| Addresses | Billing Address | Update | Change Request | Intermountain Health St Vincent Regional Hospital
1233 North 30th Street
Billings, MT 59101 | Intermountain Health St Vincent Regional Hospital
PO BOX 1010
LAFAYETTE, CO 80026 | 10/1/2024 11:44 AM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2023 9:54:40 AM | 8/19/2024 12:43:22 PM | 8/19/2024 12:43 PM |
| Addresses | Billing Address | Update | Change Request | St. Vincent Healthcare
1233 North 30th Street
Billings, MT 59101 | Intermountain Health St Vincent Regional Hospital
1233 North 30th Street
Billings, MT 59101 | 8/12/2024 1:00 PM |
| Addresses | Shipping Address | Update | Change Request | St. Vincent Healthcare Inpatient Pharmacy
1233 N 30th St
Billings, MT 59101 | Intermountain Health St Vincent Regional Hospital Inpatient Pharmacy
1233 N 30th St
Billings, MT 59101 | 8/12/2024 1:00 PM |
| Details | Entity Name | Update | Change Request | St. Vincent Healthcare | Intermountain Health St Vincent Regional Hospital | 8/12/2024 1:00 PM |
| Contacts | Primary Contact | Update | Group Change Request | Stubbs, Charles B.
340B Pharmacist
Intermountain Healthcare
8012841113 | Landry, Ben
340B Pharmacist
Intermountain Health
2072005264 | 4/30/2024 8:04 AM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2022 9:28:27 AM | 8/30/2023 9:54:40 AM | 8/30/2023 9:54 AM |
| Contacts | Primary Contact | Update | Group Change Request | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | Stubbs, Charles B.
340B Pharmacist
Intermountain Healthcare
8012841113 | 7/5/2023 8:35 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 7:14 AM |
| Contacts | Primary Contact | Update | Group Change Request | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | 2/22/2023 6:57 AM |
| Addresses | Billing Address | Update | Change Request | St. Vincent Healthcare
P.O. Box 1010
Lafayette, CO 80026 | St. Vincent Healthcare
1233 North 30th Street
Billings, MT 59101 | 10/7/2022 8:17 AM |
| Addresses | Shipping Address | Insert | Change Request | | St. Vincent Healthcare Inpatient Pharmacy
1233 N 30th St
Billings, MT 59101 | 10/7/2022 8:17 AM |
| Addresses | Shipping Address | Insert | Change Request | | St. Vincent Healthcare Cancer Centers of Montana Pharmacy
1315 Golden Valley Circle
Billings, MT 59102 | 10/7/2022 8:17 AM |
| Details | Last Recertification Date | Update | Recertification | 9/13/2021 12:08:07 PM | 9/7/2022 9:28:27 AM | 9/7/2022 9:28 AM |
| 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 | 9/6/2022 6:52 AM |
| Contacts | Primary Contact | Update | Change Request | Mains, Ashley
Director of Pharmacy Business Services
SCL Health
3038135016 | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | 3/9/2022 1:21 PM |
| Contacts | Primary Contact | Update | Recertification | Mains, Ashley
System Pharmacy Manager - 340B Program
SCL Health
3038135016 | Mains, Ashley
Director of Pharmacy Business Services
SCL Health
3038135016 | 9/13/2021 12:08 PM |
| Details | Last Recertification Date | Update | Recertification | 9/14/2020 11:44:52 AM | 9/13/2021 12:08:07 PM | 9/13/2021 12:08 PM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1134564255 (MT) | | 8/17/2021 7:14 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | MT | 9/14/2020 11:44 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | MT | 9/14/2020 11:44 AM |
| Contacts | Primary Contact | Update | Recertification | Mains, Ashley
Director of Pharmacy Business Services
SCL Health
3038135016 | Mains, Ashley
System Pharmacy Manager - 340B Program
SCL Health
3038135016 | 9/14/2020 11:44 AM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2019 3:49:40 PM | 9/14/2020 11:44:52 AM | 9/14/2020 11:44 AM |
| Contacts | Primary Contact | Update | Change Request | Finneman, Lonnye
Director of Pharmacy
SCL Health
4062378123 | Mains, Ashley
Director of Pharmacy Business Services
SCL Health
3038135016 | 2/13/2020 8:23 AM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2018 9:20:58 AM | 9/2/2019 3:49:40 PM | 9/2/2019 3:49 PM |
