Covered Entity Details

DSH370025B SAINT FRANCIS HOSPITAL MUSKOGEE (Active) - information as of 5/29/2025 1:56:53 AM

Main Details

Name

SAINT FRANCIS HOSPITAL MUSKOGEE

Subdivision Name

Xavier Building - MRI - MRI

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH370025B

Medicare Provider Number

370025

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/12/2022

Participating Start Date

1/1/2023

Participating Approval Date

11/23/2022

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Saint Francis Health System
Deborah D Dage, SRVP/Chief Financial Officer
(918) 494-8418

Primary Contact

Saint Francis Health System
Theodore Houston, Manager Pharmacy Financials and 340B Program
(918) 494-1862

Addresses

Street Address

101 Rockefeller Drive
Suite 101
Muskogee, OK 74401

Billing Address

Saint Francis Health System
Att: Accounts Payable
PO BOX 707004
Tulsa, OK 74170-7004

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
OK	200700900A	1386188837

Shipping Addresses

Shipping Address 1

Saint Francis Hospital Muskogee
300 Rockefeller Drive
Muskogee, OK 74401

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
DSH370025A	Child	DSH	SAINT FRANCIS HOSPITAL MUSKOGEE	Xavier Building - Physical Therapy - Physical Therapy	101 Rockefeller Drive	Muskogee	OK	Active
DSH370025B	Child	DSH	SAINT FRANCIS HOSPITAL MUSKOGEE	Xavier Building - MRI - MRI	101 Rockefeller Drive	Muskogee	OK	Active
DSH370025C	Child	DSH	SAINT FRANCIS HOSPITAL MUSKOGEE	SAINT FRANCIS HOSPITAL MUSKOGEE SLE - SLEEP CENTER - Sleep center	151 ECO FRIENDLY DR	Muskogee	OK	Terminated
DSH370025D	Child	DSH	SAINT FRANCIS HOSPITAL MUSKOGEE	Xavier Building - Occupational Therapy - Occupational Therapy	101 Rockefeller Drive	Muskogee	OK	Active
DSH370025E	Child	DSH	SAINT FRANCIS HOSPITAL MUSKOGEE	Xavier Building - Ultrasound - Ultrasound	101 Rockefeller Drive	Muskogee	OK	Active
DSH370025F	Child	DSH	SAINT FRANCIS HOSPITAL MUSKOGEE	Xavier Building - Breast Center - Mammograms	101 Rockefeller Drive	Muskogee	OK	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	PC Change Request	Walker, Robert Douglas Manager, Pharmacy Saint Francis Health System 9184941059	Houston, Theodore Manager Pharmacy Financials and 340B Program Saint Francis Health System 9184941862	10/16/2024 2:24 PM
Details	Last Recertification Date	Update	Recertification	8/22/2023 7:52:58 PM	8/15/2024 1:32:47 PM	8/15/2024 1:32 PM
Addresses	Billing Address	Insert	Group Change Request		Saint Francis Health System Att: Accounts Payable PO BOX 707004 Tulsa, OK 74170-7004	12/18/2023 8:07 AM
Addresses	Shipping Address	Insert	Group Change Request		Saint Francis Hospital Muskogee 300 Rockefeller Drive Muskogee, OK 74401	12/18/2023 8:07 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	237017105 (AR)		12/14/2023 6:24 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	9000160063 (CO)		12/14/2023 6:24 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1386188837 (AR)		12/14/2023 6:24 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1386188837 (CO)		12/14/2023 6:24 AM
Details	Last Recertification Date	Update	Recertification		8/22/2023 7:52:58 PM	8/22/2023 7:52 PM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Dage, Deborah D SRVP/Chief Financial Officer Saint Francis Health System 9184948418	11/23/2022 9:08 AM
Details	340B ID	Update	New Registration		DSH370025B	11/23/2022 9:08 AM
Details	Entity Subname	Update	New Registration	Xavier Building - MRI	Xavier Building - MRI - MRI	11/23/2022 9:08 AM
Dates	Participating Approval Date	Update	New Registration		11/23/2022 9:08:06 AM	11/23/2022 9:08 AM
Details	State	Update	New Registration	Pending	Approved	11/23/2022 9:08 AM
Dates	Signed By Date	Update	New Registration		11/15/2022 8:20:57 PM	11/23/2022 9:08 AM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	11/23/2022 9:08 AM
Addresses	Main Address	Insert	New Registration		101 Rockefeller Drive Suite 101 Muskogee, OK 74401	10/12/2022 11:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2022 11:48 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		237017105	10/12/2022 11:48 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		AR	10/12/2022 11:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2022 11:48 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		9000160063	10/12/2022 11:48 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	10/12/2022 11:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2022 11:48 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		200700900A	10/12/2022 11:48 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OK	10/12/2022 11:48 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1386188837	10/12/2022 11:48 AM
Medicaid Billing	NPI: State	Insert	New Registration		AR	10/12/2022 11:48 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1386188837	10/12/2022 11:48 AM
Medicaid Billing	NPI: State	Insert	New Registration		CO	10/12/2022 11:48 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1386188837	10/12/2022 11:48 AM
Medicaid Billing	NPI: State	Insert	New Registration		OK	10/12/2022 11:48 AM
Contacts	Primary Contact	Insert	New Registration		Walker, Robert Douglas Manager, Pharmacy Saint Francis Health System 9184941059	10/12/2022 11:48 AM
Contacts	Authorizing Official	Insert	New Registration		Dage, Deborah D SRVP/Chief Financial Officer Saint Francis Health System 9184948418	10/12/2022 11:48 AM
Details	Assistance Received From Date	Insert	New Registration			10/12/2022 11:48 AM
Details	Assistance Received To Date	Insert	New Registration			10/12/2022 11:48 AM
Details	Last Recertification Date	Insert	New Registration			10/12/2022 11:48 AM
Details	Grant Number	Insert	New Registration			10/12/2022 11:48 AM
Details	340B ID	Insert	New Registration			10/12/2022 11:48 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2022 11:48 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2022 11:48 AM
Details	Medicare Provider Number	Insert	New Registration		370025	10/12/2022 11:48 AM
Details	Entity Name	Insert	New Registration		SAINT FRANCIS HOSPITAL MUSKOGEE	10/12/2022 11:48 AM
Details	NOFO Number	Insert	New Registration			10/12/2022 11:48 AM
Details	Program Code	Insert	New Registration		DSH	10/12/2022 11:48 AM
Details	Entity Subname	Insert	New Registration		Xavier Building - MRI	10/12/2022 11:48 AM
Dates	Participating Approval Date	Insert	New Registration			10/12/2022 11:48 AM
Details	State	Insert	New Registration		Pending	10/12/2022 11:48 AM
Dates	Registration Date	Insert	New Registration		10/12/2022 11:48:05 AM	10/12/2022 11:48 AM
Dates	Signed By Date	Insert	New Registration			10/12/2022 11:48 AM
Dates	Start Date	Insert	New Registration			10/12/2022 11:48 AM
Terminations	Termination Comments	Insert	New Registration			10/12/2022 11:48 AM
Terminations	Termination Date	Insert	New Registration			10/12/2022 11:48 AM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2022 11:48 AM
Terminations	Termination Reason	Insert	New Registration			10/12/2022 11:48 AM