Covered Entity Details

CAH271347-00 Holy Rosary Healthcare dba Intermountain Health Holy Rosary Hospital (Active) - information as of 6/8/2025 1:05:33 AM

Main Details

Name

Holy Rosary Healthcare dba Intermountain Health Holy Rosary Hospital

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH271347-00

Medicare Provider Number

271347

Additional Details

Current Program Status

Active

Registration Date

8/19/2011

Participating Start Date

10/1/2011

Participating Approval Date

9/20/2011

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

SCL Health Montana Region
Pam Palagi, VP Financial Services
(406) 723-2414

Primary Contact

Intermountain Health
Ben Landry, 340B Pharmacist
(207) 200-5264

Addresses

Street Address

2600 Wilson Street
Miles City, MT 59301

Billing Address

Intermountain Health Holy Rosary Hospital
P.O. Box 1010
Lafayette, CO 80026

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
12/16/11- Deleted Medicaid#(was 0419666 )and NPI #(was 1396074548)	12/16/2011

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

Intermountain Health Holy Rosary Hospital
2600 Wilson Street
Miles City, MT 59301

Shipping Address 2

INTERMOUNTAIN SCC ACUTE SERVICES PHARMACY
7268 S BINGHAM JUNCTION BLVD
STE A
MIDVALE, UT 84047

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/13/2023	01/23/2023	07/11/2023	07/17/2023
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/13/2023	01/23/2023	07/11/2023	07/17/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/13/2023	01/23/2023	07/11/2023	07/17/2023
Contract Detail	ALBERTSONS LLC	OSCO PHARMACY #39	519 SOUTH HAYNES AVENUE	MILES CITY	MT	59301	07/19/2016	10/01/2016		07/19/2016
Contract Detail	BIG SKY PHARMACY	ATTN: JAMES MICHAEL ETCHEMENDY, PERSON I	701 MAIN ST P. O. BOX 1299	MILES CITY	MT	59301	01/15/2016	04/01/2016	08/15/2024	08/15/2024
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	01/15/2016	04/01/2016	11/20/2019	11/22/2019
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	G3320 BEECHER RD		FLINT	MI	48532-3614	01/15/2016	04/01/2016	04/01/2017	04/20/2017
Contract Detail	IHC HEALTH SERVICES, INC.	DBA: INTERMOUNTAIN HOME DELIVERY PHARMAC	DBA: INTERMOUNTAIN SPECIALTY PHARMACY 7268 S BINGHAM JUNCTION BLVD STE B1	MIDVALE	UT	84047	10/19/2023	01/01/2024		01/01/2024
Contract Detail	IHC HEALTH SERVICES, INC.	DBA: INTERMOUNTAIN SPECIALTY PHARMACY	4393 RIVERBOAT RD SUITE 101	TAYLORSVILLE	UT	84123	10/19/2023	01/01/2024	05/24/2024	05/24/2024
Contract Detail	INTERMOUNTAIN HEALTH GOOD SAMARITAN HOSP	PHARMACY DEPT	200 EXEMPLA CIR	LAFAYETTE	CO	80026	10/12/2015	01/01/2016	11/20/2019	11/22/2019
Contract Detail	INTERMOUNTAIN HEALTH SAINT JOSEPH HOSPIT	1825 MARION ST		DENVER	CO	80218	03/11/2013	04/01/2013	09/30/2015	10/12/2015
Contract Detail	INTERMOUNTAIN HEALTH SAINT JOSEPH HOSPIT	1825 MARION ST		DENVER	CO	80218	07/19/2016	10/01/2016	03/17/2021	03/19/2021
Contract Detail	INTERMOUNTAIN PHARMACY #07	200 EXEMPLA CIR STE P1-142		LAFAYETTE	CO	80026	07/12/2019	10/01/2019		10/01/2019
Contract Detail	INTERMOUNTAIN PHARMACY #12	1233 N 30TH ST	STE W103	BILLINGS	MT	59101	10/13/2022	10/24/2022		10/24/2022
Contract Detail	INTERMOUNTAIN SPECIALTY PHARMACY - DENVE	1830 N FRANKLIN ST	STE 190	DENVER	CO	80218	01/09/2017	04/01/2017		01/09/2017
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/13/2023	01/23/2023	07/11/2023	07/17/2023
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/13/2023	01/23/2023	07/11/2023	07/17/2023
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/18/2022	07/01/2022	10/04/2022	10/06/2022
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/24/2023	01/25/2023	07/11/2023	07/17/2023
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/15/2016	04/01/2016	11/20/2019	11/22/2019
Contract Detail	WAL-MART PHARMACY 10-2608	3205 STOWER STREET		MILES CITY	MT	59301	01/15/2016	04/01/2016	08/07/2024	08/09/2024
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/08/2016	07/01/2016	11/20/2019	11/22/2019
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/15/2016	04/01/2016	11/20/2019	11/22/2019
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/13/2023	01/23/2023	01/23/2023	01/25/2023
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	02/16/2023	02/16/2023	08/07/2024	08/09/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/19/2023	01/01/2024	08/07/2024	08/09/2024

