Covered Entity Details

CAH241306-00 HealthPartners RC dba Olivia Hospital & Clinic (Active) - information as of 6/6/2025 12:37:01 PM

Main Details

Name

HealthPartners RC dba Olivia Hospital & Clinic

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH241306-00

Medicare Provider Number

241306

Additional Details

Current Program Status

Active

Registration Date

8/20/2012

Participating Start Date

10/1/2012

Participating Approval Date

9/4/2012

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Hutchinson Health
Pamela J. Larson, CFO
(320) 484-4472

Primary Contact

HealthPartners RC
Michelle Golden, 340B Manager
(715) 531-6371

Addresses

Street Address

100 Healthy Way
Olivia, MN 56277-1117

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
MN		1629091871,1932387255,1467525162,1649470782

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	PARK NICOLLET PHARMACY #87017	3800 PARK NICOLLET BLVD STE 1170		ST LOUIS PARK	MN	55416-2527	07/08/2022	10/01/2022		10/01/2022
Contract Detail	SNYDER DRUG	801 E DEPUE		OLIVIA	MN	56277	10/03/2016	01/01/2017	01/01/2017	09/08/2020
Contract Detail	THRIFTY WHITE PARTNERS IN CARE	706 38TH ST NW UNIT B		FARGO	ND	58102	07/15/2022	10/01/2022	04/01/2025	05/13/2025
Contract Detail	THRIFTY WHITE PHARMACY #765	303 N. MAIN STREET	P.O. BOX 600	RENVILLE	MN	56284	10/03/2016	01/01/2017	11/06/2021	12/14/2021
Contract Detail	THRIFTY WHITE PHARMACY #790	105 S 1ST ST		OLIVIA	MN	56277-2442	04/06/2018	07/01/2018		04/06/2018
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/06/2020	01/01/2021	01/16/2024	03/20/2024
Contract Detail	WAL-MART PHARMACY 10-1470	700 19TH AVE SE		WILLMAR	MN	56201	10/06/2020	01/01/2021	01/01/2021	04/20/2021
Contract Detail	WAL-MART PHARMACY 10-1738	1300 TRUNK HWY. 15 SOUTH		HUTCHINSON	MN	55350	10/06/2020	01/01/2021	01/16/2024	03/20/2024
Contract Detail	WAL-MART PHARMACY 10-1858	3001 EAST HWY 7, STE 100		MONTEVIDEO	MN	56265	10/06/2020	01/01/2021	01/01/2021	04/20/2021
Contract Detail	WAL-MART PHARMACY 10-1865	1410 EAST BRIDGE STREET		REDWOOD FALLS	MN	56283	10/06/2020	01/01/2021	01/16/2024	03/20/2024
Contract Detail	WAL-MART PHARMACY 10-3624	9320 CEDAR STREET		MONTICELLO	MN	55362	10/06/2020	01/01/2021	01/01/2021	04/20/2021
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/06/2020	01/01/2021	01/16/2024	03/20/2024
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/07/2023	10/01/2023	01/16/2024	03/20/2024
Contract Detail	WHITE DRUG #52	706 38TH ST N STE B		FARGO	ND	58102-2953	10/03/2016	01/01/2017	06/27/2022	07/07/2023
Contract Detail	WHITE DRUG #61	706 38TH ST NW UNIT A		FARGO	ND	58102	10/03/2016	01/01/2017		07/25/2017

