Covered Entity Details

DSH060031AB Penrose Hospital (Active) - information as of 4/24/2025 11:59:31 PM

Main Details

Name

Penrose Hospital

Subdivision Name

Penrose Cardiology - Cardiology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH060031AB

Medicare Provider Number

060031

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/10/2022

Participating Start Date

1/1/2023

Participating Approval Date

10/20/2022

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

Penrose St. Francis Health Services
Kevin Wikoff, Market CFO
(719) 571-2498

Primary Contact

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

Addresses

Street Address

2222 N NEVADA AVE
4007
COLORADO SPRINGS, CO 80907

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	05031000	1750896320,1932112125

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
DSH060031A	Child	DSH	Penrose Hospital	St. Francis Medical Center - Catholic Health Initiatives Colorado Operating Room	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031AA	Child	DSH	Penrose Hospital	St. Francis Medical Center - Ambulatory Care/PACU - PACU	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031AB	Child	DSH	Penrose Hospital	Penrose Cardiology - Cardiology	2222 N NEVADA AVE	COLORADO SPRINGS	CO	Active
DSH060031AC	Child	DSH	Penrose Hospital	Wound Care - Wound Care	2222 N NEVADA AVE	COLORADO SPRINGS	CO	Active
DSH060031AD	Child	DSH	Penrose Hospital	ED OBSERVATION UNIT - ED OBSERVATION UNIT	2222 N NEVADA AVE	COLORADO SPRINGS	CO	Active
DSH060031AE	Child	DSH	Penrose Hospital	MRI - MRI	2222 N NEVADA AVE	COLORADO SPRINGS	CO	Active
DSH060031AF	Child	DSH	Penrose Hospital	RADIOISOTOPE - RADIOISOTOPE	2222 N NEVADA AVE	COLORADO SPRINGS	CO	Active
DSH060031AG	Child	DSH	Penrose Hospital	RESPIRATORY THERAPY - RESPIRATORY THERAPY	2222 N NEVADA AVE	COLORADO SPRINGS	CO	Active
DSH060031AH	Child	DSH	Penrose Hospital	RENAL DIALYSIS - RENAL DIALYSIS	2222 N NEVADA AVE	COLORADO SPRINGS	CO	Active
DSH060031AJ	Child	DSH	Penrose Hospital	LABORATORY - LABORATORY	2222 N NEVADA AVE	COLORADO SPRINGS	CO	Active
DSH060031AK	Child	DSH	Penrose Hospital	RADIOLOGY-THERAPEUTIC - RADIOLOGY-THERAPEUTIC	2222 N NEVADA AVE	COLORADO SPRINGS	CO	Active
DSH060031AL	Child	DSH	Penrose Hospital	SLEEP CENTER - SLEEP CENTER	2222 N NEVADA AVE	COLORADO SPRINGS	CO	Active
DSH060031B	Child	DSH	Penrose Hospital	St. Francis Medical Center - Emergency Room	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031C	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Women's Surgery Center	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031D	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Wound Clinic	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031E	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Cardiac Rehabilitation	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031F	Child	DSH	Penrose Hospital	St. Francis Medical Center - Gastro Intestinal Services-GI LAB	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031G	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Sleep Center	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031H	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Renal Dialysis	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031J	Child	DSH	Penrose Hospital	St. Francis Medical Center - Electrocardiology	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031K	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Speech Pathology	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031L	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Physical Therapy	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031M	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Respiratory Therapy	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031N	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Blood Bank	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031P	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Laboratory	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031Q	Child	DSH	Penrose Hospital	St. Francis Medical Center - Cardiac Catheterization	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031R	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Magnetic Resonance Imaging (MRI)	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031S	Child	DSH	Penrose Hospital	St. Francis Medical Center - CT Scan	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031T	Child	DSH	Penrose Hospital	Radioisotope	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031U	Child	DSH	Penrose Hospital	SFMC Ultrasound	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031V	Child	DSH	Penrose Hospital	Radiology-Diagnostic	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031W	Child	DSH	Penrose Hospital	Delivery Room & Labor Room	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031X	Child	DSH	Penrose Hospital	St. Francis Medical Center - Infusion Therapy - Infusion Therapy	6001 E Woodmen Rd	Colorado Springs	CO	Active
DSH060031Y	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Electro Physiology Lab - SFMC Electro Physiology Lab	6001 E Woodmen Rd	Colorado Springs	CO	Terminated
