Covered Entity Details

CAH351312-00 NORTHWOOD DEACONESS HEALTH CENTER (Active) - information as of 5/23/2025 12:05:24 AM

Main Details

Name

NORTHWOOD DEACONESS HEALTH CENTER

Subdivision Name

Type

Critical Access Hospital

Rural

340B ID

CAH351312-00

Medicare Provider Number

351312

Additional Details

Current Program Status

Active

Registration Date

1/6/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/13/2015

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Northwood Deaconess Health Center
Greta McKenzie, CFO
(701) 587-6459

Primary Contact

Northwood Deaconess Health Center
Jenny A Metz, Pharmacy Manager
(701) 587-6480

Addresses

Street Address

4 N PARK STREET
NORTHWOOD, ND 58267

Billing Address

Northwood Deaconess Health Center
PO Box 190
Northwood, ND 58267-0190

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	LARIMORE DRUG AND GIFT INC	203 TOWNER AVENUE	BOX 438	LARIMORE	ND	58251	03/19/2015	04/01/2015	09/01/2020	09/01/2020
Contract Detail	PAUL BILDEN PHARMACY	10 NORTH MAIN STREET		NORTHWOOD	ND	58267-0399	03/19/2015	04/01/2015	07/01/2020	07/01/2020
Contract Detail	PHARMACISTS ASSOCIATES LLC	DBA COOPERSTOWN DRUG	901 BURREL AVE SE, PO BOX 627	COOPERSTOWN	ND	58425-0627	10/04/2018	01/01/2019		01/01/2019
Contract Detail	PHARMACISTS ASSOCIATES LLC	DBA NORTHWOOD DRUG	10 N MAIN ST	NORTHWOOD	ND	58267-4005	06/26/2020	07/01/2020		07/01/2020
Contract Detail	PHARMACISTS ASSOCIATES LLC	DBA LARIMORE DRUG	203 TOWNER AVE	LARIMORE	ND	58251	08/31/2020	09/01/2020		09/01/2020

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH351312-01	Child	CAH	NORTHWOOD DEACONESS HEALTH CENTER	Health Center Clinic Larimore	611 Towner Ave	Larimore	ND	Active
CAH351312-02	Child	CAH	NORTHWOOD DEACONESS HEALTH CENTER	Health Center Clinic Binford - Clinic	308 Whinery St	Binford	ND	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Antonson, Pete CFO Northwood Deaconess Health Center 7015876459	McKenzie, Greta CFO Northwood Deaconess Health Center 7015876459	4/2/2025 1:58 PM
Contacts	Authorizing Official	Update	Profile Change Request	Antonson, Pete CEO Northwood Deaconess Health Center 7015876459	Antonson, Pete CFO Northwood Deaconess Health Center 7015876459	3/18/2025 6:55 AM
Contacts	Signed By	Update	Profile Change Request	Antonson, Pete CEO Northwood Deaconess Health Center 7015876459	Antonson, Pete CFO Northwood Deaconess Health Center 7015876459	3/18/2025 6:55 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 3:23:08 PM	9/3/2024 12:41:50 PM	9/3/2024 12:41 PM
Details	Last Recertification Date	Update	Recertification	9/16/2022 6:23:00 AM	8/16/2023 3:23:08 PM	8/16/2023 3:23 PM
Details	Last Recertification Date	Update	Recertification	8/18/2021 9:39:51 AM	9/16/2022 6:23:00 AM	9/16/2022 6:23 AM
Details	Last Recertification Date	Update	Recertification	9/2/2020 4:52:53 PM	8/18/2021 9:39:51 AM	8/18/2021 9:39 AM
Details	Last Recertification Date	Update	Recertification	8/22/2019 11:28:46 AM	9/2/2020 4:52:53 PM	9/2/2020 4:52 PM
Contacts	Primary Contact	Update	Change Request	Schwartz, Tina Business Office Manager Northwood Deaconess Health Center 7015876454	Metz, Jenny A Pharmacy Manager Northwood Deaconess Health Center 7015876480	6/26/2020 6:41 AM
Details	Last Recertification Date	Update	Recertification	8/15/2018 4:17:40 PM	8/22/2019 11:28:46 AM	8/22/2019 11:28 AM
Details	Last Recertification Date	Update	Recertification	11/6/2017 12:55:56 PM	8/15/2018 4:17:40 PM	8/15/2018 4:17 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/6/2017 12:55:56 PM	11/6/2017 12:55 PM
Contacts	Primary Contact	Update	Recertification	Schwartz, Tina Business Office Manager 7015876454	Schwartz, Tina Business Office Manager Northwood Deaconess Health Center 7015876454	11/6/2017 10:59 AM
Contacts	Authorizing Official	Update		Antonson, Pete CEO 7015876459	Antonson, Pete CEO Northwood Deaconess Health Center 7015876459	10/18/2017 10:52 AM
Contacts	Signed By	Update		Antonson, Pete CEO 7015876459	Antonson, Pete CEO Northwood Deaconess Health Center 7015876459	10/18/2017 10:52 AM
Addresses	Main Address	Insert			4 N PARK STREET NORTHWOOD, ND 58267	8/10/2016 1:29 PM
Contacts	Authorizing Official	Insert			Antonson, Pete CEO 7015876459	8/10/2016 1:29 PM
Contacts	Signed By	Insert			Antonson, Pete CEO 7015876459	8/10/2016 1:29 PM
Contacts	Primary Contact	Insert			Schwartz, Tina Business Office Manager 7015876454	8/10/2016 1:29 PM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 1:29 PM
Details	Last Recertification Date	Update			8/10/2015 12:00:00 AM	8/10/2015 11:48 AM
Addresses	Billing Address	Insert			Northwood Deaconess Health Center PO Box 190 Northwood, ND 58267-0190	5/19/2015 4:14 PM
Dates	Participating Approval Date	Update			3/13/2015 12:00:00 AM	3/13/2015 10:48 AM
Details	State	Update		Pending	Active	3/13/2015 10:48 AM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/13/2015 10:48 AM
Details	340B ID	Update		ONLINE_REG_48241	CAH351312-00	1/6/2015 2:10 PM
Details	340B ID	Update			ONLINE_REG_48241	1/6/2015 11:04 AM
Details	Last Recertification Date	Insert				1/6/2015 11:04 AM
Details	Grant Number	Insert				1/6/2015 11:04 AM
Details	340B ID	Insert				1/6/2015 11:04 AM
Details	Is Authorizing Official EHB Data	Insert				1/6/2015 11:04 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/6/2015 11:04 AM
Details	Medicare Provider Number	Insert			351312	1/6/2015 11:04 AM
Details	Entity Name	Insert			NORTHWOOD DEACONESS HEALTH CENTER	1/6/2015 11:04 AM
Details	Program Code	Insert			CAH	1/6/2015 11:04 AM
Details	Entity Subname	Insert				1/6/2015 11:04 AM
Dates	Participating Approval Date	Insert				1/6/2015 11:04 AM
Details	State	Insert			Pending	1/6/2015 11:04 AM
Dates	Registration Date	Insert			1/6/2015 12:00:00 AM	1/6/2015 11:04 AM
Dates	Signed By Date	Insert			1/6/2015 12:00:00 AM	1/6/2015 11:04 AM
Dates	Start Date	Insert				1/6/2015 11:04 AM
Terminations	Termination Comments	Insert				1/6/2015 11:04 AM
Terminations	Termination Date	Insert				1/6/2015 11:04 AM
Terminations	Termination Effective Date	Insert				1/6/2015 11:04 AM
Terminations	Termination Reason	Insert				1/6/2015 11:04 AM