Covered Entity Details

CAH531312-06 West Park Hospital District (Active) - information as of 4/28/2025 1:44:45 AM

Main Details

Name

West Park Hospital District

Subdivision Name

Cody Regional Health Rural Health Clinic - OB/GYN Clinic

Type

Critical Access Hospital

Rural

340B ID

CAH531312-06

Medicare Provider Number

531312

Outpatient Facility Provider Number

533401

Additional Details

Current Program Status

Active

Registration Date

1/10/2025

Participating Start Date

4/1/2025

Participating Approval Date

2/3/2025

Last Recertification Date

Contacts

Authorizing Official

Cody Regional Health
Hannah McRae, CFO
(307) 578-2490

Primary Contact

Cody Regional Health
Doug Wenke, Director of Pharmacy
(307) 578-2273

Addresses

Street Address

424 Yellowstone Ave.
330
Cody, WY 82414

Billing Address

West Park Hospital District
707 Sheridan Ave.
Cody, WY 82414

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
CAH531312-01	Child	CAH	West Park Hospital District	Cody Regional Health Rural Health Clinic - Walk-In Clinc	424 Yellowstone Ave.	Cody	WY	Active
CAH531312-02	Child	CAH	West Park Hospital District	Big Horn Basin Cancer Treatment Center	1025 Ninth Street	Cody	WY	Active
CAH531312-03	Child	CAH	West Park Hospital District	CODY REGIONAL HEALTH - Cody Regional Health Rural Health Clinic	424 YELLOWSTONE AVE	CODY	WY	Active
CAH531312-04	Child	CAH	West Park Hospital District	Cody Regional Health Rural Health Clinic - Internal Medicine	424 Yellowstone Ave.	Cody	WY	Active
CAH531312-05	Child	CAH	West Park Hospital District	Cody Regional Health Rural Health Clinic - Psychiatric Clinic	424 Yellowstone Ave.	Cody	WY	Active
CAH531312-06	Child	CAH	West Park Hospital District	Cody Regional Health Rural Health Clinic - OB/GYN Clinic	424 Yellowstone Ave.	Cody	WY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Addresses	Billing Address	Insert	New Registration		West Park Hospital District 707 Sheridan Ave. Cody, WY 82414	2/3/2025 8:07 AM
Contacts	Signed By	Insert	New Registration		McRae, Hannah CFO Cody Regional Health 3075782490	2/3/2025 8:07 AM
Details	340B ID	Update	New Registration		CAH531312-06	2/3/2025 8:07 AM
Details	Entity Subname	Update	New Registration	Cody Regional Health Rural Health Clinic	Cody Regional Health Rural Health Clinic - OB/GYN Clinic	2/3/2025 8:07 AM
Dates	Participating Approval Date	Update	New Registration		2/3/2025 8:07:35 AM	2/3/2025 8:07 AM
Details	State	Update	New Registration	Pending	Approved	2/3/2025 8:07 AM
Dates	Signed By Date	Update	New Registration		1/31/2025 3:05:02 PM	2/3/2025 8:07 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	2/3/2025 8:07 AM
Addresses	Billing Address	Insert	New Registration		West Park Hospital District 707 Sheridan Ave. Cody, WY 82414	1/31/2025 3:05 PM
Addresses	Billing Address	Insert	New Registration		West Park Hospital District 707 Sheridan Ave. Cody, WY 82414	1/23/2025 3:31 PM
Addresses	Billing Address	Insert	New Registration		West Park Hospital District 707 Sheridan Ave. Cody, WY 82414	1/15/2025 1:34 PM
Addresses	Main Address	Insert	New Registration		424 Yellowstone Ave. 330 Cody, WY 82414	1/10/2025 5:13 PM
Addresses	Billing Address	Insert	New Registration		West Park Hospital District 707 Sheridan Ave. Cody, WY 82414	1/10/2025 5:13 PM
Contacts	Primary Contact	Insert	New Registration		Wenke, Doug Director of Pharmacy Cody Regional Health 3075782273	1/10/2025 5:13 PM
Contacts	Authorizing Official	Insert	New Registration		McRae, Hannah CFO Cody Regional Health 3075782490	1/10/2025 5:13 PM
Details	Assistance Received From Date	Insert	New Registration			1/10/2025 5:13 PM
Details	Assistance Received To Date	Insert	New Registration			1/10/2025 5:13 PM
Details	Last Recertification Date	Insert	New Registration			1/10/2025 5:13 PM
Details	Grant Number	Insert	New Registration			1/10/2025 5:13 PM
Details	340B ID	Insert	New Registration			1/10/2025 5:13 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/10/2025 5:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/10/2025 5:13 PM
Details	Medicare Provider Number	Insert	New Registration		531312	1/10/2025 5:13 PM
Details	Entity Name	Insert	New Registration		West Park Hospital District	1/10/2025 5:13 PM
Details	NOFO Number	Insert	New Registration			1/10/2025 5:13 PM
Details	Program Code	Insert	New Registration		CAH	1/10/2025 5:13 PM
Details	Entity Subname	Insert	New Registration		Cody Regional Health Rural Health Clinic	1/10/2025 5:13 PM
Dates	Participating Approval Date	Insert	New Registration			1/10/2025 5:13 PM
Details	State	Insert	New Registration		Pending	1/10/2025 5:13 PM
Dates	Registration Date	Insert	New Registration		1/10/2025 5:13:28 PM	1/10/2025 5:13 PM
Dates	Signed By Date	Insert	New Registration			1/10/2025 5:13 PM
Dates	Start Date	Insert	New Registration			1/10/2025 5:13 PM
Terminations	Termination Comments	Insert	New Registration			1/10/2025 5:13 PM
Terminations	Termination Date	Insert	New Registration			1/10/2025 5:13 PM
Terminations	Termination Effective Date	Insert	New Registration			1/10/2025 5:13 PM
Terminations	Termination Reason	Insert	New Registration			1/10/2025 5:13 PM