Covered Entity Details

CAH381321-00 Grande Ronde Hospital, Inc. (Active) - information as of 6/27/2025 12:27:24 AM

Main Details

Name

Grande Ronde Hospital, Inc.

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH381321-00

Medicare Provider Number

381321

Additional Details

Current Program Status

Active

Registration Date

1/11/2013

Participating Start Date

4/1/2013

Participating Approval Date

1/22/2013

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Grand Ronde Hospital
Robert Seymour, CFO/Senior Director of Finance
(541) 963-1463

Primary Contact

Grande Ronde Hospital, Inc.
Hope A Murphy, Pharmacy Manager
(541) 963-1878

Addresses

Street Address

900 Sunset Drive
La Grande, OR 97850

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?
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	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/14/2021	07/01/2021		07/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/14/2021	07/01/2021		07/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/14/2021	07/01/2021		07/01/2021
Contract Detail	ARDON HEALTH, LLC	11835 NE GLENN WIDING DR		PORTLAND	OR	97220-9057	04/14/2021	07/01/2021		07/01/2021
Contract Detail	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	04/08/2015	07/01/2015	12/03/2018	12/06/2018
Contract Detail	AVELLA OF SACRAMENTO, INC.	2288 AUBURN BLVD #102		SACRAMENTO	CA	95821	04/08/2015	07/01/2015	12/03/2018	12/06/2018
Contract Detail	BI-MART CORP	BI-MART PHCY #637	2510 ADAMS AVE	LA GRANDE	OR	97850	04/02/2015	07/01/2015	12/03/2018	12/06/2018
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/14/2021	07/01/2021		07/01/2021
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/14/2021	07/01/2021		07/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/14/2021	07/01/2021		07/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/14/2021	07/01/2021		07/01/2021
Contract Detail	RED CROSS DRUG STORE	RED CROSS UNITED DRUG, INC.	1123 ADAMS AVE RED CROSS UNITED DRUG INC	LA GRANDE	OR	97850-2692	04/02/2015	07/01/2015		08/14/2017
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1827	2111 ADAMS AVENUE	LA GRANDE	OR	97850	04/01/2015	07/01/2015		08/14/2017
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #4381	1205 CAMPBELL ST	BAKER CITY	OR	97814	04/01/2015	07/01/2015		08/14/2017
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0371	601 W NORTH ST	ENTERPRISE	OR	97828-1427	04/01/2015	07/01/2015		08/14/2017
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1160	1600 PLAZA WAY	WALLA WALLA	WA	99362	07/12/2017	10/01/2017	05/07/2018	05/24/2018
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1590	455 N COLUMBIA ST	MILTON FREEWATER	OR	97862	07/12/2017	10/01/2017	07/31/2018	08/27/2018
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1642	201 SW 20TH ST	PENDLETON	OR	97801-1864	07/12/2017	10/01/2017	07/31/2018	08/27/2018
Contract Detail	SAFEWAY INC	SAV-ON PHARMACY #3211	1120 CAMPBELL ST	BAKER CITY	OR	97814	07/17/2017	10/01/2017	07/31/2018	08/27/2018
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5396	1217 CAMPBELL STREET	BAKER CITY	OR	97814	04/14/2017	07/01/2017	07/11/2023	07/12/2023
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5398	2212 ISLAND AVENUE SUITE 201	LA GRANDE	OR	97850	04/14/2017	07/01/2017	04/30/2023	07/12/2023
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2019	10/01/2019		10/01/2019
Contract Detail	WAL-MART PHARMACY 10-1889	11619 ISLAND AVENUE		ISLAND CITY	OR	97850	04/02/2015	07/01/2015		08/14/2017
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2019	10/01/2019		10/01/2019
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/12/2023	04/01/2023		04/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/11/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH381321-01	Child	CAH	Grande Ronde Hospital, Inc.	GRANDE RONDE HOSPITAL WOMENS CLINIC	710 SUNSET DR	LA GRANDE	OR	Active
CAH381321-02	Child	CAH	Grande Ronde Hospital, Inc.	GRANDE RONDE HOSP REGL ORTHO CLINIC	710 SUNSET DR STE F	LA GRANDE	OR	Active
CAH381321-03	Child	CAH	Grande Ronde Hospital, Inc.	GRANDE RONDE HOSPITAL REGIONAL MEDI	506 4TH ST	LA GRANDE	OR	Active
CAH381321-04	Child	CAH	Grande Ronde Hospital, Inc.	GRANDE RONDE HOSPITAL CHILDRENS CLI	710 SUNSET DR	LA GRANDE	OR	Active
CAH381321-05	Child	CAH	Grande Ronde Hospital, Inc.	GRANDE RONDE HOSP REGL ENT CLINIC	710 SUNSET DR STE F	LA GRANDE	OR	Active
CAH381321-06	Child	CAH	Grande Ronde Hospital, Inc.	ELGIN CLINIC	570 S. 8th St.	ELGIN	OR	Active
