Covered Entity Details

DSH060054E COMMUNITY HOSPITAL (Approved) - information as of 5/27/2025 11:32:09 PM

Main Details

Name

COMMUNITY HOSPITAL

Subdivision Name

GV Rheumatology - Rheumatology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH060054E

Medicare Provider Number

060054

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/15/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/21/2025

Last Recertification Date

Contacts

Authorizing Official

Community Hospital
Christian A. Thomas, CEO
(970) 644-3011

Primary Contact

Colorado West Healthcare System
Cynthia M Houchin, Coordinator
(970) 644-3552

Addresses

Street Address

688 23 1/2 Road
Suite 202
GRAND JUNCTION, CO 81505

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	5054002	1497723407

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
DSH060054A	Child	DSH	COMMUNITY HOSPITAL	GRAND VALLEY ONCOLOGY	688 23 1/2 Road	GRAND JUNCTION	CO	Active
DSH060054B	Child	DSH	COMMUNITY HOSPITAL	GRAND VALLEY ONCOLOGY - Clinic	688 23 1/2 Road	Grand Junction	CO	Active
DSH060054C	Child	DSH	COMMUNITY HOSPITAL	GRAND VALLEY ONCOLOGY - RADIATION ONCOLOGY	688 23 1/2 Road	Grand Junction	CO	Active
DSH060054D	Child	DSH	COMMUNITY HOSPITAL	CH GV Gyne Onc - Gynecologic Oncology	688 23 1/2 Road	GRAND JUNCTION	CO	Approved
DSH060054E	Child	DSH	COMMUNITY HOSPITAL	GV Rheumatology - Rheumatology	688 23 1/2 Road	GRAND JUNCTION	CO	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Thomas, Christian A. CEO Community Hospital 9706443011	4/21/2025 2:47 PM
Details	340B ID	Update	New Registration		DSH060054E	4/21/2025 2:47 PM
Details	Entity Subname	Update	New Registration	GV Rheumatology	GV Rheumatology - Rheumatology	4/21/2025 2:47 PM
Dates	Participating Approval Date	Update	New Registration		4/21/2025 2:47:40 PM	4/21/2025 2:47 PM
Details	State	Update	New Registration	Pending	Approved	4/21/2025 2:47 PM
Dates	Signed By Date	Update	New Registration		4/15/2025 4:13:11 PM	4/21/2025 2:47 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/21/2025 2:47 PM
Addresses	Main Address	Insert	New Registration		688 23 1/2 Road Suite 202 GRAND JUNCTION, CO 81505	4/15/2025 1:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2025 1:04 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		5054002	4/15/2025 1:04 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	4/15/2025 1:04 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1497723407	4/15/2025 1:04 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	4/15/2025 1:04 PM
Contacts	Primary Contact	Insert	New Registration		Houchin, Cynthia M Coordinator Colorado West Healthcare System 9706443552	4/15/2025 1:04 PM
Contacts	Authorizing Official	Insert	New Registration		Thomas, Christian A. CEO Community Hospital 9706443011	4/15/2025 1:04 PM
Details	Assistance Received From Date	Insert	New Registration			4/15/2025 1:04 PM
Details	Assistance Received To Date	Insert	New Registration			4/15/2025 1:04 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2025 1:04 PM
Details	Grant Number	Insert	New Registration			4/15/2025 1:04 PM
Details	340B ID	Insert	New Registration			4/15/2025 1:04 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2025 1:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2025 1:04 PM
Details	Medicare Provider Number	Insert	New Registration		060054	4/15/2025 1:04 PM
Details	Entity Name	Insert	New Registration		COMMUNITY HOSPITAL	4/15/2025 1:04 PM
Details	NOFO Number	Insert	New Registration			4/15/2025 1:04 PM
Details	Program Code	Insert	New Registration		DSH	4/15/2025 1:04 PM
Details	Entity Subname	Insert	New Registration		GV Rheumatology	4/15/2025 1:04 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2025 1:04 PM
Details	State	Insert	New Registration		Pending	4/15/2025 1:04 PM
Dates	Registration Date	Insert	New Registration		4/15/2025 1:04:58 PM	4/15/2025 1:04 PM
Dates	Signed By Date	Insert	New Registration			4/15/2025 1:04 PM
Dates	Start Date	Insert	New Registration			4/15/2025 1:04 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2025 1:04 PM
Terminations	Termination Date	Insert	New Registration			4/15/2025 1:04 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2025 1:04 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2025 1:04 PM