DSH060031Z	Child	DSH	PENROSE/ST. FRANCIS HEALTHCARE	St. Francis Medical Center - Special Procedures - SFMC Special Procedures	6001 E Woodmen Rd	Colorado Springs	CO	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Entity Name	Update	Change Request	Centura Penrose Hospital/St. Francis Hospital	Penrose Hospital	12/11/2024 8:59 AM
Addresses	Billing Address	Update	Recertification	Centura Health PO BOX 372660 Denver, CO 80237	CommonSpirit Health PO BOX 372660 Denver, CO 80237	9/4/2024 3:45 PM
Details	Last Recertification Date	Update	Recertification	8/28/2023 9:36:38 AM	9/4/2024 3:45:41 PM	9/4/2024 3:45 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	Entity Name	Update	Recertification	PENROSE/ST. FRANCIS HEALTHCARE	Centura Penrose Hospital/St. Francis Hospital	9/11/2023 11:33 AM
Contacts	Authorizing Official	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
Medicaid Billing	NPI: Number	Insert	Recertification		1932112125	8/28/2023 9:36 AM
Medicaid Billing	NPI: State	Insert	Recertification		CO	8/28/2023 9:36 AM
Details	Last Recertification Date	Update	Recertification		8/28/2023 9:36:38 AM	8/28/2023 9:36 AM
Contacts	Signed By	Update	Profile Change Request	Richert, Tadd M VP Finance - Acute CAre Centura-Penrose St. Francis 3036737864	Richert, Tadd M VP Finance - Acute CAre Centura St. Anthony North Hospital 3036737864	6/2/2023 10:57 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	Richert, Tadd M Group VP Finance Centura-Penrose St. Francis 7195717202	Richert, Tadd M VP Finance - Acute CAre Centura-Penrose St. Francis 3036737864	5/25/2023 4:13 PM
Contacts	Authorizing Official	Update	Change Request	Richert, Tadd M Group VP Finance Centura-Penrose St. Francis 7195717202	Wikoff, Kevin CFO St. Anthony Hospital 7203215016	5/25/2023 1:30 PM
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
Contacts	Primary Contact	Update	Group Change Request	Birkel, Carter Manager, Pharmacy Operations Centura-Penrose St. Francis 7197765657	Morgan, Samantha 340B Program Manager Centura Health 3036737380	4/27/2023 12:36 PM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Richert, Tadd M Group VP Finance Centura-Penrose St. Francis 7195717202	10/20/2022 2:09 PM
Details	340B ID	Update	New Registration		DSH060031AB	10/20/2022 2:09 PM
Details	Entity Subname	Update	New Registration	Penrose Cardiology	Penrose Cardiology - Cardiology	10/20/2022 2:09 PM
Dates	Participating Approval Date	Update	New Registration		10/20/2022 2:09:31 PM	10/20/2022 2:09 PM
Details	State	Update	New Registration	Pending	Approved	10/20/2022 2:09 PM
Dates	Signed By Date	Update	New Registration		10/14/2022 9:22:42 AM	10/20/2022 2:09 PM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	10/20/2022 2:09 PM
Addresses	Main Address	Insert	New Registration		2222 N NEVADA AVE 4007 COLORADO SPRINGS, CO 80907	10/10/2022 12:53 PM
Addresses	Billing Address	Insert	New Registration		Centura Health PO BOX 372660 Denver, CO 80237	10/10/2022 12:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2022 12:53 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		05031000	10/10/2022 12:53 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	10/10/2022 12:53 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1750896320	10/10/2022 12:53 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	10/10/2022 12:53 PM
Contacts	Primary Contact	Insert	New Registration		Birkel, Carter Manager, Pharmacy Operations Centura-Penrose St. Francis 7197765657	10/10/2022 12:53 PM
Contacts	Authorizing Official	Insert	New Registration		Richert, Tadd M Group VP Finance Centura-Penrose St. Francis 7195717202	10/10/2022 12:53 PM
Details	Assistance Received From Date	Insert	New Registration			10/10/2022 12:53 PM
Details	Assistance Received To Date	Insert	New Registration			10/10/2022 12:53 PM
Details	Last Recertification Date	Insert	New Registration			10/10/2022 12:53 PM
Details	Grant Number	Insert	New Registration			10/10/2022 12:53 PM
Details	340B ID	Insert	New Registration			10/10/2022 12:53 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/10/2022 12:53 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/10/2022 12:53 PM
Details	Medicare Provider Number	Insert	New Registration		060031	10/10/2022 12:53 PM
Details	Entity Name	Insert	New Registration		PENROSE/ST. FRANCIS HEALTHCARE	10/10/2022 12:53 PM
Details	NOFO Number	Insert	New Registration			10/10/2022 12:53 PM
Details	Program Code	Insert	New Registration		DSH	10/10/2022 12:53 PM
Details	Entity Subname	Insert	New Registration		Penrose Cardiology	10/10/2022 12:53 PM
Dates	Participating Approval Date	Insert	New Registration			10/10/2022 12:53 PM
Details	State	Insert	New Registration		Pending	10/10/2022 12:53 PM
Dates	Registration Date	Insert	New Registration		10/10/2022 12:53:58 PM	10/10/2022 12:53 PM
Dates	Signed By Date	Insert	New Registration			10/10/2022 12:53 PM
Dates	Start Date	Insert	New Registration			10/10/2022 12:53 PM
Terminations	Termination Comments	Insert	New Registration			10/10/2022 12:53 PM
Terminations	Termination Date	Insert	New Registration			10/10/2022 12:53 PM
Terminations	Termination Effective Date	Insert	New Registration			10/10/2022 12:53 PM
Terminations	Termination Reason	Insert	New Registration			10/10/2022 12:53 PM