Covered Entity Details

CHC26587-05 SAINT HOPE FOUNDATION (Active) - information as of 5/26/2025 12:54:19 AM

Main Details

Name

SAINT HOPE FOUNDATION

Subdivision Name

St. Hope Community Health Clinic- Jersey Village

Type

HRSA-Funded Health Center

Site ID

BPS-H80-032857

340B ID

CHC26587-05

Grant Number

H80CS26587

Additional Details

Current Program Status

Active

Registration Date

1/4/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/6/2022

Last Recertification Date

2/18/2025

Contacts

Authorizing Official

St. Hope Foundation
Timika Sam-Cooper, Chief Operations Officer
(713) 778-1300 Ext: 2342

Primary Contact

St. Hope Foundation, Inc
Nourhane Badawi, Chief Pharmacy Officer
(713) 778-1300

Addresses

Street Address

20320 Northwest Fwy Ste 500
Jersey Village, TX 77065

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	05/12/2022	05/17/2022	05/17/2022
Contract Detail	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	05/12/2022	05/17/2022	05/17/2022
Contract Detail	AVITA PHARMACY 1030	6800 WEST LOOP S STE 225		BELLAIRE	TX	77401	05/12/2022	05/17/2022	05/17/2022
Contract Detail	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	05/12/2022	05/17/2022	05/17/2022
Contract Detail	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	05/12/2022	05/17/2022	05/17/2022

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC26587-00	Active	BPS-H80-013712	SAINT HOPE FOUNDATION	St. Hope Foundation Community Health Clinic	255 NORTHPOINT DR	HOUSTON	TX
CHC26587-01	Active	BPS-H80-028024	SAINT HOPE FOUNDATION	St. Hope Community Health Center-Sugar Land	14815 Southwest Fwy	Sugar Land	TX
CHC26587-02	Active	BPS-H80-018255	SAINT HOPE FOUNDATION	St. Hope Community Health Clinic- Bellaire	6800 West Loop S Ste 560	Bellaire	TX
CHC26587-03	Active	BPS-H80-018081	SAINT HOPE FOUNDATION	St. Hope Community Health Center Clinic	1414 S Frazier St, Ste 105	Conroe	TX
CHC26587-04	Active	BPS-H80-027154	SAINT HOPE FOUNDATION	St. Hope Community Health Center- Dickinson	3750 Medical Park Dr. STE 150	Dickinson	TX
CHC26587-05	Active	BPS-H80-032857	SAINT HOPE FOUNDATION	St. Hope Community Health Clinic- Jersey Village	20320 Northwest Fwy Ste 500	Jersey Village	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date
CHC26587-00	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	10/01/2015
CHC26587-03	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	07/01/2017
CHC26587-01	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	07/01/2017
CHC26587-02	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	07/01/2018
CHC26587-04	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	04/01/2019
CHC26587-05	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	05/17/2022
CHC26587-00	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	10/01/2015
CHC26587-03	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	07/01/2017
CHC26587-01	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	07/01/2017
CHC26587-02	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	07/01/2018
CHC26587-04	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	04/01/2019
CHC26587-05	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	05/17/2022
CHC26587-00	AVITA PHARMACY 1030	6800 WEST LOOP S STE 225		BELLAIRE	TX	77401	07/01/2016
CHC26587-03	AVITA PHARMACY 1030	6800 WEST LOOP S STE 225		BELLAIRE	TX	77401	07/01/2017
CHC26587-01	AVITA PHARMACY 1030	6800 WEST LOOP S STE 225		BELLAIRE	TX	77401	07/01/2017
CHC26587-02	AVITA PHARMACY 1030	6800 WEST LOOP S STE 225		BELLAIRE	TX	77401	07/01/2018
CHC26587-04	AVITA PHARMACY 1030	6800 WEST LOOP S STE 225		BELLAIRE	TX	77401	04/01/2019
CHC26587-05	AVITA PHARMACY 1030	6800 WEST LOOP S STE 225		BELLAIRE	TX	77401	05/17/2022
CHC26587-00	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	07/01/2016
CHC26587-03	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	07/01/2017
CHC26587-01	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	07/01/2017
CHC26587-02	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	07/01/2018
CHC26587-04	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	04/01/2019
CHC26587-05	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	05/17/2022
CHC26587-00	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2015
CHC26587-03	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	07/01/2017
CHC26587-01	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	07/01/2017
CHC26587-02	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	07/01/2018
CHC26587-04	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	04/01/2019
CHC26587-05	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	05/17/2022

