Covered Entity Details

CAH351311-00 LISBON AREA HEALTH SERVICES (Active) - information as of 6/8/2025 1:05:35 AM

Main Details

Name

LISBON AREA HEALTH SERVICES

Subdivision Name

Type

Critical Access Hospital

Rural

340B ID

CAH351311-00

Medicare Provider Number

351311

Additional Details

Current Program Status

Active

Registration Date

9/27/2010

Participating Start Date

9/28/2010

Participating Approval Date

9/27/2010

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

Lisbon Area Health Services-CHI Oakes Hospital
Rebecca Lynn Thompson, President
(701) 710-0429

Primary Contact

CommonSpirit Health - Central Region
Mitchell Schultz, RPh, 340b Regional Manager
(701) 928-0620

Addresses

Street Address

905 MAIN ST
LISBON, ND 58054

Billing Address

LISBON AREA HEALTH SERVICES
Attn: 5800-5100150
PO BOX 636000
LITTLETON, CO 80163

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	Termination Date	Last Updated On
Contract Detail	NUCARA PHARMACY #34	NUDAK VENTURES NORTH DAKOTA LLC	407 MAIN ST PO BOX 601	LISBON	ND	58054-4143	07/16/2021	10/01/2021		10/01/2021
Contract Detail	ST JOSEPH'S MCAULEY PHARMACY	DIGNITY HEALTH	500 W THOMAS RD, STE 190	PHOENIX	AZ	85013-4237	07/16/2020	10/01/2020	04/30/2021	10/25/2021
Contract Detail	WHITE DRUG #52	706 38TH ST N STE B		FARGO	ND	58102-2953	01/15/2020	04/01/2020	08/01/2022	08/12/2022
Contract Detail	WHITE DRUG #61	706 38TH ST NW UNIT A		FARGO	ND	58102	01/15/2020	04/01/2020		04/01/2020
Contract Detail	WHITE DRUG #72	404 MAIN ST	P.O. BOX 770	LISBON	ND	58054-4142	01/15/2020	04/01/2020		04/01/2020