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
Addresses	Billing Address	Update	Change Request	SCL HEALTH-HOLY ROSARY HEALTHCARE P.O. Box 1010 Lafayette, CO 80026	Intermountain Health Holy Rosary Hospital P.O. Box 1010 Lafayette, CO 80026	3/24/2025 8:09 AM
Addresses	Shipping Address	Update	Change Request	HOLY ROSARY HEALTHCARE 2600 Wilson Street Miles City, MT 59301	Intermountain Health Holy Rosary Hospital 2600 Wilson Street Miles City, MT 59301	3/24/2025 8:09 AM
Details	Last Recertification Date	Update	Recertification	8/26/2023 12:23:25 PM	8/19/2024 12:42:28 PM	8/19/2024 12:42 PM
Contacts	Primary Contact	Update	Change Request	Stubbs, Charles B. 340B Pharmacist Intermountain Healthcare 8012841113	Landry, Ben 340B Pharmacist Intermountain Health 2072005264	5/6/2024 11:30 AM
Details	Entity Name	Update	Change Request	Holy Rosary Healthcare	Holy Rosary Healthcare dba Intermountain Health Holy Rosary Hospital	5/6/2024 11:30 AM
Details	Last Recertification Date	Update	Recertification	9/6/2022 4:26:23 PM	8/26/2023 12:23:25 PM	8/26/2023 12:23 PM
Contacts	Primary Contact	Update	Change Request	Starck, Raylene Director of Pharmacy Holy Rosary Healthcare 4062334210	Stubbs, Charles B. 340B Pharmacist Intermountain Healthcare 8012841113	7/5/2023 11:09 AM
Addresses	Shipping Address	Insert	Change Request		HOLY ROSARY HEALTHCARE 2600 Wilson Street Miles City, MT 59301	4/4/2023 6:47 AM
Addresses	Shipping Address	Insert	Change Request		INTERMOUNTAIN SCC ACUTE SERVICES PHARMACY 7268 S BINGHAM JUNCTION BLVD STE A MIDVALE, UT 84047	4/4/2023 6:47 AM
Contacts	Primary Contact	Update	Change Request	Starck, Raylene Director of Pharmacy Holy Rosary Healthcare 4062334210	Starck, Raylene Director of Pharmacy Holy Rosary Healthcare 4062334210	2/22/2023 6:55 AM
Details	Last Recertification Date	Update	Recertification	9/2/2021 2:38:46 PM	9/6/2022 4:26:23 PM	9/6/2022 4:26 PM
Contacts	Authorizing Official	Update	AO Change Request	Palagi, Pam VP of Finacial Services SCL Health 4067232414	Palagi, Pam VP Financial Services SCL Health Montana Region 4067232414	9/5/2022 8:38 AM
Details	Last Recertification Date	Update	Recertification	9/1/2020 11:45:45 AM	9/2/2021 2:38:46 PM	9/2/2021 2:38 PM
Details	Last Recertification Date	Update	Recertification	8/26/2019 1:35:35 PM	9/1/2020 11:45:45 AM	9/1/2020 11:45 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 3:33:23 PM	8/26/2019 1:35:35 PM	8/26/2019 1:35 PM
Contacts	Authorizing Official	Update	AO Change Request	Lewis, Paul CEO SCL Health 4062332602	Palagi, Pam VP of Finacial Services SCL Health 4067232414	8/23/2018 6:36 AM
Contacts	Primary Contact	Update	Recertification	Starck, Raylene Pharmacy Director Holy Rosary Healthcare 4062334210	Starck, Raylene Director of Pharmacy Holy Rosary Healthcare 4062334210	8/21/2018 3:33 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 11:42:57 AM	8/21/2018 3:33:23 PM	8/21/2018 3:33 PM
Addresses	Billing Address	Insert	Change Request		SCL HEALTH-HOLY ROSARY HEALTHCARE P.O. Box 1010 Lafayette, CO 80026	5/2/2018 10:45 AM
