Covered Entity Details

DSH420065Q BON SECOURS - ST. FRANCIS XAVIER HOSPITAL (ToBeTerminated) - information as of 6/24/2025 12:05:25 AM

Main Details

Name

BON SECOURS - ST. FRANCIS XAVIER HOSPITAL

Subdivision Name

Oncology Infusion Clinic Downtown

Type

Disproportionate Share Hospital

Rural

340B ID

DSH420065Q

Medicare Provider Number

420065

Outpatient Facility Provider Number

Additional Details

Current Program Status

ToBeTerminated

Registration Date

5/19/2023

Participating Start Date

6/1/2023

Participating Approval Date

6/1/2023

Last Recertification Date

8/18/2024

Termination Date
Termination Reason

7/1/2025
Change of covered entity type

Contacts

Authorizing Official

Roper St Francis Healthcare
Rebecca Ann Tucker, SVP, Chief Financial Officer
(843) 727-3403

Primary Contact

Bon Secours Saint Francis Hospital
Louis Glavinos, 340B Pharmacy Manager and Oncology Outpatient Pharmacy Infusion Manager
(843) 402-1675

Addresses

Street Address

316 Calhoun St
5th Floor Pettit Tower
5600
CHARLESTON, SC 29401-5744

Billing Address

Bon Secours St Francis Xavier Hospital
2095 Henry Tecklenburg Dr
Charleston, SC 29414

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
SC	381885	1851361778

Shipping Addresses

Shipping Address 1

Charleston Oncology, A Department of Bon Secours St Francis Hospital
316 Calhoun St
Main Pharmacy 2nd Floor
Charleston, SC 29401

