Covered Entity Details

DSH190125F ST FRANCIS MEDICAL CENTER, INC (Active) - information as of 6/16/2025 11:24:46 PM

Main Details

Name

ST FRANCIS MEDICAL CENTER, INC

Subdivision Name

PS PACU - Recovery Room

Type

Disproportionate Share Hospital

Rural

340B ID

DSH190125F

Medicare Provider Number

190125

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/11/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/19/2022

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

St. Francis Medical Center
Andrew D. LeBlanc, CFO
(318) 966-7369

Primary Contact

St. Francis Medical Center
Anna Michele Chop, Director, Pharmacy Services
(318) 966-7246

Addresses

Street Address

312 Grammont Street
Monroe, LA 71201

Billing Address

FMOLHS Accounts Payable
PO Box 83880
Baton Rouge, LA 70884

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
LA	1739570	1295723229

Shipping Addresses

Shipping Address 1

St. Francis Medical Center
309 Jackson Street
Monroe, LA 71201

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
DSH190125A	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	ST FRANCIS PRIMARY CARE CLINIC, SUITE 309	2600 Tower Drive	MONROE	LA	Terminated
DSH190125B	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	ST FRANCIS NORTH HOSPITAL	3421 MEDICAL PARK DRIVE	MONROE	LA	Terminated
DSH190125C	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	Oncology-3 Back - Infusion	411 Calypso Street	Monroe	LA	Active
DSH190125D	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	PS ASU - Pre/Post Unit	312 Grammont Street	Monroe	LA	Active
DSH190125E	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	PS CathLab - PS CathLab	312 Grammont Street	Monroe	LA	Active
DSH190125F	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	PS PACU - Recovery Room	312 Grammont Street	Monroe	LA	Active
DSH190125G	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	PS Radiology-Diagnostic - PS Radiology-Diagnostic	312 Grammont Street	Monroe	LA	Active
DSH190125H	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	PS Operating Room - PS Operating Room	312 Grammont Street	Monroe	LA	Active
DSH190125J	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	PET Imaging - CT Scan	411 Calypso Street	Monroe	LA	Active
DSH190125K	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	Respiratory Therapy/PFT - Respiratory Therapy/PFT	517 Catalpa Street	Monroe	LA	Terminated
DSH190125L	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	PS First Floor Nursing Unit - Adults/Pediatrics	312 Grammont Street	Monroe	LA	Active
DSH190125M	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	PS 3rd Floor Nursing Unit - Adults/Pediatrics	312 Grammont Street	Monroe	LA	Active
DSH190125N	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	SFMC CHC Campus-US Imaging - Diagnostic Radiology	2600 Tower Drive	Monroe	LA	Active
DSH190125P	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	SFMC CHC Campus- Diagnostic Radiology - Diagnostic Radiology	2600 Tower Drive	Monroe	LA	Active
DSH190125Q	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	SFMC CHC Campus-MRI Imaging - MRI	2600 Tower Drive	Monroe	LA	Active
DSH190125R	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	SFMC CHC Campus-Kitty Degree Breast Health Center - Diagnostic Radiology	2600 Tower Drive	Monroe	LA	Active
DSH190125S	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	SFMC CHC Campus-CT Imaging - CT	2600 Tower Drive	Monroe	LA	Active
DSH190125T	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	SFMC P&S Campus Anesthesia - Anesthesia	312 Grammont Street	Monroe	LA	Active
DSH190125U	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	SFMC Main Campus Lab Oncology - Oncology Lab	411 Calypso Street	Monroe	LA	Active
DSH190125V	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	SFMC Main Campus Oncology Service Line - SFMC Oncology and Hematology Clinic	411 Calypso Street	Monroe	LA	Active
DSH190125W	Child	DSH	ST FRANCIS MEDICAL CENTER, INC	SFMC Main Campus OP Oncology/Infusion - St. Francis Oncology Infusion Services	411 Calypso Street	Monroe	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Rogers, Jeremy VP, Chief Financial Officer Our Lady of Lourdes Health 3374702147	LeBlanc, Andrew D. CFO St. Francis Medical Center 3189667369	1/29/2025 12:30 PM
Contacts	Primary Contact	Update	Profile Change Request	Chop, Anna Michele Director of Pharmacy St. Francis Medical Center 3189667246	Chop, Anna Michele Director, Pharmacy Services St. Francis Medical Center 3189667246	10/29/2024 11:14 AM
Details	Last Recertification Date	Update	Recertification	8/21/2023 8:52:17 AM	8/13/2024 11:04:21 AM	8/13/2024 11:04 AM
