6:13:17 PM	8/30/2023 11:27:44 AM	8/30/2023 11:27 AM
Details	Last Recertification Date	Update	Recertification	8/30/2021 2:53:42 PM	8/30/2022 6:13:17 PM	8/30/2022 6:13 PM
Contacts	Primary Contact	Update	Profile Change Request	Welborn, James Douglas Director of Pharmacy St. Bernards Medical Center 8702074268	Welborn, James Douglas Assistant Vice President of Pharmacy Services St. Bernards Medical Center 8702071800	9/1/2021 3:31 PM
Details	Last Recertification Date	Update	Recertification	9/10/2020 12:45:38 PM	8/30/2021 2:53:42 PM	8/30/2021 2:53 PM
Medicaid Billing	NPI: State	Update	Recertification		AR	9/10/2020 12:45 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1255632568	9/10/2020 12:45 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/10/2020 12:45 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1922043686	9/10/2020 12:45 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/10/2020 12:45 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1255632568	9/10/2020 12:45 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/10/2020 12:45 PM
Details	Last Recertification Date	Update	Recertification		9/10/2020 12:45:38 PM	9/10/2020 12:45 PM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/13/2020 6:18 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010327302	3/13/2020 6:18 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	3/13/2020 6:18 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/10/2020 6:02 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		101693105	3/10/2020 6:02 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	3/10/2020 6:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1922043686	3/10/2020 6:02 PM
Contacts	Signed By	Insert	New Registration		Barylske, Benjamin F VP of Finance / CFO St Bernards Healthcare 8702074565	1/21/2020 11:11 AM
Details	340B ID	Update	New Registration		DSH040020S	1/21/2020 11:11 AM
Details	Entity Name	Update	New Registration	ST BERNARDS MEDICAL CENTER	ST BERNARDS HOSPITAL INC DBA ST BERNARDS MEDICAL CENTER	1/21/2020 11:11 AM
Details	Entity Subname	Update	New Registration	St. Bernards Gastroenterology Associates	St. Bernards Gastroenterology Associates - Gastroenterology	1/21/2020 11:11 AM
Dates	Participating Approval Date	Update	New Registration		1/21/2020 11:11:02 AM	1/21/2020 11:11 AM
Details	State	Update	New Registration	Pending	Approved	1/21/2020 11:11 AM
Dates	Signed By Date	Update	New Registration		1/15/2020 5:04:39 PM	1/21/2020 11:11 AM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	1/21/2020 11:11 AM
Addresses	Main Address	Insert	New Registration		1007 E Matthews Ave Jonesboro, AR 72401	1/8/2020 10:42 AM
Contacts	Authorizing Official	Insert	New Registration		Barylske, Benjamin F VP of Finance / CFO St Bernards Healthcare 8702074565	1/8/2020 10:42 AM
Contacts	Primary Contact	Insert	New Registration		Welborn, James Douglas Director of Pharmacy St. Bernards Medical Center 8702074268	1/8/2020 10:42 AM
Details	Last Recertification Date	Insert	New Registration			1/8/2020 10:42 AM
Details	Grant Number	Insert	New Registration			1/8/2020 10:42 AM
Details	340B ID	Insert	New Registration			1/8/2020 10:42 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/8/2020 10:42 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/8/2020 10:42 AM
Details	Medicare Provider Number	Insert	New Registration		040020	1/8/2020 10:42 AM
Details	Entity Name	Insert	New Registration		ST BERNARDS MEDICAL CENTER	1/8/2020 10:42 AM
Details	Program Code	Insert	New Registration		DSH	1/8/2020 10:42 AM
Details	Entity Subname	Insert	New Registration		St. Bernards Gastroenterology Associates	1/8/2020 10:42 AM
Dates	Participating Approval Date	Insert	New Registration			1/8/2020 10:42 AM
Details	State	Insert	New Registration		Pending	1/8/2020 10:42 AM
Dates	Registration Date	Insert	New Registration		1/8/2020 10:42:21 AM	1/8/2020 10:42 AM
Dates	Signed By Date	Insert	New Registration			1/8/2020 10:42 AM
Dates	Start Date	Insert	New Registration			1/8/2020 10:42 AM
Terminations	Termination Comments	Insert	New Registration			1/8/2020 10:42 AM
Terminations	Termination Date	Insert	New Registration			1/8/2020 10:42 AM
Terminations	Termination Effective Date	Insert	New Registration			1/8/2020 10:42 AM
Terminations	Termination Reason	Insert	New Registration			1/8/2020 10:42 AM