CAH381321-07	Child	CAH	Grande Ronde Hospital, Inc.	GRANDE RONDE HOSP UROLOGY CLINIC	700 SUNSET DR	LA GRANDE	OR	Active
CAH381321-08	Child	CAH	Grande Ronde Hospital, Inc.	Grande Ronde Hospital Union Clinic	142 E DEARBORN	UNION	OR	Active
CAH381321-09	Child	CAH	Grande Ronde Hospital, Inc.	Neurology - Neurology	700 Sunset Drive Ste A	La Grande	OR	Active
CAH381321-10	Child	CAH	Grande Ronde Hospital, Inc.	General Surgery - Surgeons Clinic	710 Sunset Drive	La Grande	OR	Active
CAH381321-11	Child	CAH	Grande Ronde Hospital, Inc.	GRANDE RONDE HOSPITAL - Dermatology	700 SUNSET DR	LA GRANDE	OR	Active
CAH381321-12	Child	CAH	Grande Ronde Hospital, Inc.	GRANDE RONDE HOSPITAL - Rheumatology	710 SUNSET DR	LA GRANDE	OR	Active
CAH381321-13	Child	CAH	Grande Ronde Hospital, Inc.	GRANDE RONDE HOSPITAL - Podiatry	710 SUNSET DR	LA GRANDE	OR	Active
CAH381321-14	Child	CAH	Grande Ronde Hospital, Inc.	GRANDE RONDE HOSPITAL - Urgent Care	10303 S WALTON RD	LA GRANDE	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 3:19:48 PM	8/20/2024 1:36:01 PM	8/20/2024 1:36 PM
Contacts	Primary Contact	Update	Change Request	Hickey, Amy A Senior Accountant Grande Ronde Hospital 5419622535	Murphy, Hope A Pharmacy Manager Grande Ronde Hospital, Inc. 5419631878	10/12/2023 9:42 AM
Details	Last Recertification Date	Update	Recertification	8/30/2022 4:23:21 PM	8/17/2023 3:19:48 PM	8/17/2023 3:19 PM
Details	Last Recertification Date	Update	Recertification	8/17/2021 5:07:02 PM	8/30/2022 4:23:21 PM	8/30/2022 4:23 PM
Details	Last Recertification Date	Update	Recertification	8/24/2020 8:23:43 AM	8/17/2021 5:07:02 PM	8/17/2021 5:07 PM
Details	Last Recertification Date	Update	Recertification	9/10/2019 7:33:24 AM	8/24/2020 8:23:43 AM	8/24/2020 8:23 AM
Details	Last Recertification Date	Update	Recertification	8/27/2018 5:23:04 PM	9/10/2019 7:33:24 AM	9/10/2019 7:33 AM
Details	Last Recertification Date	Update	Recertification	11/7/2017 8:14:58 AM	8/27/2018 5:23:04 PM	8/27/2018 5:23 PM
Contacts	Primary Contact	Insert	Recertification		Hickey, Amy A Senior Accountant Grande Ronde Hospital 5419622535	11/7/2017 8:14 AM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/7/2017 8:14:58 AM	11/7/2017 8:14 AM
Contacts	Authorizing Official	Insert	Change Request		Seymour, Robert CFO/Senior Director of Finance Grand Ronde Hospital 5419631463	11/2/2017 10:21 AM
Contacts	Signed By	Insert			Weis, Wade E. Sr. Director of Finance/CFO 5419631463	8/14/2017 7:36 AM
Addresses	Main Address	Insert			900 Sunset Drive La Grande, OR 97850	8/14/2017 7:36 AM
Details	Last Recertification Date	Update		8/7/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 1:53 PM
Details	Last Recertification Date	Update		9/5/2014 12:00:00 AM	8/7/2015 12:00:00 AM	8/7/2015 12:05 PM
Details	Last Recertification Date	Update		9/6/2013 10:54:45 AM	9/5/2014 12:00:00 AM	9/5/2014 6:11 PM
Details	Last Recertification Date	Update			9/6/2013 10:54:45 AM	9/6/2013 10:54 AM
Details	340B ID	Update		IS-FF-CAH381321	CAH381321-00	1/22/2013 11:03 AM
Dates	Participating Approval Date	Update			1/22/2013 12:00:00 AM	1/22/2013 11:03 AM
Details	State	Update		Pending	Active	1/22/2013 11:03 AM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	1/22/2013 11:03 AM
Details	340B ID	Update		FF CAH381321	IS-FF-CAH381321	1/18/2013 10:37 AM
Details	340B ID	Update		FF011313B	FF CAH381321	1/16/2013 3:10 PM
Details	340B ID	Update		ONLINE_REG	FF011313B	1/13/2013 10:02 AM
Details	Last Recertification Date	Insert				1/11/2013 2:59 PM
Details	Grant Number	Insert				1/11/2013 2:59 PM
Details	340B ID	Insert			ONLINE_REG	1/11/2013 2:59 PM
Details	Is Authorizing Official EHB Data	Insert				1/11/2013 2:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/11/2013 2:59 PM
Details	Medicare Provider Number	Insert			381321	1/11/2013 2:59 PM
Details	Entity Name	Insert			Grande Ronde Hospital, Inc.	1/11/2013 2:59 PM
Details	Program Code	Insert			CAH	1/11/2013 2:59 PM
Details	Entity Subname	Insert				1/11/2013 2:59 PM
Dates	Participating Approval Date	Insert				1/11/2013 2:59 PM
Details	State	Insert			Pending	1/11/2013 2:59 PM
Dates	Registration Date	Insert			1/11/2013 12:00:00 AM	1/11/2013 2:59 PM
Dates	Signed By Date	Insert			1/11/2013 12:00:00 AM	1/11/2013 2:59 PM
Dates	Start Date	Insert				1/11/2013 2:59 PM
Terminations	Termination Comments	Insert				1/11/2013 2:59 PM
Terminations	Termination Date	Insert				1/11/2013 2:59 PM
Terminations	Termination Effective Date	Insert				1/11/2013 2:59 PM
Terminations	Termination Reason	Insert				1/11/2013 2:59 PM