Contacts	Authorizing Official	Update	Profile Change Request	Rogers, Jeremy Chief Operating Officer/Chief Financial Officer St. Francis Medical Center 3189667212	Rogers, Jeremy VP, Chief Financial Officer Our Lady of Lourdes Health 3374702147	4/30/2024 7:27 AM
Contacts	Signed By	Update	Profile Change Request	Rogers, Jeremy Chief Operating Officer/Chief Financial Officer St. Francis Medical Center 3189667212	Rogers, Jeremy VP, Chief Financial Officer Our Lady of Lourdes Health 3374702147	4/30/2024 7:27 AM
Contacts	Authorizing Official	Update	Profile Change Request	Rogers, Jeremy VP, Finance/CFO St. Francis Medical Center 3189667212	Rogers, Jeremy Chief Operating Officer/Chief Financial Officer St. Francis Medical Center 3189667212	2/13/2024 2:50 PM
Contacts	Signed By	Update	Profile Change Request	Rogers, Jeremy VP, Finance/CFO St. Francis Medical Center 3189667212	Rogers, Jeremy Chief Operating Officer/Chief Financial Officer St. Francis Medical Center 3189667212	2/13/2024 2:50 PM
Details	Last Recertification Date	Update	Recertification	8/31/2022 3:02:33 PM	8/21/2023 8:52:17 AM	8/21/2023 8:52 AM
Details	Last Recertification Date	Update	Recertification		8/31/2022 3:02:33 PM	8/31/2022 3:02 PM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Rogers, Jeremy VP, Finance/CFO St. Francis Medical Center 3189667212	1/19/2022 11:34 AM
Details	340B ID	Update	New Registration		DSH190125F	1/19/2022 11:34 AM
Details	Entity Name	Update	New Registration	ST. FRANCIS MEDICAL CENTER	ST FRANCIS MEDICAL CENTER, INC	1/19/2022 11:34 AM
Details	Entity Subname	Update	New Registration	PS PACU	PS PACU - Recovery Room	1/19/2022 11:34 AM
Dates	Participating Approval Date	Update	New Registration		1/19/2022 11:34:44 AM	1/19/2022 11:34 AM
Details	State	Update	New Registration	Pending	Approved	1/19/2022 11:34 AM
Dates	Signed By Date	Update	New Registration		1/13/2022 10:03:33 AM	1/19/2022 11:34 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/19/2022 11:34 AM
Addresses	Main Address	Insert	New Registration		312 Grammont Street Monroe, LA 71201	1/11/2022 4:52 PM
Addresses	Billing Address	Insert	New Registration		FMOLHS Accounts Payable PO Box 83880 Baton Rouge, LA 70884	1/11/2022 4:52 PM
Addresses	Shipping Address	Insert	New Registration		St. Francis Medical Center 309 Jackson Street Monroe, LA 71201	1/11/2022 4:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2022 4:52 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1739570	1/11/2022 4:52 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	1/11/2022 4:52 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1295723229	1/11/2022 4:52 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	1/11/2022 4:52 PM
Contacts	Primary Contact	Insert	New Registration		Chop, Anna Michele Director of Pharmacy St. Francis Medical Center 3189667246	1/11/2022 4:52 PM
Contacts	Authorizing Official	Insert	New Registration		Rogers, Jeremy VP, Finance/CFO St. Francis Medical Center 3189667212	1/11/2022 4:52 PM
Details	Assistance Received From Date	Insert	New Registration			1/11/2022 4:52 PM
Details	Assistance Received To Date	Insert	New Registration			1/11/2022 4:52 PM
Details	Last Recertification Date	Insert	New Registration			1/11/2022 4:52 PM
Details	Grant Number	Insert	New Registration			1/11/2022 4:52 PM
Details	340B ID	Insert	New Registration			1/11/2022 4:52 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/11/2022 4:52 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/11/2022 4:52 PM
Details	Medicare Provider Number	Insert	New Registration		190125	1/11/2022 4:52 PM
Details	Entity Name	Insert	New Registration		ST. FRANCIS MEDICAL CENTER	1/11/2022 4:52 PM
Details	NOFO Number	Insert	New Registration			1/11/2022 4:52 PM
Details	Program Code	Insert	New Registration		DSH	1/11/2022 4:52 PM
Details	Entity Subname	Insert	New Registration		PS PACU	1/11/2022 4:52 PM
Dates	Participating Approval Date	Insert	New Registration			1/11/2022 4:52 PM
Details	State	Insert	New Registration		Pending	1/11/2022 4:52 PM
Dates	Registration Date	Insert	New Registration		1/11/2022 4:52:52 PM	1/11/2022 4:52 PM
Dates	Signed By Date	Insert	New Registration			1/11/2022 4:52 PM
Dates	Start Date	Insert	New Registration			1/11/2022 4:52 PM
Terminations	Termination Comments	Insert	New Registration			1/11/2022 4:52 PM
Terminations	Termination Date	Insert	New Registration			1/11/2022 4:52 PM
Terminations	Termination Effective Date	Insert	New Registration			1/11/2022 4:52 PM
Terminations	Termination Reason	Insert	New Registration			1/11/2022 4:52 PM