Covered Entity Details

DSH320090G SANTA FE MEDICAL CENTER (Active) - information as of 4/25/2025 7:30:22 PM

Main Details

Name

SANTA FE MEDICAL CENTER

Subdivision Name

PMG ST MICHAELS - INTERNAL MEDICINE

Type

Disproportionate Share Hospital

Rural

340B ID

DSH320090G

Medicare Provider Number

320090

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/11/2023

Participating Start Date

10/1/2023

Participating Approval Date

8/30/2023

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

Presbyterian Healthcare Services
Erica Downing, VP, Pharmacy and Infusion Services & Chief Pharmacy Officer
(505) 724-8994

Primary Contact

Presbyterian Healthcare Services
Barbara Fried-Smith, 340B Program Coordinator
(505) 886-4820

Addresses

Street Address

454 ST MICHAELS DRIVE
SANTA FE, NM 87505

Billing Address
Same as Street Address

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?
No

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
DSH320090A	Child	DSH	SANTA FE MEDICAL CENTER	PMG ST MICHAELS - RHEUMATOLOGY	454 ST MICHAELS DRIVE	SANTA FE	NM	Active
DSH320090B	Child	DSH	SANTA FE MEDICAL CENTER	PMG ST MICHAELS - ENDOCRINOLOGY	454 ST MICHAELS DRIVE	SANTA FE	NM	Active
DSH320090C	Child	DSH	SANTA FE MEDICAL CENTER	PMG ST MICHAELS - BEHAVIORAL HEALTH	454 ST MICHAELS DRIVE	SANTA FE	NM	Active
DSH320090D	Child	DSH	SANTA FE MEDICAL CENTER	PMG ST MICHAELS - SLEEP/PULM	454 ST MICHAELS DRIVE	SANTA FE	NM	Active
DSH320090E	Child	DSH	SANTA FE MEDICAL CENTER	PMG ST MICHAELS - FAMILY PRACTICE	454 ST MICHAELS DRIVE	SANTA FE	NM	Active
DSH320090F	Child	DSH	SANTA FE MEDICAL CENTER	PMG ST MICHAELS - URGENT CARE	454 ST MICHAELS DRIVE	SANTA FE	NM	Active
DSH320090G	Child	DSH	SANTA FE MEDICAL CENTER	PMG ST MICHAELS - INTERNAL MEDICINE	454 ST MICHAELS DRIVE	SANTA FE	NM	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		9/4/2024 10:08:52 AM	9/4/2024 10:08 AM
Contacts	Primary Contact	Update	Group Change Request	Shreve, Patrick 340B Analyst III Presbyterian Healthcare Services 5057247192	Fried-Smith, Barbara 340B Program Coordinator Presbyterian Healthcare Services 5058864820	7/30/2024 12:25 PM
Contacts	Primary Contact	Update	Group Change Request	Green, Kelly 340B Program Manager Presbyterian Healthcare Services 5057247761	Shreve, Patrick 340B Analyst III Presbyterian Healthcare Services 5057247192	3/18/2024 7:31 AM
Details	State	Update		Approved	Active	10/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Downing, Erica VP, Pharmacy and Infusion Services & Chief Pharmacy Officer Presbyterian Healthcare Services 5057248994	8/30/2023 7:15 AM
Details	340B ID	Update	New Registration		DSH320090G	8/30/2023 7:15 AM
Details	Entity Subname	Update	New Registration	PMG ST MICHAELS	PMG ST MICHAELS - INTERNAL MEDICINE	8/30/2023 7:15 AM
Dates	Participating Approval Date	Update	New Registration		8/30/2023 7:15:45 AM	8/30/2023 7:15 AM
Details	State	Update	New Registration	Pending	Approved	8/30/2023 7:15 AM
Dates	Signed By Date	Update	New Registration		7/12/2023 2:21:03 PM	8/30/2023 7:15 AM
Dates	Start Date	Update	New Registration		10/1/2023 12:00:00 AM	8/30/2023 7:15 AM
Addresses	Main Address	Insert	New Registration		454 ST MICHAELS DRIVE SANTA FE, NM 87505	7/11/2023 7:39 PM
Contacts	Primary Contact	Insert	New Registration		Green, Kelly 340B Program Manager Presbyterian Healthcare Services 5057247761	7/11/2023 7:39 PM
Contacts	Authorizing Official	Insert	New Registration		Downing, Erica VP, Pharmacy and Infusion Services & Chief Pharmacy Officer Presbyterian Healthcare Services 5057248994	7/11/2023 7:39 PM
Details	Assistance Received From Date	Insert	New Registration			7/11/2023 7:39 PM
Details	Assistance Received To Date	Insert	New Registration			7/11/2023 7:39 PM
Details	Last Recertification Date	Insert	New Registration			7/11/2023 7:39 PM
Details	Grant Number	Insert	New Registration			7/11/2023 7:39 PM
Details	340B ID	Insert	New Registration			7/11/2023 7:39 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/11/2023 7:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/11/2023 7:39 PM
Details	Medicare Provider Number	Insert	New Registration		320090	7/11/2023 7:39 PM
Details	Entity Name	Insert	New Registration		SANTA FE MEDICAL CENTER	7/11/2023 7:39 PM
Details	NOFO Number	Insert	New Registration			7/11/2023 7:39 PM
Details	Program Code	Insert	New Registration		DSH	7/11/2023 7:39 PM
Details	Entity Subname	Insert	New Registration		PMG ST MICHAELS	7/11/2023 7:39 PM
Dates	Participating Approval Date	Insert	New Registration			7/11/2023 7:39 PM
Details	State	Insert	New Registration		Pending	7/11/2023 7:39 PM
Dates	Registration Date	Insert	New Registration		7/11/2023 7:39:23 PM	7/11/2023 7:39 PM
Dates	Signed By Date	Insert	New Registration			7/11/2023 7:39 PM
Dates	Start Date	Insert	New Registration			7/11/2023 7:39 PM
Terminations	Termination Comments	Insert	New Registration			7/11/2023 7:39 PM
Terminations	Termination Date	Insert	New Registration			7/11/2023 7:39 PM
Terminations	Termination Effective Date	Insert	New Registration			7/11/2023 7:39 PM
Terminations	Termination Reason	Insert	New Registration			7/11/2023 7:39 PM