Covered Entity Details

SCH170175-00 St. Catherine Hospital - Dodge City (Active) - information as of 5/6/2025 11:09:25 PM

Main Details

Name

St. Catherine Hospital - Dodge City

Subdivision Name

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH170175-00

Medicare Provider Number

170175

Additional Details

Current Program Status

Active

Registration Date

1/11/2023

Participating Start Date

4/1/2023

Participating Approval Date

1/26/2023

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

CommonSpirit Health
Shawna Roark, VP of Finance & CFO
(620) 272-2551

Primary Contact

CommonSpirit Health
Samantha Morgan, System Manager, 340B Program
(303) 673-7354

Addresses

Street Address

3001 Avenue A
Dodge City, KS 67801

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
KS	13010039	1689317190,1790428639

Shipping Addresses

Shipping Address 1

St. Catherine Hospital - Dodge City
3001 Avenue A
Dodge City, KS 67801

Shipping Address 2

CommonSpirit Health - Central Distribution Center
2551 W 84th Ave
Westminster, CO 80031

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
Contract Detail	CENTURA HEALTH PHARMACY SERVICES	2551 W. 84TH AVE		WESTMINSTER	CO	80031	01/26/2023	04/01/2023			04/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/15/2025 6:57 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		13010039	4/15/2025 6:57 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	4/15/2025 6:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1689317190	4/15/2025 6:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		KS	4/15/2025 6:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1790428639	4/15/2025 6:57 PM
Medicaid Billing	NPI: State	Insert	Change Request		KS	4/15/2025 6:57 PM
Contacts	Primary Contact	Update	Profile Change Request	Morgan, Samantha System Manager, 340B Program CommonSpirit Health 3036737380	Morgan, Samantha System Manager, 340B Program CommonSpirit Health 3036737354	2/19/2025 5:39 PM
Contacts	Primary Contact	Update	Change Request	Morgan, Samantha System Manager, 340B Mountain Region CommonSpirit Health 3036737380	Morgan, Samantha System Manager, 340B Program CommonSpirit Health 3036737380	12/26/2024 7:29 AM
Details	Entity Name	Update	Change Request	Centura St. Catherine Hospital - Dodge City	St. Catherine Hospital - Dodge City	12/26/2024 7:29 AM
Addresses	Billing Address	Update	Recertification	Centura Health PO Box 372660 Denver, CO 80237	CommonSpirit Health PO Box 372660 Denver, CO 80237	9/3/2024 3:23 PM
Addresses	Shipping Address	Insert	Recertification		St. Catherine Hospital - Dodge City 3001 Avenue A Dodge City, KS 67801	9/3/2024 3:23 PM
Addresses	Shipping Address	Insert	Recertification		CommonSpirit Health - Central Distribution Center 2551 W 84th Ave Westminster, CO 80031	9/3/2024 3:23 PM
Details	Last Recertification Date	Update	Recertification	8/22/2023 3:41:37 PM	9/3/2024 3:23:06 PM	9/3/2024 3:23 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	Authorizing Official	Update	Change Request	Roark, Shawna CFO St. Catherine Hospital 6202722551	Roark, Shawna VP of Finance & CFO CommonSpirit Health 6202722551	8/1/2024 7:14 AM
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	Last Recertification Date	Update	Recertification		8/22/2023 3:41:37 PM	8/22/2023 3:41 PM
Contacts	Authorizing Official	Update	Change Request	Fitzthum, John COO Centura Health 6202258404	Roark, Shawna CFO St. Catherine Hospital 6202722551	7/26/2023 4:51 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
Details	State	Update		Approved	Active	4/1/2023 12:01 AM
Details	Entity Name	Update	Change Request	WESTERN PLAINS MEDICAL COMPLEX	Centura St. Catherine Hospital - Dodge City	1/31/2023 8:16 AM
Addresses	Billing Address	Insert	New Registration		Centura Health PO Box 372660 Denver, CO 80237	1/26/2023 4:00 PM
Contacts	Signed By	Insert	New Registration		Fitzthum, John COO Centura Health 6202258404	1/26/2023 4:00 PM
Details	340B ID	Update	New Registration		SCH170175-00	1/26/2023 4:00 PM
Dates	Participating Approval Date	Update	New Registration		1/26/2023 4:00:55 PM	1/26/2023 4:00 PM
Details	State	Update	New Registration	Pending	Approved	1/26/2023 4:00 PM
Dates	Signed By Date	Update	New Registration		1/21/2023 1:14:01 PM	1/26/2023 4:00 PM
Dates	Start Date	Update	New Registration		4/1/2023 12:00:00 AM	1/26/2023 4:00 PM
Addresses	Main Address	Insert	New Registration		3001 AVENUE A DODGE CITY, KS 67801	1/11/2023 12:38 PM
Addresses	Billing Address	Insert	New Registration		Centura Health PO Box 372660 Denver, CO 80237	1/11/2023 12:38 PM
Contacts	Primary Contact	Insert	New Registration		Morgan, Samantha 340B Program Manager Centura Health 3036737380	1/11/2023 12:38 PM
Contacts	Authorizing Official	Insert	New Registration		Fitzthum, John COO Centura Health 6202258404	1/11/2023 12:38 PM
Details	Assistance Received From Date	Insert	New Registration			1/11/2023 12:38 PM
Details	Assistance Received To Date	Insert	New Registration			1/11/2023 12:38 PM
Details	Last Recertification Date	Insert	New Registration			1/11/2023 12:38 PM
Details	Grant Number	Insert	New Registration			1/11/2023 12:38 PM
Details	340B ID	Insert	New Registration			1/11/2023 12:38 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/11/2023 12:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/11/2023 12:38 PM
Details	Medicare Provider Number	Insert	New Registration		170175	1/11/2023 12:38 PM
Details	Entity Name	Insert	New Registration		WESTERN PLAINS MEDICAL COMPLEX	1/11/2023 12:38 PM
Details	NOFO Number	Insert	New Registration			1/11/2023 12:38 PM
Details	Program Code	Insert	New Registration		SCH	1/11/2023 12:38 PM
Details	Entity Subname	Insert	New Registration			1/11/2023 12:38 PM
Dates	Participating Approval Date	Insert	New Registration			1/11/2023 12:38 PM
Details	State	Insert	New Registration		Pending	1/11/2023 12:38 PM
Dates	Registration Date	Insert	New Registration		1/11/2023 12:38:46 PM	1/11/2023 12:38 PM
Dates	Signed By Date	Insert	New Registration			1/11/2023 12:38 PM
Dates	Start Date	Insert	New Registration			1/11/2023 12:38 PM
Terminations	Termination Comments	Insert	New Registration			1/11/2023 12:38 PM
Terminations	Termination Date	Insert	New Registration			1/11/2023 12:38 PM
Terminations	Termination Effective Date	Insert	New Registration			1/11/2023 12:38 PM
Terminations	Termination Reason	Insert	New Registration			1/11/2023 12:38 PM