Covered Entity Details

CAH461306-00 GUNNISON VALLEY HOSPITAL (Active) - information as of 5/10/2025 10:47:38 PM

Main Details

Name

GUNNISON VALLEY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH461306-00

Medicare Provider Number

461306

Additional Details

Current Program Status

Active

Registration Date

9/22/2010

Participating Start Date

9/30/2010

Participating Approval Date

9/30/2010

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Gunnison Valley Hospital
BRIAN C. MURRAY, CFO
(435) 528-2146

Primary Contact

Gunnison Valley Hospital
WILLARD TUCKER, PHARMACIST
(435) 528-2132

Addresses

Street Address

64 E 100 N
GUNNISON, UT 84634-0759

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?
No

Shipping Addresses

Shipping Address 1

Gunnison Valley Hospital
64 E 100 N
Gunnison, UT 84634-0759

Shipping Address 2

Gunnison Valley Hospital DBA: Manti Pharmacy
156 S Main Street
Manti, UT 84642

Shipping Address 3

Gunnison Valley Hospital DBA: Salina Pharmacy
63 W 550 N
Salina, UT 84654

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	G-THRIFT CORP DBA: GUNNISON PHARMACY	ATTN: SHAWN REED SORENSEN, PERSON IN CHA	520 SOUTH MAIN	GUNNISON	UT	84634	01/09/2014	04/01/2014	01/01/2016	02/03/2021
Contract Detail	GUNNISON FAMILY PHARMACY & FLORAL, INC	77 S MAIN ST		GUNNISON	UT	84634-7706	04/21/2014	04/21/2014	01/01/2016	02/03/2021
Contract Detail	GUNNISON VALLEY HOSPITAL- MANTI PHARMACY	156 S MAIN ST		MANTI	UT	84642	01/02/2024	04/01/2024	04/01/2024	10/01/2024
Contract Detail	GUNNISON VALLEY HOSPITAL- SALINA PHARMAC	550 N 63 W		SALINA	UT	84654	01/02/2024	04/01/2024	04/01/2024	10/01/2024
Contract Detail	IHC HEALTH SERVICES, INC.	DBA: INTERMOUNTAIN PHARMACY #142	530 N 250 W	SALINA	UT	84654-5514	10/03/2014	01/01/2015	01/01/2016	02/03/2021
Contract Detail	SUPER DRUG AND HERBAL STORE		520 SOUTH HWY 89 P.O. BOX 716	GUNNISON	UT	84634-0716	05/11/2012	05/11/2012	01/01/2016	02/03/2021
Contract Detail	WAL-MART PHARMACY 10-2794	777 NO. MAIN STREET		EPHRAIM	UT	84627	05/11/2012	05/11/2012	01/01/2016	02/03/2021
Contract Detail	WAL-MART PHARMACY 10-5168	10 EAST 1300 SOUTH		RICHFIELD	UT	84701	05/11/2012	05/11/2012	01/01/2016	02/03/2021