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH241306-01	Child	CAH	Renville County Hospital & Clinics	Renville County Hospital & Clinics - Olivia Clinic	100 Healthy Way	Olivia	MN	Terminated
CAH241306-02	Child	CAH	HealthPartners RC dba Olivia Hospital & Clinic	Hector Clinic	131 Birch Ave W	Hector	MN	Active
CAH241306-03	Child	CAH	HealthPartners RC dba Olivia Hospital & Clinic	Renville Clinic	420 MAIN STREET N	RENVILLE	MN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Anderson, Nancy Ann Chief Financial Officer HealthPartners RC 3205233477	Larson, Pamela J. CFO Hutchinson Health 3204844472	11/8/2024 8:46 AM
Details	Last Recertification Date	Update	Recertification	8/21/2023 11:29:07 AM	8/14/2024 2:29:41 PM	8/14/2024 2:29 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 8:11:09 AM	8/21/2023 11:29:07 AM	8/21/2023 11:29 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1467525162	12/9/2022 12:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		MN	12/9/2022 12:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1649470782	12/9/2022 12:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		MN	12/9/2022 12:43 PM
Details	Last Recertification Date	Update	Recertification	9/10/2021 3:56:35 PM	8/29/2022 8:11:09 AM	8/29/2022 8:11 AM
Contacts	Primary Contact	Update	Profile Change Request	Golden, Michelle 340B Coordinator HealthPartners RC 7155316371	Golden, Michelle 340B Manager HealthPartners RC 7155316371	7/8/2022 11:56 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1629091871	9/22/2021 9:40 AM
Medicaid Billing	NPI: State	Insert	Change Request		MN	9/22/2021 9:40 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1932387255	9/22/2021 9:40 AM
Medicaid Billing	NPI: State	Insert	Change Request		MN	9/22/2021 9:40 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 9:20:23 AM	9/10/2021 3:56:35 PM	9/10/2021 3:56 PM
Contacts	Authorizing Official	Update	Change Request	Blad, Nathan President HealthPartners RC 3205233575	Anderson, Nancy Ann Chief Financial Officer HealthPartners RC 3205233477	1/29/2021 1:21 PM
Contacts	Primary Contact	Update	Change Request	Anderson, Nancy Ann Chief Financial Officer HealthPartners RC 3205233477	Golden, Michelle 340B Coordinator HealthPartners RC 7155316371	1/29/2021 1:21 PM
Contacts	Primary Contact	Update	Recertification	Anderson, Nancy Chief Financial Officer Olivia Hospital & Clinic 3205233477	Anderson, Nancy Ann Chief Financial Officer HealthPartners RC 3205233477	9/9/2020 9:20 AM
Details	Last Recertification Date	Update	Recertification	8/26/2019 10:06:37 AM	9/9/2020 9:20:23 AM	9/9/2020 9:20 AM
Contacts	Authorizing Official	Update	AO Change Request	Blad, Nathan President Olivia Hospital & Clinic 3205233575	Blad, Nathan President HealthPartners RC 3205233575	9/9/2020 8:41 AM
Details	Entity Name	Update	Change Request	Renville County Hospital & Clinics	HealthPartners RC dba Olivia Hospital & Clinic	5/1/2020 5:28 PM
Contacts	Primary Contact	Update	Profile Change Request	Anderson, Nancy Chief Financial Officer RC Hospital & Clinics 3205233477	Anderson, Nancy Chief Financial Officer Olivia Hospital & Clinic 3205233477	4/22/2020 3:15 PM
Contacts	Authorizing Official	Update	Profile Change Request	Blad, Nathan CEO RC Hospital & Clinics 3205233575	Blad, Nathan President Olivia Hospital & Clinic 3205233575	4/22/2020 3:06 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 2:26:19 PM	8/26/2019 10:06:37 AM	8/26/2019 10:06 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 12:44:08 PM	8/21/2018 2:26:19 PM	8/21/2018 2:26 PM
Contacts	Primary Contact	Update	Recertification	Blad, Nathan CEO 3205233575	Anderson, Nancy Chief Financial Officer RC Hospital & Clinics 3205233477	11/15/2017 12:44 PM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/15/2017 12:44:08 PM	11/15/2017 12:44 PM
Contacts	Authorizing Official	Update		Blad, Nathan CEO 3205233575	Blad, Nathan CEO RC Hospital & Clinics 3205233575	10/30/2017 11:15 AM
Addresses	Main Address	Insert			100 Healthy Way Olivia, MN 56277-1117	7/25/2017 10:09 AM
Contacts	Signed By	Insert			Haugo, Glenn CEO 3205231261	7/25/2017 10:09 AM
Contacts	Authorizing Official	Update		Bland, Nathan CEO 3205231261	Blad, Nathan CEO 3205233575	7/25/2017 10:09 AM
Contacts	Primary Contact	Insert			Blad, Nathan CEO 3205233575	7/25/2017 10:09 AM
Details	Last Recertification Date	Update		9/9/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 5:43 PM
Details	Last Recertification Date	Update		9/10/2014 12:00:00 AM	9/9/2015 12:00:00 AM	9/9/2015 5:33 PM
Details	Last Recertification Date	Update		9/13/2013 12:00:00 AM	9/10/2014 12:00:00 AM	9/10/2014 4:16 PM
Details	Last Recertification Date	Update			9/13/2013 12:00:00 AM	9/13/2013 4:00 PM
Contacts	Authorizing Official	Insert			Bland, Nathan CEO 3205231261	9/13/2013 3:39 PM
Details	340B ID	Update		IS-CA-CAH241306-00	CAH241306-00	9/4/2012 4:55 PM
Dates	Participating Approval Date	Update			9/4/2012 12:00:00 AM	9/4/2012 4:55 PM
Details	State	Update		Pending	Active	9/4/2012 4:55 PM
Dates	Start Date	Update			10/1/2012 12:00:00 AM	9/4/2012 4:55 PM
Details	340B ID	Update		CA-CA082212B	IS-CA-CAH241306-00	9/4/2012 4:22 PM
Details	340B ID	Update		CA082212B	CA-CA082212B	8/28/2012 12:07 PM
Details	340B ID	Update		ONLINE_REG	CA082212B	8/22/2012 8:09 AM
Details	Last Recertification Date	Insert				8/20/2012 5:42 PM
Details	Grant Number	Insert				8/20/2012 5:42 PM
Details	340B ID	Insert			ONLINE_REG	8/20/2012 5:42 PM
Details	Is Authorizing Official EHB Data	Insert				8/20/2012 5:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/20/2012 5:42 PM
Details	Medicare Provider Number	Insert			241306	8/20/2012 5:42 PM
Details	Entity Name	Insert			Renville County Hospital & Clinics	8/20/2012 5:42 PM
Details	Program Code	Insert			CAH	8/20/2012 5:42 PM
Details	Entity Subname	Insert				8/20/2012 5:42 PM
Dates	Participating Approval Date	Insert				8/20/2012 5:42 PM
Details	State	Insert			Pending	8/20/2012 5:42 PM
Dates	Registration Date	Insert			8/20/2012 12:00:00 AM	8/20/2012 5:42 PM
Dates	Signed By Date	Insert			8/20/2012 12:00:00 AM	8/20/2012 5:42 PM
Dates	Start Date	Insert				8/20/2012 5:42 PM
Terminations	Termination Comments	Insert				8/20/2012 5:42 PM
Terminations	Termination Date	Insert				8/20/2012 5:42 PM
Terminations	Termination Effective Date	Insert				8/20/2012 5:42 PM
Terminations	Termination Reason	Insert				8/20/2012 5:42 PM