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
DSH420065A	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	St. Francis Hospital Infusion Therapy	2085 Henry Tecklenburg Drive	Charleston	SC	ToBeTerminated
DSH420065B	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	ST. FRANCIS HOSPITAL PET/CT & RADIA / Radiation Oncology	2085 HENRY TECKLENBURG DR.	CHARLESTON	SC	ToBeTerminated
DSH420065C	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Pain Management	2093 HENRY TECKLENBURG DR	CHARLESTON	SC	ToBeTerminated
DSH420065D	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Breast Care	2145 HENRY TECKLENBURG DR	CHARLESTON	SC	ToBeTerminated
DSH420065E	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Oncology Clinic Downtown	125 DOUGHTY ST	CHARLESTON	SC	ToBeTerminated
DSH420065F	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Oncology Clinic Berkeley	300 CALLEN BLVD	SUMMERVILLE	SC	ToBeTerminated
DSH420065G	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Oncology Infusion Clinic North Charleston	2910 TRICOM ST	N CHARLESTON	SC	ToBeTerminated
DSH420065H	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Rheumatology Clinic West Ashley	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	ToBeTerminated
DSH420065J	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Oncology Infusion Therapy Mt Pleasant	3510 N HIGHWAY 17	MT PLEASANT	SC	ToBeTerminated
DSH420065K	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Outpatient Infusion Therapy North Charleston	8950 UNIVERSITY BLVD	N CHARLESTON	SC	ToBeTerminated
DSH420065L	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	BON SECOURS ST FRANCIS XAVIER HOSPI - LCHO Oncology - MP - RSFH Oncology	3510 N HIGHWAY 17	MT PLEASANT	SC	ToBeTerminated
DSH420065M	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Oncology Infusion Clinic West Ashley	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	ToBeTerminated
DSH420065N	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Oncology Clinic North Charleston	2910 TRICOM ST	N CHARLESTON	SC	ToBeTerminated
DSH420065P	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	BON SECOURS ST FRANCIS XAVIER HOSPI - LCHO Oncology - University - RSFH Oncology	8950 UNIVERSITY BLVD	N CHARLESTON	SC	ToBeTerminated
DSH420065Q	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Oncology Infusion Clinic Downtown	316 Calhoun St	CHARLESTON	SC	ToBeTerminated
DSH420065R	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Oncology Clinic West Ashley	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	ToBeTerminated
DSH420065S	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Oncology Infusion Clinic Berkeley	300 CALLEN BLVD	SUMMERVILLE	SC	ToBeTerminated
DSH420065T	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Outpatient Infusion Clinic Mt Pleasant	3510 N HIGHWAY 17	MT PLEASANT	SC	ToBeTerminated
DSH420065U	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Outpatient Infusion Clinic Berkeley	300 CALLEN BLVD	SUMMERVILLE	SC	ToBeTerminated
DSH420065V	Child	DSH	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	Oncology Clinic Mt Pleasant	3510 N HIGHWAY 17	MT PLEASANT	SC	ToBeTerminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		7/1/2025 12:00:00 AM	4/25/2025 9:00 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	4/25/2025 9:00 AM
Terminations	Termination Date	Update	Hospital Type Change Request		7/1/2025 12:00:00 AM	4/25/2025 9:00 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		7/1/2025 12:00:00 AM	4/25/2025 9:00 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	4/25/2025 9:00 AM
Details	Entity Subname	Update	Change Request	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology DT - RSFH Oncology	Oncology Infusion Clinic Downtown	2/11/2025 9:12 AM
Addresses	Main Address	Update	Change Request	316 Calhoun St 5th Floor Pettit Tower 5600 CHARLESTON, SC 29403-5744	316 Calhoun St 5th Floor Pettit Tower 5600 CHARLESTON, SC 29401-5744	11/19/2024 2:58 PM
Contacts	Authorizing Official	Update	Change Request	Desmond, Matthew Regional President BSSF MPH VP Ops Roper Saint Francis 8437242103	Tucker, Rebecca Ann SVP, Chief Financial Officer Roper St Francis Healthcare 8437273403	9/11/2024 1:15 PM
Details	Last Recertification Date	Update	Recertification	9/5/2023 9:01:25 AM	8/18/2024 11:22:48 AM	8/18/2024 11:22 AM
Addresses	Shipping Address	Update	Change Request	Bon Secours St Francis Xavier Hospital 2095 Henry Tecklenburg Dr Charleston, SC 29414	Charleston Oncology, A Department of Bon Secours St Francis Hospital 316 Calhoun St Main Pharmacy 2nd Floor Charleston, SC 29401	5/16/2024 2:37 PM
