Covered Entity Details

CAH381320-02 Columbia Lutheran Charities DBA Columbia Memorial Hospital (Active) - information as of 5/26/2025 12:54:33 AM

Main Details

Name

Columbia Lutheran Charities DBA Columbia Memorial Hospital

Subdivision Name

CMH Urology Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH381320-02

Medicare Provider Number

381320

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/13/2013

Participating Start Date

4/1/2013

Participating Approval Date

2/12/2013

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Columbia Memorial Hospital
Chris Laman, Vice President of Strategy
(503) 338-7505

Primary Contact

Columbia Memorial Hospital
Jeffrey Chow, Outpatient Pharmacy Manager
(503) 738-3006

Addresses

Street Address

2265 Exchange Street
Astoria, OR 97103

Billing Address

Columbia Lutheran Charities DBA Columbia Memorial Hospital
CMH Urology Clinic
2111 Exchange Street
Astoria, OR 97103

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

Shipping Address 1

Columbia Lutheran Charities DBA Columbia Memorial Hospital
CMH Urology Clinic
2111 Exchange Street
Astoria, OR 97103

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH381320-01	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	CMH WC Clinic	2265 Exchange Street	Astoria	OR	Active
CAH381320-02	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	CMH Urology Clinic	2265 Exchange Street	Astoria	OR	Active
CAH381320-03	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	CMH Orthopedic Clinic	2265 Exchange Street	Astoria	OR	Active
CAH381320-04	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	CMH General Surgery Clinic	2055 Exchange Street	Astoria	OR	Active
CAH381320-05	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	CMH Pediatric Clinic	2158 Exchange St.	Astoria	OR	Active
CAH381320-06	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	CMH Cardiology Clinic	2095 Exchange Street	Astoria	OR	Active
CAH381320-07	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	CMH Oncology Clinic	1905 Exchange Street	Astoria	OR	Active
CAH381320-08	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	CMH Urgent Care Clinic	2265 Exchange Street	Astoria	OR	Active
CAH381320-09	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	COLUMBIA LUTHERAN CHARITIES - Rural Health Clinic	1639 SE ENSIGN LN	WARRENTON	OR	Active
CAH381320-10	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	CMH PULMONOLOGY CLINIC - Pulmonology	2055 Exchange St	ASTORIA	OR	Active
CAH381320-11	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	CMH ENDOCRINOLOGY CLINIC - Endocrinology	2158 EXCHANGE ST	ASTORIA	OR	Active
CAH381320-12	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	Astoria Primary Care - Primary Care	2158 Exchange ST	Astoria	OR	Active
CAH381320-13	Child	CAH	Columbia Lutheran Charities DBA Columbia Memorial Hospital	COLUMBIA LUTHERAN CHARITIES - Seaside Clinic	1111 N ROOSEVELT DR	SEASIDE	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 11:52:31 AM	8/20/2024 12:52:44 PM	8/20/2024 12:52 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 10:49:19 AM	8/29/2023 11:52:31 AM	8/29/2023 11:52 AM
Contacts	Primary Contact	Update	PC Change Request	Laman, Chris Vice President of Strategy Columbia Memorial Hospital 5033387505	Chow, Jeffrey Outpatient Pharmacy Manager Columbia Memorial Hospital 5037383006	8/14/2023 1:53 PM
Contacts	Authorizing Official	Update	Change Request	Safley, Tom VP of Finance 5033387505	Laman, Chris Vice President of Strategy Columbia Memorial Hospital 5033387505	11/29/2022 1:58 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 2:36:24 PM	8/30/2022 10:49:19 AM	8/30/2022 10:49 AM
Contacts	Primary Contact	Update	Profile Change Request	Laman, Chris Vice President of Strategy Columbia Memorial Hospital 5033384665	Laman, Chris Vice President of Strategy Columbia Memorial Hospital 5033387505	8/29/2022 11:04 AM
Details	Last Recertification Date	Update	Recertification	8/20/2020 2:39:59 PM	8/23/2021 2:36:24 PM	8/23/2021 2:36 PM
Contacts	Primary Contact	Update	Profile Change Request	Laman, Chris Director of Pharmacy & Cancer Center Services Columbia Memorial Hospital 5033384665	Laman, Chris Vice President of Strategy Columbia Memorial Hospital 5033384665	8/18/2021 6:48 PM
Details	Last Recertification Date	Update	Recertification	8/27/2019 4:12:51 PM	8/20/2020 2:39:59 PM	8/20/2020 2:39 PM
