Covered Entity Details

CH10630L BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC (Approved) - information as of 5/5/2025 11:57:37 PM

Main Details

Name

BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC

Subdivision Name

Kaniksu CCBHC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039408

340B ID

CH10630L

Grant Number

H80CS00302

Additional Details

Current Program Status

Approved

Registration Date

4/10/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/24/2025

Last Recertification Date

Contacts

Authorizing Official

Boundary Regional Community Health Center, Inc
Emma Keverkamp, Chief Financial Officer
(208) 263-7101 Ext: 2213

Primary Contact

Boundary Regional Community Health Center Inc
Kayla Ann Dotson, Pharmacy Director
(208) 263-7101

Addresses

Street Address

1033 Baldy Mountain Rd
Sandpoint, ID 83864-9202

Billing Address

Boundary Regional Community Health Center, Inc
PO Box 2160
Sandpoint, ID 83864

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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
Contract Detail	WAL-MART PHARMACY 10-2485	476999 HWY 95 NORTH		PONDERAY	ID	83852	04/24/2025	07/01/2025			04/24/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH106300	Active	BPS-H80-001522	BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.	BOUNDARY REGIONAL CHC	6615 COMANCHE ST	BONNERS FERRY	ID
CH10630H	Active	BPS-H80-033578	BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.	Sandpoint Clinic	810 6th Ave	Sandpoint	ID
CH10630J	Active	BPS-H80-011424	BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.	KHS Priest River	6509 Highway 2, Ste 101	Priest River	ID
CH10630K	Terminated	BPS-H80-014642	BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.	Sandpoint Pediatrics - Kaniksu Health Services	420 N SECOND AVE	SANDPOINT	ID
CH10630L	Approved	BPS-H80-039408	BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC	Kaniksu CCBHC	1033 Baldy Mountain Rd	Sandpoint	ID
CH10630M	Approved	BPS-H80-034313	BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC	RURAL MOBILE CLINIC BONNER CNTY	6615 Comanche St	Bonners Ferry	ID

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH106300	DE BLAQUIERE ENTERPRISES INC	WHITE CROSS PHARMACY SANDPOINT	1319 HIGHWAY 2 STE A	SANDPOINT	ID	83864	10/01/2013
CH106300	DEBLAQUIERE ENT. INC.	DBA WHITE CROSS PHARMACY - OLDTOWN	86 TANK RD	OLDTOWN	ID	83822	04/01/2021
CH106300	DOC'S PHARMACY INC.	MEDICINE MAN SANDPOINT	624 LARCH ST	SANDPOINT	ID	83864-8383	10/01/2013	10/24/2016
CH106300	MEDICINE MAN BONNERS FERRY PHARMACY		6452 MAIN STREET	BONNERS FERRY	ID	83805	01/01/2016
CH106300	SAFEWAY INC	SAFEWAY PHARMACY #2954	6519 MAIN STREET	BONNERS FERRY	ID	83805	01/01/2014
CH106300	SAFEWAY INC	SAFEWAY PHARMACY #0350	702 N. 5TH AVENUE	SANDPOINT	ID	83864	01/01/2014
CH106300	SAFEWAY INC	SAFEWAY PHARMACY #1159	121 W. WALNUT ST	NEWPORT	WA	99156	04/01/2014	04/01/2020
CH106300	SANDPOINT SUPER DRUG	604 N FIFTH AVE.		SANDPOINT	ID	83864	10/01/2013	10/24/2016
CH106300	SANDPOINT SUPER DRUG	604 N FIFTH AVE.		SANDPOINT	ID	83864	01/01/2019	08/31/2022
CH106300	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH106300	WAL-MART PHARMACY 10-2485	476999 HWY 95 NORTH		PONDERAY	ID	83852	04/01/2014
CH10630L	WAL-MART PHARMACY 10-2485	476999 HWY 95 NORTH		PONDERAY	ID	83852	07/01/2025
CH106300	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH106300	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH106300	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH106300	WELL LIFE BOUNDARY PHARMACY	6603 MAIN STREET		BONNERS FERRY	ID	83805	10/01/2013	10/24/2016
CH106300	WHITE CROSS PHARMACY - PRIEST RIVER	5453 HIGHWAY 2	PO BOX 458	PRIEST RIVER	ID	83856	10/01/2013
CH10630J	WHITE CROSS PHARMACY - PRIEST RIVER	5453 HIGHWAY 2	PO BOX 458	PRIEST RIVER	ID	83856	07/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Keverkamp, Emma Chief Financial Officer Boundary Regional Community Health Center, Inc 2082637101-2213	4/24/2025 6:34 AM
Details	340B ID	Update	New Registration		CH10630L	4/24/2025 6:34 AM
Dates	Participating Approval Date	Update	New Registration		4/24/2025 6:34:56 AM	4/24/2025 6:34 AM
Details	State	Update	New Registration	Pending	Approved	4/24/2025 6:34 AM
Dates	Signed By Date	Update	New Registration		4/14/2025 2:16:07 PM	4/24/2025 6:34 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/24/2025 6:34 AM
Addresses	Main Address	Insert	New Registration		1033 Baldy Mountain Rd Sandpoint, ID 83864-9202	4/10/2025 10:57 AM
Addresses	Billing Address	Insert	New Registration		Boundary Regional Community Health Center, Inc PO Box 2160 Sandpoint, ID 83864	4/10/2025 10:57 AM
Contacts	Authorizing Official	Insert	New Registration		Keverkamp, Emma Chief Financial Officer Boundary Regional Community Health Center, Inc 2082637101-2213	4/10/2025 10:57 AM
Contacts	Primary Contact	Insert	New Registration		Dotson, Kayla Ann Pharmacy Director Boundary Regional Community Health Center Inc 2082637101	4/10/2025 10:57 AM
Details	Assistance Received From Date	Insert	New Registration			4/10/2025 10:57 AM
Details	Assistance Received To Date	Insert	New Registration			4/10/2025 10:57 AM
Details	Last Recertification Date	Insert	New Registration			4/10/2025 10:57 AM
Details	Grant Number	Insert	New Registration		H80CS00302	4/10/2025 10:57 AM
Details	340B ID	Insert	New Registration			4/10/2025 10:57 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/10/2025 10:57 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/10/2025 10:57 AM
Details	Medicare Provider Number	Insert	New Registration			4/10/2025 10:57 AM
Details	Entity Name	Insert	New Registration		BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC	4/10/2025 10:57 AM
Details	NOFO Number	Insert	New Registration			4/10/2025 10:57 AM
Details	Program Code	Insert	New Registration		CH	4/10/2025 10:57 AM
Details	Entity Subname	Insert	New Registration		Kaniksu CCBHC	4/10/2025 10:57 AM
Dates	Participating Approval Date	Insert	New Registration			4/10/2025 10:57 AM
Details	State	Insert	New Registration		Pending	4/10/2025 10:57 AM
Dates	Registration Date	Insert	New Registration		4/10/2025 10:57:42 AM	4/10/2025 10:57 AM
Dates	Signed By Date	Insert	New Registration			4/10/2025 10:57 AM
Dates	Start Date	Insert	New Registration			4/10/2025 10:57 AM
Terminations	Termination Comments	Insert	New Registration			4/10/2025 10:57 AM
Terminations	Termination Date	Insert	New Registration			4/10/2025 10:57 AM
Terminations	Termination Effective Date	Insert	New Registration			4/10/2025 10:57 AM
Terminations	Termination Reason	Insert	New Registration			4/10/2025 10:57 AM

340B Drug Pricing Program Database