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 3:26:16 PM	2/18/2025 12:47:36 PM	2/18/2025 12:47 PM
Details	Last Recertification Date	Update	Recertification	2/15/2023 4:25:15 PM	2/1/2024 3:26:16 PM	2/1/2024 3:26 PM
Addresses	Main Address	Update	Recertification	20320 Northwest Fwy Ste 500 Jersey Village, TX 77065-5644	20320 Northwest Fwy Ste 500 Jersey Village, TX 77065	2/15/2023 4:25 PM
Details	Last Recertification Date	Update	Recertification		2/15/2023 4:25:15 PM	2/15/2023 4:25 PM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Sam-Cooper, Timika Chief Operations Officer St. Hope Foundation 7137781300-2342	1/6/2022 8:13 AM
Details	340B ID	Update	New Registration		CHC26587-05	1/6/2022 8:13 AM
Dates	Participating Approval Date	Update	New Registration		1/6/2022 8:13:36 AM	1/6/2022 8:13 AM
Details	State	Update	New Registration	Pending	Approved	1/6/2022 8:13 AM
Dates	Signed By Date	Update	New Registration		1/4/2022 5:07:47 PM	1/6/2022 8:13 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/6/2022 8:13 AM
Addresses	Main Address	Insert	New Registration		20320 Northwest Fwy Ste 500 Jersey Village, TX 77065-5644	1/4/2022 5:07 PM
Contacts	Authorizing Official	Insert	New Registration		Sam-Cooper, Timika Chief Operations Officer St. Hope Foundation 7137781300-2342	1/4/2022 5:07 PM
Contacts	Primary Contact	Insert	New Registration		Badawi, Nourhane Chief Pharmacy Officer St. Hope Foundation, Inc 7137781300	1/4/2022 5:07 PM
Details	Assistance Received From Date	Insert	New Registration			1/4/2022 5:07 PM
Details	Assistance Received To Date	Insert	New Registration			1/4/2022 5:07 PM
Details	Last Recertification Date	Insert	New Registration			1/4/2022 5:07 PM
Details	Grant Number	Insert	New Registration		H80CS26587	1/4/2022 5:07 PM
Details	340B ID	Insert	New Registration			1/4/2022 5:07 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/4/2022 5:07 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/4/2022 5:07 PM
Details	Medicare Provider Number	Insert	New Registration			1/4/2022 5:07 PM
Details	Entity Name	Insert	New Registration		SAINT HOPE FOUNDATION	1/4/2022 5:07 PM
Details	NOFO Number	Insert	New Registration			1/4/2022 5:07 PM
Details	Program Code	Insert	New Registration		CH	1/4/2022 5:07 PM
Details	Entity Subname	Insert	New Registration		St. Hope Community Health Clinic- Jersey Village	1/4/2022 5:07 PM
Dates	Participating Approval Date	Insert	New Registration			1/4/2022 5:07 PM
Details	State	Insert	New Registration		Pending	1/4/2022 5:07 PM
Dates	Registration Date	Insert	New Registration		1/4/2022 5:07:44 PM	1/4/2022 5:07 PM
Dates	Signed By Date	Insert	New Registration			1/4/2022 5:07 PM
Dates	Start Date	Insert	New Registration			1/4/2022 5:07 PM
Terminations	Termination Comments	Insert	New Registration			1/4/2022 5:07 PM
Terminations	Termination Date	Insert	New Registration			1/4/2022 5:07 PM
Terminations	Termination Effective Date	Insert	New Registration			1/4/2022 5:07 PM
Terminations	Termination Reason	Insert	New Registration			1/4/2022 5:07 PM

340B Drug Pricing Program Database