Contacts	Primary Contact	Update	Profile Change Request	Laman, Chris Director of Pharmacy & Cancer Center Services Columbia Memorial Hospital 5033384581	Laman, Chris Director of Pharmacy & Cancer Center Services Columbia Memorial Hospital 5033384665	8/20/2020 1:15 PM
Details	Last Recertification Date	Update	Recertification	8/28/2018 11:55:44 AM	8/27/2019 4:12:51 PM	8/27/2019 4:12 PM
Details	Last Recertification Date	Update	Recertification	12/5/2017 10:17:35 AM	8/28/2018 11:55:44 AM	8/28/2018 11:55 AM
Contacts	Authorizing Official	Update	Change Request	Thorsen, Erik CEO Columbia Memorial Hospital 5033254321-3476	Schmitt, Zachary Chief Financial Officer Columbia Memorial Hospital 5033387505	1/16/2018 10:39 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	170989 (OR)		1/15/2018 1:32 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134146939 ( )		1/15/2018 1:32 PM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	12/5/2017 10:17:35 AM	12/5/2017 10:17 AM
Contacts	Authorizing Official	Update	AO Change Request	Brenden, Stephanie VP of Finance 5033384517	Thorsen, Erik CEO Columbia Memorial Hospital 5033254321-3476	11/6/2017 12:13 PM
Contacts	Primary Contact	Update		Laman, Chris Director of Pharmacy & Cancer Center Services 5033384581	Laman, Chris Director of Pharmacy & Cancer Center Services Columbia Memorial Hospital 5033384581	9/29/2017 9:29 AM
Contacts	Authorizing Official	Update		Schmitt, Zachary Chief Financial Officer Columbia Memorial Hospital 5033387505	Safley, Tom VP of Finance 5033387505	9/11/2017 3:29 PM
Contacts	Signed By	Insert			Rivers, William Guy Chief Financial Officer 5033384002	6/15/2017 6:46 PM
Contacts	Primary Contact	Insert			Laman, Chris Director of Pharmacy & Cancer Center Services 5033384581	6/15/2017 6:46 PM
Contacts	Authorizing Official	Insert			Brenden, Stephanie VP of Finance 5033384517	1/10/2017 11:37 AM
Addresses	Main Address	Insert			2265 Exchange Street Astoria, OR 97103	8/29/2016 5:32 PM
Addresses	Billing Address	Insert			Columbia Lutheran Charities DBA Columbia Memorial Hospital CMH Urology Clinic 2111 Exchange Street Astoria, OR 97103	8/29/2016 5:32 PM
Addresses	Shipping Address	Insert			Columbia Lutheran Charities DBA Columbia Memorial Hospital CMH Urology Clinic 2111 Exchange Street Astoria, OR 97103	8/29/2016 5:32 PM
Medicaid Billing	Medicaid: Number	Update		500642622	170989	8/29/2016 5:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/18/2016 11:09 AM
Medicaid Billing	Medicaid: Number	Insert			500642622	8/18/2016 11:09 AM
Medicaid Billing	Medicaid: State	Insert			OR	8/18/2016 11:09 AM
Medicaid Billing	NPI: Number	Insert			1134146939	8/18/2016 11:09 AM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 11:09 AM
Details	Last Recertification Date	Update		9/5/2014 12:00:00 AM	8/25/2015 12:00:00 AM	8/25/2015 4:08 PM
Details	Last Recertification Date	Update		9/6/2013 5:29:05 PM	9/5/2014 12:00:00 AM	9/5/2014 12:13 PM
Details	Last Recertification Date	Update			9/6/2013 5:29:05 PM	9/6/2013 5:29 PM
Details	340B ID	Update		ISBLCAH381320-02	CAH381320-02	2/12/2013 5:08 PM
Dates	Participating Approval Date	Update			2/12/2013 12:00:00 AM	2/12/2013 5:08 PM
Details	State	Update		Pending	Active	2/12/2013 5:08 PM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	2/12/2013 5:08 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	ISBLCAH381320-02	2/7/2013 5:06 PM
Details	Last Recertification Date	Insert				1/13/2013 10:56 PM
Details	Grant Number	Insert				1/13/2013 10:56 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/13/2013 10:56 PM
Details	Is Authorizing Official EHB Data	Insert				1/13/2013 10:56 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/13/2013 10:56 PM
Details	Medicare Provider Number	Insert			381320	1/13/2013 10:56 PM
Details	Entity Name	Insert			Columbia Lutheran Charities DBA Columbia Memorial Hospital	1/13/2013 10:56 PM
Details	Program Code	Insert			CAH	1/13/2013 10:56 PM
Details	Entity Subname	Insert			CMH Urology Clinic	1/13/2013 10:56 PM
Dates	Participating Approval Date	Insert				1/13/2013 10:56 PM
Details	State	Insert			Pending	1/13/2013 10:56 PM
Dates	Registration Date	Insert			1/13/2013 12:00:00 AM	1/13/2013 10:56 PM
Dates	Signed By Date	Insert			1/13/2013 12:00:00 AM	1/13/2013 10:56 PM
Dates	Start Date	Insert				1/13/2013 10:56 PM
Terminations	Termination Comments	Insert				1/13/2013 10:56 PM
Terminations	Termination Date	Insert				1/13/2013 10:56 PM
Terminations	Termination Effective Date	Insert				1/13/2013 10:56 PM
Terminations	Termination Reason	Insert				1/13/2013 10:56 PM