Covered Entity Details

SCH060071-05 DELTA COUNTY MEMORIAL HOSPITAL (Approved) - information as of 5/13/2025 1:36:03 AM

Main Details

Name

DELTA COUNTY MEMORIAL HOSPITAL

Subdivision Name

DELTA HEALTH UROLOGY - Urology

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH060071-05

Medicare Provider Number

060071

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/1/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/21/2025

Last Recertification Date

Contacts

Authorizing Official

Delta Health
Jonathan Cohee, Chief Executive Officer
(970) 874-2285

Primary Contact

Delta Health
Cari Dillon, Director of Pharmacy
(970) 874-2433

Addresses

Street Address

1501 E 3RD ST
DELTA, CO 81416-2815

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?
Yes

State	Medicaid Number	NPI Number
CO	9000142443	1558928515

Shipping Addresses

Shipping Address 1

Delta County Memorial Hospital
1501 E 3rd Street, Attn: Pharmacy
Delta, CO 81416

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
SCH060071-01	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	DELTA INTERNAL MEDICINE CLINIC - ADULT PRIMARY CARE	1450 BURGESS STREET	Delta	CO	Approved
SCH060071-02	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	DCMH WEST ELK CLINIC HOTCHKISS - Primary Care	230 E HOTCHKISS AVENUE	HOTCHKISS	CO	Approved
SCH060071-03	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	DELTA FAMILY MEDICINE - Primary Care	70 Stafford Lane	Delta	CO	Approved
SCH060071-04	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	ONCOLOGY CLINIC - Oncology	1501 E 3rd Street	Delta	CO	Approved
SCH060071-05	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	DELTA HEALTH UROLOGY - Urology	1501 E 3RD ST	DELTA	CO	Approved
SCH060071-06	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	DELTA HEALTH SURGICAL - Surgery	95 STAFFORD LN	DELTA	CO	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Cohee, Jonathan Chief Executive Officer Delta Health 9708742285	4/21/2025 10:35 AM
Details	340B ID	Update	New Registration		SCH060071-05	4/21/2025 10:35 AM
Details	Entity Subname	Update	New Registration	DELTA HEALTH UROLOGY	DELTA HEALTH UROLOGY - Urology	4/21/2025 10:35 AM
Dates	Participating Approval Date	Update	New Registration		4/21/2025 10:35:30 AM	4/21/2025 10:35 AM
Details	State	Update	New Registration	Pending	Approved	4/21/2025 10:35 AM
Dates	Signed By Date	Update	New Registration		4/17/2025 12:37:14 PM	4/21/2025 10:35 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/21/2025 10:35 AM
Addresses	Main Address	Insert	New Registration		1501 E 3RD ST DELTA, CO 81416-2815	4/1/2025 5:27 PM
Addresses	Shipping Address	Insert	New Registration		Delta County Memorial Hospital 1501 E 3rd Street, Attn: Pharmacy Delta, CO 81416	4/1/2025 5:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/1/2025 5:27 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		9000142443	4/1/2025 5:27 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	4/1/2025 5:27 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558928515	4/1/2025 5:27 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	4/1/2025 5:27 PM
Contacts	Primary Contact	Insert	New Registration		Dillon, Cari Director of Pharmacy Delta Health 9708742433	4/1/2025 5:27 PM
Contacts	Authorizing Official	Insert	New Registration		Cohee, Jonathan Chief Executive Officer Delta Health 9708742285	4/1/2025 5:27 PM
Details	Assistance Received From Date	Insert	New Registration			4/1/2025 5:27 PM
Details	Assistance Received To Date	Insert	New Registration			4/1/2025 5:27 PM
Details	Last Recertification Date	Insert	New Registration			4/1/2025 5:27 PM
Details	Grant Number	Insert	New Registration			4/1/2025 5:27 PM
Details	340B ID	Insert	New Registration			4/1/2025 5:27 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/1/2025 5:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/1/2025 5:27 PM
Details	Medicare Provider Number	Insert	New Registration		060071	4/1/2025 5:27 PM
Details	Entity Name	Insert	New Registration		DELTA COUNTY MEMORIAL HOSPITAL	4/1/2025 5:27 PM
Details	NOFO Number	Insert	New Registration			4/1/2025 5:27 PM
Details	Program Code	Insert	New Registration		SCH	4/1/2025 5:27 PM
Details	Entity Subname	Insert	New Registration		DELTA HEALTH UROLOGY	4/1/2025 5:27 PM
Dates	Participating Approval Date	Insert	New Registration			4/1/2025 5:27 PM
Details	State	Insert	New Registration		Pending	4/1/2025 5:27 PM
Dates	Registration Date	Insert	New Registration		4/1/2025 5:27:04 PM	4/1/2025 5:27 PM
Dates	Signed By Date	Insert	New Registration			4/1/2025 5:27 PM
Dates	Start Date	Insert	New Registration			4/1/2025 5:27 PM
Terminations	Termination Comments	Insert	New Registration			4/1/2025 5:27 PM
Terminations	Termination Date	Insert	New Registration			4/1/2025 5:27 PM
Terminations	Termination Effective Date	Insert	New Registration			4/1/2025 5:27 PM
Terminations	Termination Reason	Insert	New Registration			4/1/2025 5:27 PM