Addresses	Billing Address	Insert	Change Request		Bon Secours St Francis Xavier Hospital 2095 Henry Tecklenburg Dr Charleston, SC 29414	2/1/2024 7:31 AM
Addresses	Shipping Address	Insert	Change Request		Bon Secours St Francis Xavier Hospital 2095 Henry Tecklenburg Dr Charleston, SC 29414	2/1/2024 7:31 AM
Contacts	Primary Contact	Update	Profile Change Request	Glavinos, Louis 340B Pharmacy Manager Bon Secours Saint Francis Hospital 8434021675	Glavinos, Louis 340B Pharmacy Manager and Oncology Outpatient Pharmacy Infusion Manager Bon Secours Saint Francis Hospital 8434021675	1/17/2024 2:28 PM
Contacts	Authorizing Official	Update	Change Request	Glenn, Christopher Lawrence Director of Finance Roper St. Francis Healthcare 8437891705	Desmond, Matthew Regional President BSSF MPH VP Ops Roper Saint Francis 8437242103	10/4/2023 11:28 AM
Addresses	Main Address	Update	Change Request	125 DOUGHTY ST STE 500 CHARLESTON, SC 29403-5744	316 Calhoun St 5th Floor Pettit Tower 5600 CHARLESTON, SC 29403-5744	9/18/2023 9:18 AM
Details	Last Recertification Date	Update	Recertification		9/5/2023 9:01:25 AM	9/5/2023 9:01 AM
Contacts	Primary Contact	Update	PC Change Request	Baxley, Thomas Pharmacy Manager Bon Secours Saint Francis Hospital 8434021417	Glavinos, Louis 340B Pharmacy Manager Bon Secours Saint Francis Hospital 8434021675	6/8/2023 12:44 PM
Details	State	Update	OPA Edit	Approved	Active	6/1/2023 11:30 AM
Dates	Start Date	Update	OPA Edit	7/1/2023 12:00:00 AM	6/1/2023 12:00:00 AM	6/1/2023 11:30 AM
Contacts	Signed By	Insert	New Registration		Glenn, Christopher Lawrence Director of Finance Roper St. Francis Healthcare 8437891705	6/1/2023 9:19 AM
Details	340B ID	Update	New Registration		DSH420065Q	6/1/2023 9:19 AM
Details	Entity Name	Update	New Registration	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS - ST. FRANCIS XAVIER HOSPITAL	6/1/2023 9:19 AM
Details	Entity Subname	Update	New Registration	BON SECOURS ST FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology DT - RSFH Oncology	6/1/2023 9:19 AM
Dates	Participating Approval Date	Update	New Registration		6/1/2023 9:19:59 AM	6/1/2023 9:19 AM
Details	State	Update	New Registration	Pending	Approved	6/1/2023 9:19 AM
Dates	Signed By Date	Update	New Registration		5/31/2023 1:46:39 PM	6/1/2023 9:19 AM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	6/1/2023 9:19 AM
Addresses	Main Address	Insert	New Registration		125 DOUGHTY ST STE 500 CHARLESTON, SC 29403-5744	5/19/2023 3:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/19/2023 3:10 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		381885	5/19/2023 3:10 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		SC	5/19/2023 3:10 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1851361778	5/19/2023 3:10 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	5/19/2023 3:10 PM
Contacts	Primary Contact	Insert	New Registration		Baxley, Thomas Pharmacy Manager Bon Secours Saint Francis Hospital 8434021417	5/19/2023 3:10 PM
Contacts	Authorizing Official	Insert	New Registration		Glenn, Christopher Lawrence Director of Finance Roper St. Francis Healthcare 8437891705	5/19/2023 3:10 PM
Details	Assistance Received From Date	Insert	New Registration			5/19/2023 3:10 PM
Details	Assistance Received To Date	Insert	New Registration			5/19/2023 3:10 PM
Details	Last Recertification Date	Insert	New Registration			5/19/2023 3:10 PM
Details	Grant Number	Insert	New Registration			5/19/2023 3:10 PM
Details	340B ID	Insert	New Registration			5/19/2023 3:10 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			5/19/2023 3:10 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			5/19/2023 3:10 PM
Details	Medicare Provider Number	Insert	New Registration		420065	5/19/2023 3:10 PM
Details	Entity Name	Insert	New Registration		BON SECOURS ST. FRANCIS XAVIER HOSPI	5/19/2023 3:10 PM
Details	NOFO Number	Insert	New Registration			5/19/2023 3:10 PM
Details	Program Code	Insert	New Registration		DSH	5/19/2023 3:10 PM
Details	Entity Subname	Insert	New Registration		BON SECOURS ST FRANCIS XAVIER HOSPI	5/19/2023 3:10 PM
Dates	Participating Approval Date	Insert	New Registration			5/19/2023 3:10 PM
Details	State	Insert	New Registration		Pending	5/19/2023 3:10 PM
Dates	Registration Date	Insert	New Registration		5/19/2023 3:10:13 PM	5/19/2023 3:10 PM
Dates	Signed By Date	Insert	New Registration			5/19/2023 3:10 PM
Dates	Start Date	Insert	New Registration			5/19/2023 3:10 PM
Terminations	Termination Comments	Insert	New Registration			5/19/2023 3:10 PM
Terminations	Termination Date	Insert	New Registration			5/19/2023 3:10 PM
Terminations	Termination Effective Date	Insert	New Registration			5/19/2023 3:10 PM
Terminations	Termination Reason	Insert	New Registration			5/19/2023 3:10 PM