Covered Entity Details

CAH381313-01 St. Charles Health System, Inc., d/b/a St. Charles Prineville (Terminated) - information as of 5/30/2025 8:13:08 PM

Main Details

Name

St. Charles Health System, Inc., d/b/a St. Charles Prineville

Subdivision Name

St. Charles Family Care - Prineville

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH381313-01

Medicare Provider Number

381313

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/13/2014

Participating Start Date

1/1/2015

Participating Approval Date

12/11/2014

Last Recertification Date

8/19/2019

Termination Date
Termination Reason

10/1/2019
Outpatient facility moved within the 4 walls of the parent hospital

Contacts

Authorizing Official

St. Charles Health System, Inc.
Jennifer Rue Welander, Chief Financial Officer
(541) 706-7707

Primary Contact

St. Charles Health System, Inc.
Linda Kay Higginson, 340B Program Manager
(541) 706-6978

Addresses

Street Address

384 SE Combs Flat Rd
Prineville, OR 97754

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	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
CAH381313-01	Child	CAH	St. Charles Health System, Inc., d/b/a St. Charles Prineville	St. Charles Family Care - Prineville	384 SE Combs Flat Rd	Prineville	OR	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Details	State	Update	Termination Request	Active	To Be Terminated	9/30/2019 1:06 PM
Terminations	Termination Comments	Update	Termination Request		St. Charles Family Care -Prineville located within the four walls of the covered entity CAH381313 so already eligible for 340B	9/30/2019 1:06 PM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	9/30/2019 1:06 PM
Terminations	Termination Effective Date	Update	Termination Request		10/1/2019 12:00:00 AM	9/30/2019 1:06 PM
Terminations	Termination Reason	Update	Termination Request		Outpatient facility moved within the 4 walls of the parent hospital	9/30/2019 1:06 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 10:19:36 AM	8/19/2019 5:40:23 PM	8/19/2019 5:40 PM
Details	Last Recertification Date	Update	Recertification	11/16/2017 9:42:58 AM	8/22/2018 10:19:36 AM	8/22/2018 10:19 AM
Contacts	Primary Contact	Update	Change Request	Powell, Michael Director of Pharmacy St Charles Health System 5417066832	Higginson, Linda Kay 340B Program Manager St. Charles Health System, Inc. 5417066978	7/25/2018 9:01 AM
Details	Entity Name	Update	Recertification	St. Charles Health System, Inc.	St. Charles Health System, Inc., d/b/a St. Charles Prineville	11/16/2017 10:53 AM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/16/2017 9:42:58 AM	11/16/2017 9:42 AM
Contacts	Authorizing Official	Update		Welander, Jennifer Chief Financial Officer 5417067707	Welander, Jennifer Rue Chief Financial Officer St. Charles Health System, Inc. 5417067707	11/1/2017 10:01 AM
Contacts	Primary Contact	Update		Powell, Michael Director of Pharmacy 5417066832	Powell, Michael Director of Pharmacy St Charles Health System 5417066832	10/31/2017 8:05 PM
Contacts	Authorizing Official	Insert			Welander, Jennifer Chief Financial Officer 5417067707	7/26/2017 5:52 PM
Contacts	Primary Contact	Insert			Powell, Michael Director of Pharmacy 5417066832	5/25/2017 9:38 AM
Contacts	Signed By	Insert			Bruce, Gary VP General Counsel 5417063707	11/22/2016 5:15 PM
Addresses	Main Address	Insert			384 SE Combs Flat Rd Prineville, OR 97754	11/15/2016 12:37 PM
Details	Entity Name	Update		St. Charles Health System, Inc. PRINEVILLE	St. Charles Health System, Inc.	11/15/2016 12:37 PM
Details	Last Recertification Date	Update		8/7/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 6:14 PM
Details	Entity Name	Update		St. Charles Health System, Inc.	St. Charles Health System, Inc. PRINEVILLE	7/28/2016 10:52 AM
Details	Entity Name	Update		PIONEER MEMORIAL HOSPITAL	St. Charles Health System, Inc.	12/31/2015 9:33 AM
Details	Entity Subname	Update		Family Care in Prineville	St. Charles Family Care - Prineville	12/31/2015 9:33 AM
Details	Last Recertification Date	Update			8/7/2015 12:00:00 AM	8/7/2015 7:27 AM
Dates	Participating Approval Date	Update			12/11/2014 12:00:00 AM	12/11/2014 6:46 AM
Details	State	Update		Pending	Active	12/11/2014 6:46 AM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	12/11/2014 6:46 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_47200	CAH381313-01	11/26/2014 1:11 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_47200	10/13/2014 7:35 PM
Details	Last Recertification Date	Insert				10/13/2014 7:35 PM
Details	Grant Number	Insert				10/13/2014 7:35 PM
Details	340B ID	Insert				10/13/2014 7:35 PM
Details	Is Authorizing Official EHB Data	Insert				10/13/2014 7:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/13/2014 7:35 PM
Details	Medicare Provider Number	Insert			381313	10/13/2014 7:35 PM
Details	Entity Name	Insert			PIONEER MEMORIAL HOSPITAL	10/13/2014 7:35 PM
Details	Program Code	Insert			CAH	10/13/2014 7:35 PM
Details	Entity Subname	Insert			Family Care in Prineville	10/13/2014 7:35 PM
Dates	Participating Approval Date	Insert				10/13/2014 7:35 PM
Details	State	Insert			Pending	10/13/2014 7:35 PM
Dates	Registration Date	Insert			10/13/2014 12:00:00 AM	10/13/2014 7:35 PM
Dates	Signed By Date	Insert			10/13/2014 12:00:00 AM	10/13/2014 7:35 PM
Dates	Start Date	Insert				10/13/2014 7:35 PM
Terminations	Termination Comments	Insert				10/13/2014 7:35 PM
Terminations	Termination Date	Insert				10/13/2014 7:35 PM
Terminations	Termination Effective Date	Insert				10/13/2014 7:35 PM
Terminations	Termination Reason	Insert				10/13/2014 7:35 PM