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH461306-01	Child	CAH	GUNNISON VALLEY HOSPITAL	GUNNISON VALLEY HOSPITAL - Main Street Family Clinic RHC	156 S MAIN ST	MANTI	UT	Approved
CAH461306-02	Child	CAH	GUNNISON VALLEY HOSPITAL	GUNNISON VALLEY HOSPITAL - Salina Family Medicine RHC	63 W 550 N	SALINA	UT	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Update	Change Request	Gunnison Valley Hospital DBA: Salina Pharmacy 63 W 500 N Salina, UT 84654	Gunnison Valley Hospital DBA: Salina Pharmacy 63 W 550 N Salina, UT 84654	11/27/2024 7:44 AM
Addresses	Shipping Address	Insert	Change Request		Gunnison Valley Hospital 64 E 100 N Gunnison, UT 84634-0759	9/17/2024 7:26 AM
Addresses	Shipping Address	Insert	Change Request		Gunnison Valley Hospital DBA: Manti Pharmacy 156 S Main Street Manti, UT 84642	9/17/2024 7:26 AM
Addresses	Shipping Address	Insert	Change Request		Gunnison Valley Hospital DBA: Salina Pharmacy 63 W 500 N Salina, UT 84654	9/17/2024 7:26 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 3:38:22 PM	8/21/2024 11:19:09 AM	8/21/2024 11:19 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 2:04:10 PM	8/16/2023 3:38:22 PM	8/16/2023 3:38 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 2:59:59 PM	8/31/2022 2:04:10 PM	8/31/2022 2:04 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 7:07:04 AM	8/16/2021 2:59:59 PM	8/16/2021 2:59 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 12:20:48 PM	8/18/2020 7:07:04 AM	8/18/2020 7:07 AM
Details	Last Recertification Date	Update	Recertification	8/23/2018 2:34:54 PM	8/21/2019 12:20:48 PM	8/21/2019 12:20 PM
Addresses	Main Address	Update	Recertification	64 EAST 100 NORTH GUNNISON, UT 84634	64 E 100 N GUNNISON, UT 84634-0759	8/23/2018 2:34 PM
Details	Last Recertification Date	Update	Recertification	11/8/2017 11:55:13 AM	8/23/2018 2:34:54 PM	8/23/2018 2:34 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/8/2017 11:55:13 AM	11/8/2017 11:55 AM
Contacts	Primary Contact	Update	Recertification	TUCKER, WILLARD PHARMACIST 4355282132	TUCKER, WILLARD PHARMACIST Gunnison Valley Hospital 4355282132	11/3/2017 10:44 AM
Contacts	Authorizing Official	Update		MURRAY, BRIAN C. CFO 4355282146	MURRAY, BRIAN C. CFO Gunnison Valley Hospital 4355282146	10/24/2017 4:34 PM
Addresses	Main Address	Insert			64 EAST 100 NORTH GUNNISON, UT 84634	8/10/2016 10:30 AM
Contacts	Primary Contact	Update		TUCKER, WILLARD PHARMACIST 4355282132	TUCKER, WILLARD PHARMACIST 4355282132	8/10/2016 10:30 AM
Contacts	Authorizing Official	Insert			MURRAY, BRIAN C. CFO 4355282146	8/10/2016 10:30 AM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 10:30 AM
Contacts	Primary Contact	Insert			TUCKER, WILLARD PHARMACIST 4355282132	8/17/2015 4:27 PM
Details	Last Recertification Date	Update		8/26/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 11:12 AM
Details	Last Recertification Date	Update		8/19/2013 12:00:00 AM	8/26/2014 12:00:00 AM	8/26/2014 6:24 AM
Details	Last Recertification Date	Update		8/19/2013 3:22:49 PM	8/19/2013 12:00:00 AM	8/29/2013 10:19 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/19/2013 3:22:49 PM	8/19/2013 3:22 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/1/2012 10:21 AM
Details	Last Recertification Date	Insert				9/30/2010 12:19 PM
Details	Grant Number	Insert				9/30/2010 12:19 PM
Details	340B ID	Insert			CAH461306-00	9/30/2010 12:19 PM
Details	Is Authorizing Official EHB Data	Insert				9/30/2010 12:19 PM
Dates	Last Date That 340B Drugs Purchased	Insert				9/30/2010 12:19 PM
Details	Medicare Provider Number	Insert			461306	9/30/2010 12:19 PM
Details	Entity Name	Insert			GUNNISON VALLEY HOSPITAL	9/30/2010 12:19 PM
Details	Program Code	Insert			CAH	9/30/2010 12:19 PM
Details	Entity Subname	Insert				9/30/2010 12:19 PM
Dates	Participating Approval Date	Insert			9/30/2010 12:00:00 AM	9/30/2010 12:19 PM
Details	State	Insert			Active	9/30/2010 12:19 PM
Dates	Registration Date	Insert			9/22/2010 12:00:00 AM	9/30/2010 12:19 PM
Dates	Signed By Date	Insert			9/22/2010 12:00:00 AM	9/30/2010 12:19 PM
Dates	Start Date	Insert			9/30/2010 12:00:00 AM	9/30/2010 12:19 PM
Terminations	Termination Comments	Insert				9/30/2010 12:19 PM
Terminations	Termination Date	Insert				9/30/2010 12:19 PM
Terminations	Termination Effective Date	Insert				9/30/2010 12:19 PM
Terminations	Termination Reason	Insert				9/30/2010 12:19 PM