Covered Entity Details

DSH060001G Banner North Colorado Medical Center (Active) - information as of 5/2/2025 10:25:47 PM

Main Details

Name

Banner North Colorado Medical Center

Subdivision Name

Banner MD Anderson Cancer Center Plastic Surgery at Banner North Colorado Medical Center - Surgical Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH060001G

Medicare Provider Number

060001

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/12/2024

Participating Start Date

10/1/2024

Participating Approval Date

7/16/2024

Last Recertification Date

Contacts

Authorizing Official

Banner Health
Patricia Gibson, Western Division Senior Finance Director
(970) 810-6140

Primary Contact

BannerHealth
Natalie Louise Yount, Director of Pharmacy
(970) 810-6901

Addresses

Street Address

1801 16th Street
Greeley, CO 80631

Billing Address

Banner Health Accounts Payable
Po Box 2977
Phoenix, AZ 85062

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
NE	10026075201	1720004450
WY	109616800	1720004450
CO	81608322,05001003,9000201018	1720004450,1992472674,1174231682

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
DSH060001A	Child	DSH	North Colorado Medical Center	SUMMIT VIEW MEDICAL COMMONS-RADIOLOGY	2001 70TH AVE	GREELEY	CO	Terminated
DSH060001B	Child	DSH	Banner North Colorado Medical Center	BANNER NORTH COLORADO EMERGENCY CARE	2000 70th Ave	Greeley	CO	Active
DSH060001C	Child	DSH	Banner North Colorado Medical Center	Banner MD Anderson Cancer Center - OP Oncology Clinic	1801 16th Street	Greeley	CO	Active
DSH060001D	Child	DSH	Banner North Colorado Medical Center	Banner NCMC MedCare Clinic - Anticoagulation Clinic	1517 16th Ave. Court	Greeley	CO	Terminated
DSH060001E	Child	DSH	Banner North Colorado Medical Center	North Colorado Medical Center - Banner MD Anderson Cancer Center	2000 Boise Ave	Loveland	CO	Active
DSH060001F	Child	DSH	Banner North Colorado Medical Center	Banner North Colorado Medical Center - Banner Infusion Center	2000 Boise Ave	Loveland	CO	Active
DSH060001G	Child	DSH	Banner North Colorado Medical Center	Banner MD Anderson Cancer Center Plastic Surgery at Banner North Colorado Medical Center - Surgical Oncology	1801 16th Street	Greeley	CO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Schultz, Lorena CFO Banner Health 9708101573	Gibson, Patricia Western Division Senior Finance Director Banner Health 9708106140	12/5/2024 2:30 PM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Schultz, Lorena CFO Banner Health 9708101573	7/16/2024 11:35 AM
Details	340B ID	Update	New Registration		DSH060001G	7/16/2024 11:35 AM
Details	Entity Name	Update	New Registration	NORTH COLORADO MEDICAL CENTER	Banner North Colorado Medical Center	7/16/2024 11:35 AM
Details	Entity Subname	Update	New Registration	Banner MD Anderson Cancer Center Plastic Surgery at Banner North Colorado Medical Center	Banner MD Anderson Cancer Center Plastic Surgery at Banner North Colorado Medical Center - Surgical Oncology	7/16/2024 11:35 AM
Dates	Participating Approval Date	Update	New Registration		7/16/2024 11:35:47 AM	7/16/2024 11:35 AM
Details	State	Update	New Registration	Pending	Approved	7/16/2024 11:35 AM
Dates	Signed By Date	Update	New Registration		7/12/2024 5:49:47 PM	7/16/2024 11:35 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	7/16/2024 11:35 AM
Addresses	Main Address	Insert	New Registration		1801 16th Street Greeley, CO 80631	7/12/2024 4:03 PM
Addresses	Billing Address	Insert	New Registration		Banner Health Accounts Payable Po Box 2977 Phoenix, AZ 85062	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		10026075201	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NE	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		109616800	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WY	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		81608322	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		05001003	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		9000201018	7/12/2024 4:03 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	7/12/2024 4:03 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1720004450	7/12/2024 4:03 PM
Medicaid Billing	NPI: State	Insert	New Registration		NE	7/12/2024 4:03 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1720004450	7/12/2024 4:03 PM
Medicaid Billing	NPI: State	Insert	New Registration		WY	7/12/2024 4:03 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1720004450	7/12/2024 4:03 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	7/12/2024 4:03 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1992472674	7/12/2024 4:03 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	7/12/2024 4:03 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1174231682	7/12/2024 4:03 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	7/12/2024 4:03 PM
Contacts	Primary Contact	Insert	New Registration		Yount, Natalie Louise Director of Pharmacy BannerHealth 9708106901	7/12/2024 4:03 PM
Contacts	Authorizing Official	Insert	New Registration		Schultz, Lorena CFO Banner Health 9708101573	7/12/2024 4:03 PM
Details	Assistance Received From Date	Insert	New Registration			7/12/2024 4:03 PM
Details	Assistance Received To Date	Insert	New Registration			7/12/2024 4:03 PM
Details	Last Recertification Date	Insert	New Registration			7/12/2024 4:03 PM
Details	Grant Number	Insert	New Registration			7/12/2024 4:03 PM
Details	340B ID	Insert	New Registration			7/12/2024 4:03 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/12/2024 4:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/12/2024 4:03 PM
Details	Medicare Provider Number	Insert	New Registration		060001	7/12/2024 4:03 PM
Details	Entity Name	Insert	New Registration		NORTH COLORADO MEDICAL CENTER	7/12/2024 4:03 PM
Details	NOFO Number	Insert	New Registration			7/12/2024 4:03 PM
Details	Program Code	Insert	New Registration		DSH	7/12/2024 4:03 PM
Details	Entity Subname	Insert	New Registration		Banner MD Anderson Cancer Center Plastic Surgery at Banner North Colorado Medical Center	7/12/2024 4:03 PM
Dates	Participating Approval Date	Insert	New Registration			7/12/2024 4:03 PM
Details	State	Insert	New Registration		Pending	7/12/2024 4:03 PM
Dates	Registration Date	Insert	New Registration		7/12/2024 4:03:33 PM	7/12/2024 4:03 PM
Dates	Signed By Date	Insert	New Registration			7/12/2024 4:03 PM
Dates	Start Date	Insert	New Registration			7/12/2024 4:03 PM
Terminations	Termination Comments	Insert	New Registration			7/12/2024 4:03 PM
Terminations	Termination Date	Insert	New Registration			7/12/2024 4:03 PM
Terminations	Termination Effective Date	Insert	New Registration			7/12/2024 4:03 PM
Terminations	Termination Reason	Insert	New Registration			7/12/2024 4:03 PM