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 11:38:30 AM	8/22/2024 10:09:11 AM	8/22/2024 10:09 AM
Contacts	Primary Contact	Update	Profile Change Request	Schultz, Mitchell RPh, 340b Division Manager CommonSpirit Health - Midwest Division 7019280620	Schultz, Mitchell RPh, 340b Regional Manager CommonSpirit Health - Central Region 7019280620	8/6/2024 1:57 PM
Contacts	Primary Contact	Update	Profile Change Request	Schultz, Mitchell RPh CommonSpirit Health - Midwest Division 7019280620	Schultz, Mitchell RPh, 340b Division Manager CommonSpirit Health - Midwest Division 7019280620	9/27/2023 5:22 PM
Details	Last Recertification Date	Update	Recertification	9/6/2022 4:58:00 PM	8/21/2023 11:38:30 AM	8/21/2023 11:38 AM
Contacts	Authorizing Official	Update	Profile Change Request	Thompson, Rebecca Interim President Lisbon Area Health Services 7017423602	Thompson, Rebecca Lynn President Lisbon Area Health Services-CHI Oakes Hospital 7017100429	4/5/2023 2:59 PM
Contacts	Authorizing Official	Update	Change Request	Mallett, Julie President Lisbon Area Health Services 7016836416	Thompson, Rebecca Interim President Lisbon Area Health Services 7017423602	3/29/2023 6:53 AM
Addresses	Billing Address	Update	Change Request	LISBON AREA HEALTH SERVICES PO BOX 353 LISBON, ND 58054	LISBON AREA HEALTH SERVICES Attn: 5800-5100150 PO BOX 636000 LITTLETON, CO 80163	1/20/2023 5:45 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 2:20:27 PM	9/6/2022 4:58:00 PM	9/6/2022 4:58 PM
Contacts	Primary Contact	Update	Profile Change Request	Schultz, Mitchell RPh CHI St. Alexius Health Carrington 7019280620	Schultz, Mitchell RPh CommonSpirit Health - Midwest Division 7019280620	3/10/2022 3:00 PM
Contacts	Primary Contact	Update	Change Request	MCRITCHIE, JILL DIRECTOR OF PHARMACY Lisbon Area Health Services 7016836438	Schultz, Mitchell RPh CHI St. Alexius Health Carrington 7019280620	2/11/2022 4:18 PM
Details	Last Recertification Date	Update	Recertification	9/2/2020 4:53:32 PM	8/23/2021 2:20:27 PM	8/23/2021 2:20 PM
Contacts	Authorizing Official	Update	Change Request	Heuser, Keith President Mercy Hospital of Valley City dba CHI Mercy Health 7018456400	Mallett, Julie President Lisbon Area Health Services 7016836416	7/30/2021 11:09 AM
Details	Last Recertification Date	Update	Recertification	8/27/2019 11:24:14 AM	9/2/2020 4:53:32 PM	9/2/2020 4:53 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 4:22:15 PM	8/27/2019 11:24:14 AM	8/27/2019 11:24 AM
Contacts	Authorizing Official	Update	AO Change Request	REINKE, PEGGY PRESIDENT Lisbon Area Health Services 7016836419	Heuser, Keith President Mercy Hospital of Valley City dba CHI Mercy Health 7018456400	8/5/2019 11:51 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 11:49:43 AM	8/21/2018 4:22:15 PM	8/21/2018 4:22 PM
Details	Last Recertification Date	Update	Recertification	10/25/2017 3:18:11 PM	11/29/2017 11:49:43 AM	11/29/2017 11:49 AM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	10/25/2017 3:18:11 PM	10/25/2017 3:18 PM
Contacts	Primary Contact	Update		MCRITCHIE, JILL DIRECTOR OF PHARMACY 7016836438	MCRITCHIE, JILL DIRECTOR OF PHARMACY Lisbon Area Health Services 7016836438	9/27/2017 3:15 PM
Contacts	Authorizing Official	Update		REINKE, PEGGY PRESIDENT 7016836419	REINKE, PEGGY PRESIDENT Lisbon Area Health Services 7016836419	9/27/2017 3:05 PM
Addresses	Main Address	Insert			905 MAIN ST LISBON, ND 58054	8/18/2016 9:54 AM
Contacts	Primary Contact	Insert			MCRITCHIE, JILL DIRECTOR OF PHARMACY 7016836438	8/18/2016 9:54 AM
Contacts	Authorizing Official	Update		LARSON, PEGGY ADMINISTRATOR 7016836419	REINKE, PEGGY PRESIDENT 7016836419	8/18/2016 9:54 AM
Details	Last Recertification Date	Update		8/12/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 9:54 AM
Details	Last Recertification Date	Update		8/28/2014 12:00:00 AM	8/12/2015 12:00:00 AM	8/12/2015 3:13 PM
Contacts	Authorizing Official	Insert			LARSON, PEGGY ADMINISTRATOR 7016836419	8/28/2014 11:56 AM
Details	Last Recertification Date	Update		9/12/2013 12:00:00 AM	8/28/2014 12:00:00 AM	8/28/2014 11:56 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/12/2013 12:00:00 AM	9/12/2013 10:07 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/1/2012 10:13 AM
Addresses	Billing Address	Insert			LISBON AREA HEALTH SERVICES PO BOX 353 LISBON, ND 58054	9/28/2010 2:55 PM
Details	Last Recertification Date	Insert				9/28/2010 2:55 PM
Details	Grant Number	Insert				9/28/2010 2:55 PM
Details	340B ID	Insert			CAH351311-00	9/28/2010 2:55 PM
Details	Is Authorizing Official EHB Data	Insert				9/28/2010 2:55 PM
Dates	Last Date That 340B Drugs Purchased	Insert				9/28/2010 2:55 PM
Details	Medicare Provider Number	Insert			351311	9/28/2010 2:55 PM
Details	Entity Name	Insert			LISBON AREA HEALTH SERVICES	9/28/2010 2:55 PM
Details	Program Code	Insert			CAH	9/28/2010 2:55 PM
Details	Entity Subname	Insert				9/28/2010 2:55 PM
Dates	Participating Approval Date	Insert			9/27/2010 12:00:00 AM	9/28/2010 2:55 PM
Details	State	Insert			Active	9/28/2010 2:55 PM
Dates	Registration Date	Insert			9/27/2010 12:00:00 AM	9/28/2010 2:55 PM
Dates	Signed By Date	Insert			9/27/2010 12:00:00 AM	9/28/2010 2:55 PM
Dates	Start Date	Insert			9/28/2010 12:00:00 AM	9/28/2010 2:55 PM
Terminations	Termination Comments	Insert				9/28/2010 2:55 PM
Terminations	Termination Date	Insert				9/28/2010 2:55 PM
Terminations	Termination Effective Date	Insert				9/28/2010 2:55 PM
Terminations	Termination Reason	Insert				9/28/2010 2:55 PM