| Addresses | Main Address | Update | Change Request |
800 S THIRD
MONTROSE, CO 81401 |
800 S Third Street
MONTROSE, CO 81401 | 5/6/2025 6:22 AM |
| Addresses | Main Address | Update | Hospital Type Change Request |
800 South 3rd Street
Montrose, CO 81401 |
800 S THIRD
MONTROSE, CO 81401 | 4/22/2025 4:11 PM |
| Medicaid Billing | NPI: Number | Delete | Hospital Type Change Request | 1205822186 ( ) | | 4/22/2025 4:11 PM |
| Medicaid Billing | NPI: Number | Insert | Hospital Type Change Request | | 1205822186 | 4/22/2025 4:11 PM |
| Medicaid Billing | NPI: State | Insert | Hospital Type Change Request | | CO | 4/22/2025 4:11 PM |
| Contacts | Primary Contact | Update | Hospital Type Change Request | Papineau, George
Director of Pharmacy
Montrose Memorial Hospital
9702407259 | Wilkins, Jodi
340B Oversight
Montrose Memorial Hospital
9702402635 | 4/22/2025 4:11 PM |
| Contacts | Authorizing Official | Update | Hospital Type Change Request | Dupper, Larry
CFO
Montrose Memorial Hospital
9702522659 | Perrotti, Paul Richard
CFO
Montrose Memorial Hospital
9702522659 | 4/22/2025 4:11 PM |
| Contacts | Signed By | Update | Hospital Type Change Request | Wilson, Stephan
Chief Financial Officer
9702407251 | Perrotti, Paul Richard
CFO
Montrose Memorial Hospital
9702522659 | 4/22/2025 4:11 PM |
| Details | Last Recertification Date | Update | Hospital Type Change Request | 9/8/2016 12:00:00 AM | | 4/22/2025 4:11 PM |
| Details | Entity Name | Update | Hospital Type Change Request | Montrose Memorial Hospital | MONTROSE MEMORIAL HOSPITAL | 4/22/2025 4:11 PM |
| Dates | Participating Approval Date | Update | Hospital Type Change Request | 8/17/2012 12:00:00 AM | 4/22/2025 4:11:32 PM | 4/22/2025 4:11 PM |
| Details | State | Update | Hospital Type Change Request | Terminated | Approved | 4/22/2025 4:11 PM |
| Dates | Registration Date | Update | Hospital Type Change Request | 6/5/2012 12:00:00 AM | 4/14/2025 11:07:15 AM | 4/22/2025 4:11 PM |
| Dates | Signed By Date | Update | Hospital Type Change Request | 6/5/2012 12:00:00 AM | 4/16/2025 4:03:24 PM | 4/22/2025 4:11 PM |
| Dates | Start Date | Update | Hospital Type Change Request | 4/1/2017 12:00:00 AM | 7/1/2025 12:00:00 AM | 4/22/2025 4:11 PM |
| Terminations | Termination Comments | Update | Hospital Type Change Request | Registration of entity as a new entity of DSH was approved. | | 4/22/2025 4:11 PM |
| Terminations | Termination Date | Update | Hospital Type Change Request | 10/1/2017 12:00:00 AM | | 4/22/2025 4:11 PM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | 10/1/2017 12:00:00 AM | | 4/22/2025 4:11 PM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | Change of covered entity type | | 4/22/2025 4:11 PM |
| Details | Comments Public | Insert | Hospital Type Change Request | | Participated starting 4/1/2017, terminated 10/1/2017. Reinstated 7/1/2025. | 4/17/2025 6:37 AM |
| Contacts | Authorizing Official | Update | | Dupper, Larry
CFO
9702522659 | Dupper, Larry
CFO
Montrose Memorial Hospital
9702522659 | 9/28/2017 2:19 PM |
| Contacts | Primary Contact | Update | | Papineau, George
Director of Pharmacy
9702407259 | Papineau, George
Director of Pharmacy
Montrose Memorial Hospital
9702407259 | 9/27/2017 12:25 PM |
| Contacts | Primary Contact | Update | | Guillory, Kitty
Pharmacy Director
9702407259 | Papineau, George
Director of Pharmacy
9702407259 | 8/30/2017 12:44 PM |
| Contacts | Authorizing Official | Insert | | | Dupper, Larry
CFO
9702522659 | 7/31/2017 5:05 PM |
| Addresses | Main Address | Insert | | |
800 South 3rd Street
Montrose, CO 81401 | 7/31/2017 5:04 PM |
| Addresses | Shipping Address | Insert | | | Montrose Memorial Hospital-Cancer
600 South Fifth St
Montrose, CO 81401 | 7/31/2017 5:04 PM |
| Contacts | Signed By | Insert | | | Wilson, Stephan
Chief Financial Officer
9702407251 | 7/31/2017 5:04 PM |
| Details | State | Update | | To Be Terminated | Terminated | 7/31/2017 5:04 PM |
| Details | State | Update | | Active | To Be Terminated | 7/31/2017 5:04 PM |
| Terminations | Termination Comments | Update | | | Registration of entity as a new entity of DSH was approved. | 7/31/2017 5:04 PM |
| Terminations | Termination Date | Update | | | 10/1/2017 12:00:00 AM | 7/31/2017 5:04 PM |
| Terminations | Termination Effective Date | Update | | | 10/1/2017 12:00:00 AM | 7/31/2017 5:04 PM |