| Details | Last Recertification Date | Update | Recertification | 11/30/2017 12:29:00 PM | 8/16/2018 9:20:58 AM | 8/16/2018 9:20 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1083655997 | 3/15/2018 3:50 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1134564255 | 3/15/2018 3:50 PM |
| Addresses | Billing Address | Insert | Change Request | | St. Vincent Healthcare
P.O. Box 1010
Lafayette, CO 80026 | 3/2/2018 2:44 PM |
| Contacts | Authorizing Official | Update | Change Request | Scremin, Karen
Interim CFO
SCL Health
3038135255 | Palagi, Pam
VP of Finacial Services
SCL Health
4067232414 | 2/12/2018 11:23 AM |
| Contacts | Primary Contact | Update | Recertification | Finneman, Lonnye
Pharmacy Director
4062378123 | Finneman, Lonnye
Director of Pharmacy
SCL Health
4062378123 | 11/30/2017 12:29 PM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2016 12:00:00 AM | 11/30/2017 12:29:00 PM | 11/30/2017 12:29 PM |
| Contacts | Authorizing Official | Update | | Scremin, Karen
Interim CFO
3038135255 | Scremin, Karen
Interim CFO
SCL Health
3038135255 | 10/11/2017 12:53 PM |
| Contacts | Signed By | Insert | | | Oldfield, Ron
CFO
4062373314 | 8/9/2017 11:45 AM |
| Contacts | Authorizing Official | Insert | | | Scremin, Karen
Interim CFO
3038135255 | 6/28/2017 12:44 PM |
| Addresses | Main Address | Insert | | |
1233 N. 30th Street
Billings, MT 59101 | 3/10/2017 2:00 PM |
| Contacts | Primary Contact | Update | | Barker, Jason
Pharmacy Manager
4062378123 | Finneman, Lonnye
Pharmacy Director
4062378123 | 3/10/2017 2:00 PM |
| Details | Last Recertification Date | Update | | 8/20/2015 12:00:00 AM | 8/18/2016 12:00:00 AM | 8/18/2016 6:43 PM |
| Details | Last Recertification Date | Update | | 8/14/2014 12:00:00 AM | 8/20/2015 12:00:00 AM | 8/20/2015 1:23 PM |
| Details | Last Recertification Date | Update | | 8/22/2013 12:00:00 AM | 8/14/2014 12:00:00 AM | 8/14/2014 2:48 PM |
| Details | Last Recertification Date | Update | | | 8/22/2013 12:00:00 AM | 8/22/2013 6:07 PM |
| Contacts | Primary Contact | Insert | | | Barker, Jason
Pharmacy Manager
4062378123 | 9/10/2012 2:56 PM |
| Details | 340B ID | Update | | IS-AP-DSH270049 | DSH270049 | 9/10/2012 2:56 PM |
| Dates | Participating Approval Date | Update | | | 9/10/2012 12:00:00 AM | 9/10/2012 2:56 PM |
| Details | State | Update | | Pending | Active | 9/10/2012 2:56 PM |
| Dates | Start Date | Update | | | 10/1/2012 12:00:00 AM | 9/10/2012 2:56 PM |
| Details | 340B ID | Update | | AP082212 | IS-AP-DSH270049 | 8/30/2012 12:05 PM |
| Details | 340B ID | Update | | ONLINE_REG | AP082212 | 8/22/2012 8:29 AM |
| Details | Last Recertification Date | Insert | | | | 8/21/2012 3:28 PM |
| Details | Grant Number | Insert | | | | 8/21/2012 3:28 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 8/21/2012 3:28 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/21/2012 3:28 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/21/2012 3:28 PM |
| Details | Medicare Provider Number | Insert | | | 270049 | 8/21/2012 3:28 PM |
| Details | Entity Name | Insert | | | St. Vincent Healthcare | 8/21/2012 3:28 PM |
| Details | Program Code | Insert | | | DSH | 8/21/2012 3:28 PM |
| Details | Entity Subname | Insert | | | | 8/21/2012 3:28 PM |
| Dates | Participating Approval Date | Insert | | | | 8/21/2012 3:28 PM |
| Details | State | Insert | | | Pending | 8/21/2012 3:28 PM |
| Dates | Registration Date | Insert | | | 8/21/2012 12:00:00 AM | 8/21/2012 3:28 PM |
| Dates | Signed By Date | Insert | | | 8/21/2012 12:00:00 AM | 8/21/2012 3:28 PM |
| Dates | Start Date | Insert | | | | 8/21/2012 3:28 PM |
| Terminations | Termination Comments | Insert | | | | 8/21/2012 3:28 PM |
| Terminations | Termination Date | Insert | | | | 8/21/2012 3:28 PM |
| Terminations | Termination Effective Date | Insert | | | | 8/21/2012 3:28 PM |
| Terminations | Termination Reason | Insert | | | | 8/21/2012 3:28 PM |