Covered Entity Details

RRC060015-03 ST ANTHONY HOSPITAL (Active) - information as of 6/19/2025 11:51:17 PM

Main Details

Name

ST ANTHONY HOSPITAL

Subdivision Name

Pain Management Clinic - Pain Management

Type

Rural Referral Center

Rural

340B ID

RRC060015-03

Medicare Provider Number

060015

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/7/2022

Participating Start Date

10/1/2022

Participating Approval Date

8/29/2022

Last Recertification Date

9/5/2024

Contacts

Authorizing Official

St. Anthony Hospital
Katy Comoglio, CFO
(720) 321-0062

Primary Contact

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

Addresses

Street Address

11700 W 2nd Pl
Suite 225
Lakewood, CO 80228

Billing Address

CommonSpirit 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	05015003	1164430567,1942819578

Shipping Addresses

Shipping Address 1

St. Anthony Hospital
11600 W 2nd Place
Lakewood, CO 80228

Shipping Address 2

St. Anthony Hospital
11700 W 2nd Place
Suite 225
Lakewood, CO 80228

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
RRC060015-01	Child	RRC	ST ANTHONY HOSPITAL	Senior Health Clinic - Senior Health	11700 W 2nd Pl	Lakewood	CO	Active
RRC060015-02	Child	RRC	ST ANTHONY HOSPITAL	Infusion Therapy - Outpatient Infusion	11700 W 2nd Pl	Lakewood	CO	Active
RRC060015-03	Child	RRC	ST ANTHONY HOSPITAL	Pain Management Clinic - Pain Management	11700 W 2nd Pl	Lakewood	CO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Recertification	11700 W 2nd Pl Ste 225 Lakewood, CO 80228	11700 W 2nd Pl Suite 225 Lakewood, CO 80228	9/5/2024 8:52 AM
Addresses	Billing Address	Update	Recertification	Centura Health PO Box 372660 Denver, CO 80237	CommonSpirit Health PO Box 372660 Denver, CO 80237	9/5/2024 8:52 AM
Addresses	Shipping Address	Insert	Recertification		St. Anthony Hospital 11600 W 2nd Place Lakewood, CO 80228	9/5/2024 8:52 AM
Addresses	Shipping Address	Insert	Recertification		St. Anthony Hospital 11700 W 2nd Place Suite 225 Lakewood, CO 80228	9/5/2024 8:52 AM
Details	Last Recertification Date	Update	Recertification	8/30/2023 3:54:56 PM	9/5/2024 8:52:21 AM	9/5/2024 8:52 AM
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
Contacts	Authorizing Official	Update	Change Request	Cullinan, Kevin CEO Centura Health 7203210018	Comoglio, Katy CFO St. Anthony Hospital 7203210062	6/13/2024 10:37 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1942819578	8/30/2023 3:54 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	8/30/2023 3:54 PM
Details	Last Recertification Date	Update	Recertification		8/30/2023 3:54:56 PM	8/30/2023 3:54 PM
Contacts	Signed By	Update	Profile Change Request	Wikoff, Kevin Marker CFO Penrose St. Francis Health Services 7195712498	Wikoff, Kevin Market CFO Penrose St. Francis Health Services 7195712498	8/29/2023 8:09 AM
Contacts	Authorizing Official	Update	Change Request	McSweeney, Christine Interim CEO St. Anthony Hospital 7203210015	Cullinan, Kevin CEO Centura Health 7203210018	8/14/2023 10:18 AM
Contacts	Authorizing Official	Update	Change Request	Wikoff, Kevin Marker CFO Penrose St. Francis Health Services 7195712498	McSweeney, Christine Interim CEO St. Anthony Hospital 7203210015	7/26/2023 6:44 AM
Contacts	Authorizing Official	Update	Profile Change Request	Wikoff, Kevin CFO St. Anthony Hospital 7203215016	Wikoff, Kevin Marker CFO Penrose St. Francis Health Services 7195712498	5/31/2023 8:33 AM
Contacts	Signed By	Update	Profile Change Request	Wikoff, Kevin CFO St. Anthony Hospital 7203215016	Wikoff, Kevin Marker CFO Penrose St. Francis Health Services 7195712498	5/31/2023 8:33 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
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Wikoff, Kevin CFO St. Anthony Hospital 7203215016	8/29/2022 1:50 PM
Details	340B ID	Update	New Registration		RRC060015-03	8/29/2022 1:50 PM
Details	Entity Subname	Update	New Registration	Pain Management Clinic	Pain Management Clinic - Pain Management	8/29/2022 1:50 PM
Dates	Participating Approval Date	Update	New Registration		8/29/2022 1:50:53 PM	8/29/2022 1:50 PM
Details	State	Update	New Registration	Pending	Approved	8/29/2022 1:50 PM
Dates	Signed By Date	Update	New Registration		7/15/2022 10:26:09 AM	8/29/2022 1:50 PM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	8/29/2022 1:50 PM
Addresses	Main Address	Insert	New Registration		11700 W 2nd Pl Ste 225 Lakewood, CO 80228	7/7/2022 2:10 PM
Addresses	Billing Address	Insert	New Registration		Centura Health PO Box 372660 Denver, CO 80237	7/7/2022 2:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/7/2022 2:10 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		05015003	7/7/2022 2:10 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	7/7/2022 2:10 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1164430567	7/7/2022 2:10 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	7/7/2022 2:10 PM
Contacts	Primary Contact	Insert	New Registration		Morgan, Samantha 340B Program Manager Centura Health 3036737380	7/7/2022 2:10 PM
Contacts	Authorizing Official	Insert	New Registration		Wikoff, Kevin CFO St. Anthony Hospital 7203215016	7/7/2022 2:10 PM
Details	Assistance Received From Date	Insert	New Registration			7/7/2022 2:10 PM
Details	Assistance Received To Date	Insert	New Registration			7/7/2022 2:10 PM
Details	Last Recertification Date	Insert	New Registration			7/7/2022 2:10 PM
Details	Grant Number	Insert	New Registration			7/7/2022 2:10 PM
Details	340B ID	Insert	New Registration			7/7/2022 2:10 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/7/2022 2:10 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/7/2022 2:10 PM
Details	Medicare Provider Number	Insert	New Registration		060015	7/7/2022 2:10 PM
Details	Entity Name	Insert	New Registration		ST ANTHONY HOSPITAL	7/7/2022 2:10 PM
Details	NOFO Number	Insert	New Registration			7/7/2022 2:10 PM
Details	Program Code	Insert	New Registration		RRC	7/7/2022 2:10 PM
Details	Entity Subname	Insert	New Registration		Pain Management Clinic	7/7/2022 2:10 PM
Dates	Participating Approval Date	Insert	New Registration			7/7/2022 2:10 PM
Details	State	Insert	New Registration		Pending	7/7/2022 2:10 PM
Dates	Registration Date	Insert	New Registration		7/7/2022 2:10:52 PM	7/7/2022 2:10 PM
Dates	Signed By Date	Insert	New Registration			7/7/2022 2:10 PM
Dates	Start Date	Insert	New Registration			7/7/2022 2:10 PM
Terminations	Termination Comments	Insert	New Registration			7/7/2022 2:10 PM
Terminations	Termination Date	Insert	New Registration			7/7/2022 2:10 PM
Terminations	Termination Effective Date	Insert	New Registration			7/7/2022 2:10 PM
Terminations	Termination Reason	Insert	New Registration			7/7/2022 2:10 PM