| Terminations | Termination Reason | Update | | | Change of covered entity type | 7/31/2017 5:04 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | 10/1/2016 12:00:00 AM | | 3/15/2017 4:10 PM |
| Details | State | Update | | Terminated | Active | 3/15/2017 4:10 PM |
| Dates | Start Date | Update | | 10/1/2012 12:00:00 AM | 4/1/2017 12:00:00 AM | 3/15/2017 4:10 PM |
| Terminations | Termination Date | Update | | 10/1/2016 12:00:00 AM | | 3/15/2017 4:10 PM |
| Terminations | Termination Effective Date | Update | | 10/1/2016 12:00:00 AM | | 3/15/2017 4:10 PM |
| Terminations | Termination Reason | Update | | Failure to recertify | | 3/15/2017 4:10 PM |
| Details | Comments Public | Insert | | | Participating 10/1/2012 until terminated effective 10/1/2016, reinstated effective 4/1/2016. | 3/15/2017 4:10 PM |
| Contacts | Primary Contact | Insert | | | Guillory, Kitty
Pharmacy Director
9702407259 | 9/8/2016 9:34 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 10/1/2016 12:00:00 AM | 9/8/2016 9:34 AM |
| Details | State | Update | | Active | Terminated | 9/8/2016 9:34 AM |
| Terminations | Termination Date | Update | | | 10/1/2016 12:00:00 AM | 9/8/2016 9:34 AM |
| Terminations | Termination Effective Date | Update | | | 10/1/2016 12:00:00 AM | 9/8/2016 9:34 AM |
| Terminations | Termination Reason | Update | | | Failure to recertify | 9/8/2016 9:34 AM |
| Details | Last Recertification Date | Update | | 8/5/2015 12:00:00 AM | 9/8/2016 12:00:00 AM | 9/8/2016 9:33 AM |
| Details | Last Recertification Date | Update | | 8/26/2014 12:00:00 AM | 8/5/2015 12:00:00 AM | 8/5/2015 12:49 PM |
| Details | Last Recertification Date | Update | | 8/22/2013 12:00:00 AM | 8/26/2014 12:00:00 AM | 8/26/2014 8:36 PM |
| Details | Last Recertification Date | Update | | | 8/22/2013 12:00:00 AM | 8/22/2013 5:56 AM |
| Details | 340B ID | Update | | CAH060006-00 | SCH060006-00 | 9/24/2012 3:52 PM |
| Details | 340B ID | Update | | IS-DM-CAH060006-00 | CAH060006-00 | 8/17/2012 2:52 PM |
| Dates | Participating Approval Date | Update | | | 8/17/2012 12:00:00 AM | 8/17/2012 2:52 PM |
| Details | State | Update | | Pending | Active | 8/17/2012 2:52 PM |
| Dates | Start Date | Update | | | 10/1/2012 12:00:00 AM | 8/17/2012 2:52 PM |
| Details | 340B ID | Update | | DM-062512 | IS-DM-CAH060006-00 | 7/11/2012 12:46 PM |
| Details | 340B ID | Update | | IS-DM-062912 | DM-062512 | 6/29/2012 10:58 AM |
| Details | 340B ID | Update | | DM-062012 | IS-DM-062912 | 6/29/2012 10:31 AM |
| Details | 340B ID | Update | | DM061912B | DM-062012 | 6/20/2012 8:43 AM |
| Details | 340B ID | Update | | ONLINE_REG | DM061912B | 6/19/2012 7:36 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 6/5/2012 11:51 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 05006002 | 6/5/2012 11:51 AM |
| Medicaid Billing | Medicaid: State | Insert | | | CO | 6/5/2012 11:51 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1205822186 | 6/5/2012 11:51 AM |
| Details | Last Recertification Date | Insert | | | | 6/5/2012 11:51 AM |
| Details | Grant Number | Insert | | | | 6/5/2012 11:51 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 6/5/2012 11:51 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 6/5/2012 11:51 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 6/5/2012 11:51 AM |
| Details | Medicare Provider Number | Insert | | | 060006 | 6/5/2012 11:51 AM |
| Details | Entity Name | Insert | | | Montrose Memorial Hospital | 6/5/2012 11:51 AM |
| Details | Program Code | Insert | | | SCH | 6/5/2012 11:51 AM |
| Details | Entity Subname | Insert | | | | 6/5/2012 11:51 AM |
| Dates | Participating Approval Date | Insert | | | | 6/5/2012 11:51 AM |
| Details | State | Insert | | | Pending | 6/5/2012 11:51 AM |
| Dates | Registration Date | Insert | | | 6/5/2012 12:00:00 AM | 6/5/2012 11:51 AM |
| Dates | Signed By Date | Insert | | | 6/5/2012 12:00:00 AM | 6/5/2012 11:51 AM |
| Dates | Start Date | Insert | | | | 6/5/2012 11:51 AM |
| Terminations | Termination Comments | Insert | | | | 6/5/2012 11:51 AM |
| Terminations | Termination Date | Insert | | | | 6/5/2012 11:51 AM |
| Terminations | Termination Effective Date | Insert | | | | 6/5/2012 11:51 AM |
| Terminations | Termination Reason | Insert | | | | 6/5/2012 11:51 AM |