Details	Last Recertification Date	Update	Recertification	8/17/2016 12:00:00 AM	11/29/2017 11:42:57 AM	11/29/2017 11:42 AM
Contacts	Primary Contact	Update		Starck, Raylene Pharmacy Director 4062334210	Starck, Raylene Pharmacy Director Holy Rosary Healthcare 4062334210	11/20/2017 4:44 PM
Contacts	Authorizing Official	Update		Lewis, Paul CEO 4062332602	Lewis, Paul CEO SCL Health 4062332602	10/10/2017 12:11 AM
Contacts	Authorizing Official	Update		Carey, Calvin VP Finance and Support Services 4062332605	Lewis, Paul CEO 4062332602	4/20/2017 11:00 PM
Addresses	Main Address	Insert			2600 Wilson Street Miles City, MT 59301	8/17/2016 3:16 PM
Contacts	Signed By	Insert			Lewis, Paul VP Finance and Support Services 4062332612	8/17/2016 3:16 PM
Contacts	Primary Contact	Update		Starck, Raylene Pharmacy Director 4062334210	Starck, Raylene Pharmacy Director 4062334210	8/17/2016 3:16 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/17/2016 12:00:00 AM	8/17/2016 3:16 PM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 6:14 PM
Contacts	Authorizing Official	Insert			Carey, Calvin VP Finance and Support Services 4062332605	9/8/2014 7:46 AM
Details	Last Recertification Date	Update		8/19/2013 1:12:16 PM	8/6/2014 12:00:00 AM	8/6/2014 3:22 PM
Contacts	Primary Contact	Insert			Starck, Raylene Pharmacy Director 4062334210	7/3/2014 4:20 PM
Details	Last Recertification Date	Update			8/19/2013 1:12:16 PM	8/19/2013 1:12 PM
Details	Comments Public	Insert			12/16/11- Deleted Medicaid#(was 0419666 )and NPI #(was 1396074548)	12/16/2011 1:39 PM
Dates	Participating Approval Date	Update			9/20/2011 12:00:00 AM	9/20/2011 5:31 PM
Details	State	Update		Pending	Active	9/20/2011 5:31 PM
Details	340B ID	Update		ONLINE_REG	CAH271347-00	8/31/2011 10:15 AM
Dates	Start Date	Update			10/1/2011 12:00:00 AM	8/31/2011 10:15 AM
Details	Last Recertification Date	Insert				8/19/2011 4:42 PM
Details	Grant Number	Insert				8/19/2011 4:42 PM
Details	340B ID	Insert			ONLINE_REG	8/19/2011 4:42 PM
Details	Is Authorizing Official EHB Data	Insert				8/19/2011 4:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/19/2011 4:42 PM
Details	Medicare Provider Number	Insert			271347	8/19/2011 4:42 PM
Details	Entity Name	Insert			Holy Rosary Healthcare	8/19/2011 4:42 PM
Details	Program Code	Insert			CAH	8/19/2011 4:42 PM
Details	Entity Subname	Insert				8/19/2011 4:42 PM
Dates	Participating Approval Date	Insert				8/19/2011 4:42 PM
Details	State	Insert			Pending	8/19/2011 4:42 PM
Dates	Registration Date	Insert			8/19/2011 12:00:00 AM	8/19/2011 4:42 PM
Dates	Signed By Date	Insert			8/19/2011 12:00:00 AM	8/19/2011 4:42 PM
Dates	Start Date	Insert				8/19/2011 4:42 PM
Terminations	Termination Comments	Insert				8/19/2011 4:42 PM
Terminations	Termination Date	Insert				8/19/2011 4:42 PM
Terminations	Termination Effective Date	Insert				8/19/2011 4:42 PM
Terminations	Termination Reason	Insert				8/19/2011 4:42 PM