Covered Entity Details

DSH060064C Centura Porter Adventist Hospital (Terminated) - information as of 5/14/2025 10:55:20 PM

Main Details

Name

Centura Porter Adventist Hospital

Subdivision Name

Mental Health Clinic - Mental Health

Type

Disproportionate Share Hospital

Rural

340B ID

DSH060064C

Medicare Provider Number

060064

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/14/2022

Participating Start Date

7/1/2022

Participating Approval Date

4/28/2022

Last Recertification Date

8/25/2022

Termination Date
Termination Reason

7/1/2023
Change of covered entity type

Contacts

Authorizing Official

Centura Health
Andrew Whitlock, CFO
(303) 673-1256

Primary Contact

CommonSpirit Health
Samantha Morgan, System Manager, 340B Mountain Region
(303) 673-7380

Addresses

Street Address

2465 S Downing St
Denver, CO 80210

Billing Address

Centura Health
PO Box 372660
Denver, CO 80237

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
CO	05064001	1801800594

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
DSH060064A	Child	DSH	Centura Porter Adventist Hospital	Wound Care Clinic - Wound Care	990 E Harvard Ave	Denver	CO	Terminated
DSH060064B	Child	DSH	Centura Porter Adventist Hospital	Transplant Clinic - Transplant Clinic	2535 S Downing St	Denver	CO	Terminated
DSH060064C	Child	DSH	Centura Porter Adventist Hospital	Mental Health Clinic - Mental Health	2465 S Downing St	Denver	CO	Terminated
DSH060064D	Child	DSH	Centura Porter Adventist Hospital	Emergency Department - Emergency	1000 E Harvard Ave	Denver	CO	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Update	New Registration	Leary, Matthew P. VP of Finance Centura Health 3036431022	Leary, Matthew P. Market VFO CommonSpirit Health 3036431022	10/14/2024 6:05 PM
Contacts	Primary Contact	Update	Profile Change Request	Morgan, Samantha Regional Manager, 340B Program CommonSpirit Health 3036737380	Morgan, Samantha System Manager, 340B Mountain Region CommonSpirit Health 3036737380	8/20/2024 1:07 PM
Contacts	Primary Contact	Update	Profile Change Request	Morgan, Samantha Director, Enterprise 340B Program Centura Health 3036737380	Morgan, Samantha Regional Manager, 340B Program CommonSpirit Health 3036737380	7/25/2024 4:28 PM
Details	State	Update		To Be Terminated	Terminated	7/1/2023 12:01 AM
Contacts	Primary Contact	Update	Profile Change Request	Morgan, Samantha 340B Program Manager Centura Health 3036737380	Morgan, Samantha Director, Enterprise 340B Program Centura Health 3036737380	5/25/2023 12:41 PM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		7/1/2023 12:00:00 AM	4/7/2023 7:11 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	4/7/2023 7:11 AM
Terminations	Termination Date	Update	Hospital Type Change Request		7/1/2023 12:00:00 AM	4/7/2023 7:11 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		7/1/2023 12:00:00 AM	4/7/2023 7:11 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	4/7/2023 7:11 AM
Contacts	Authorizing Official	Update	Change Request	Leary, Matthew P. VP of Finance Centura Health 3036431022	Whitlock, Andrew CFO Centura Health 3036731256	2/6/2023 7:35 AM
Details	Entity Name	Update	Recertification	PORTER ADVENTIST HOSPITAL	Centura Porter Adventist Hospital	8/29/2022 6:53 AM
Details	Last Recertification Date	Update	Recertification		8/25/2022 12:20:38 PM	8/25/2022 12:20 PM
Details	State	Update		Approved	Active	7/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Leary, Matthew P. VP of Finance Centura Health 3036431022	4/28/2022 7:59 AM
Details	340B ID	Update	New Registration		DSH060064C	4/28/2022 7:59 AM
Details	Entity Subname	Update	New Registration	Mental Health Clinic	Mental Health Clinic - Mental Health	4/28/2022 7:59 AM
Dates	Participating Approval Date	Update	New Registration		4/28/2022 7:59:57 AM	4/28/2022 7:59 AM
Details	State	Update	New Registration	Pending	Approved	4/28/2022 7:59 AM
Dates	Signed By Date	Update	New Registration		4/14/2022 5:42:32 PM	4/28/2022 7:59 AM
Dates	Start Date	Update	New Registration		7/1/2022 12:00:00 AM	4/28/2022 7:59 AM
Addresses	Main Address	Insert	New Registration		2465 S Downing St Denver, CO 80210	4/14/2022 5:14 PM
Addresses	Billing Address	Insert	New Registration		Centura Health PO Box 372660 Denver, CO 80237	4/14/2022 5:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2022 5:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		05064001	4/14/2022 5:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	4/14/2022 5:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1801800594	4/14/2022 5:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	4/14/2022 5:14 PM
Contacts	Authorizing Official	Insert	New Registration		Leary, Matthew P. VP of Finance Centura Health 3036431022	4/14/2022 5:14 PM
Contacts	Primary Contact	Insert	New Registration		Morgan, Samantha 340B Program Manager Centura Health 3036737380	4/14/2022 5:14 PM
Details	Assistance Received From Date	Insert	New Registration			4/14/2022 5:14 PM
Details	Assistance Received To Date	Insert	New Registration			4/14/2022 5:14 PM
Details	Last Recertification Date	Insert	New Registration			4/14/2022 5:14 PM
Details	Grant Number	Insert	New Registration			4/14/2022 5:14 PM
Details	340B ID	Insert	New Registration			4/14/2022 5:14 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2022 5:14 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2022 5:14 PM
Details	Medicare Provider Number	Insert	New Registration		060064	4/14/2022 5:14 PM
Details	Entity Name	Insert	New Registration		PORTER ADVENTIST HOSPITAL	4/14/2022 5:14 PM
Details	NOFO Number	Insert	New Registration			4/14/2022 5:14 PM
Details	Program Code	Insert	New Registration		DSH	4/14/2022 5:14 PM
Details	Entity Subname	Insert	New Registration		Mental Health Clinic	4/14/2022 5:14 PM
Dates	Participating Approval Date	Insert	New Registration			4/14/2022 5:14 PM
Details	State	Insert	New Registration		Pending	4/14/2022 5:14 PM
Dates	Registration Date	Insert	New Registration		4/14/2022 5:14:30 PM	4/14/2022 5:14 PM
Dates	Signed By Date	Insert	New Registration			4/14/2022 5:14 PM
Dates	Start Date	Insert	New Registration			4/14/2022 5:14 PM
Terminations	Termination Comments	Insert	New Registration			4/14/2022 5:14 PM
Terminations	Termination Date	Insert	New Registration			4/14/2022 5:14 PM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2022 5:14 PM
Terminations	Termination Reason	Insert	New Registration			4/14/2022 5:14 PM