Covered Entity Details

CAH061318-03 KREMMLING MEMORIAL HOSPITAL DISTRICT (Active) - information as of 5/15/2025 11:37:55 PM

Main Details

Name

KREMMLING MEMORIAL HOSPITAL DISTRICT

Subdivision Name

dba MIDDLE PARK HEALTH - GRANBY CAMPUS / OR department

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH061318-03

Medicare Provider Number

061318

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/10/2015

Participating Start Date

7/1/2015

Participating Approval Date

5/20/2015

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Kremmling Memorial Hospital District
Amy Binkley, CNO
(970) 724-3199

Primary Contact

Middle Park Health
Pauline Portinga, Certified Pharmacy Tech
(970) 724-3199

Addresses

Street Address

1000 GRANBY PARK DRIVE SOUTH
GRANBY, CO 80446

Billing Address

Kremmling Memorial Hospital District dba Middle Park Health - Granby Campus
PO Box 399
Kremmling, CO 80459

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
CAH061318-01	Child	CAH	KREMMLING MEMORIAL HOSPITAL DISTRICT	dba Middle Park Health - Granby Campus	1000 GRANBY PARK DRIVE SOUTH	GRANBY	CO	Active
CAH061318-02	Child	CAH	KREMMLING MEMORIAL HOSPITAL DISTRICT	dba MIDDLE PARK HEALTH - GRANBY CAMPUS / Emergency Department	1000 GRANBY PARK DRIVE SOUTH	GRANBY	CO	Active
CAH061318-03	Child	CAH	KREMMLING MEMORIAL HOSPITAL DISTRICT	dba MIDDLE PARK HEALTH - GRANBY CAMPUS / OR department	1000 GRANBY PARK DRIVE SOUTH	GRANBY	CO	Active
CAH061318-04	Child	CAH	KREMMLING MEMORIAL HOSPITAL DISTRICT	KREMMLING MEMORIAL HOSPITAL DIST/ Clinic	214 S 4th Street	KREMMLING	CO	Active
CAH061318-05	Child	CAH	KREMMLING MEMORIAL HOSPITAL DISTRICT	dba Middle Park Health - Winter Park Clinic - Rural Health Clinic	47 Cooper Creek Way	Winter Park	CO	Active
CAH061318-06	Child	CAH	KREMMLING MEMORIAL HOSPITAL DISTRICT	North Park Medical Center - Walden - Rural Health Clinic	350 McKinley Street	Walden	CO	Active
CAH061318-07	Child	CAH	KREMMLING MEMORIAL HOSPITAL DISTRICT	dba Middle Park Health - Granby Campus - Pain Management	1000 Granby Park Dr S	Granby	CO	Active
CAH061318-08	Child	CAH	KREMMLING MEMORIAL HOSPITAL DISTRICT	dba Middle Park Health - Grand Lake Clinic - Clinic	301 Marina Dr	Grand Lake	CO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Plemmons, Debra CNO Middle Park Medical Center 9707243121	Binkley, Amy CNO Kremmling Memorial Hospital District 9707243199	2/27/2025 6:16 AM
Details	Last Recertification Date	Update	Recertification	8/31/2023 6:33:33 PM	9/3/2024 1:20:49 PM	9/3/2024 1:20 PM
Details	Last Recertification Date	Update	Recertification	9/15/2022 2:02:17 PM	8/31/2023 6:33:33 PM	8/31/2023 6:33 PM
Addresses	Billing Address	Update	Recertification	Kremmling Memorial Hospital District dba Middle Park Medical Center PO Box 399 Kremmling, CO 80459	Kremmling Memorial Hospital District dba Middle Park Health - Granby Campus PO Box 399 Kremmling, CO 80459	9/15/2022 2:02 PM
Details	Last Recertification Date	Update	Recertification	8/18/2021 5:58:37 PM	9/15/2022 2:02:17 PM	9/15/2022 2:02 PM
Details	Entity Subname	Update	Recertification	MIDDLE PARK MEDICAL CENTER GRANBY / OR department	dba MIDDLE PARK HEALTH - GRANBY CAMPUS / OR department	9/15/2022 2:02 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 11:13:53 AM	8/18/2021 5:58:37 PM	8/18/2021 5:58 PM
Details	Last Recertification Date	Update	Recertification	9/4/2019 1:04:04 PM	9/4/2020 11:13:53 AM	9/4/2020 11:13 AM
Contacts	Primary Contact	Update	Profile Change Request	Portinga, Pauline Certified Pharmacy Tech Middle Park Health 9707243442-3199	Portinga, Pauline Certified Pharmacy Tech Middle Park Health 9707243199	9/3/2020 1:50 PM
Details	Last Recertification Date	Update	Recertification	8/23/2018 11:46:56 AM	9/4/2019 1:04:04 PM	9/4/2019 1:04 PM
Contacts	Primary Contact	Update	Profile Change Request	Portinga, Pauline Certified Pharmacy Tech Middle Park Medical Center 9707243124	Portinga, Pauline Certified Pharmacy Tech Middle Park Health 9707243442-3199	8/21/2019 3:32 PM
Details	Last Recertification Date	Update	Recertification	11/13/2017 10:11:20 AM	8/23/2018 11:46:56 AM	8/23/2018 11:46 AM
Contacts	Primary Contact	Insert	Recertification		Portinga, Pauline Certified Pharmacy Tech Middle Park Medical Center 9707243124	11/13/2017 10:11 AM
Details	Last Recertification Date	Update	Recertification	9/8/2016 12:00:00 AM	11/13/2017 10:11:20 AM	11/13/2017 10:11 AM
Contacts	Authorizing Official	Update		Plemmons, Debra CNO 9707243121	Plemmons, Debra CNO Middle Park Medical Center 9707243121	10/2/2017 11:17 AM
Contacts	Signed By	Insert			Gale, Brendan CFO 9707243111	9/8/2016 10:23 AM
Contacts	Authorizing Official	Insert			Plemmons, Debra CNO 9707243121	9/8/2016 10:23 AM
Addresses	Main Address	Insert			1000 GRANBY PARK DRIVE SOUTH GRANBY, CO 80446	9/8/2016 10:23 AM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	9/8/2016 12:00:00 AM	9/8/2016 10:23 AM
Details	Last Recertification Date	Update			8/10/2015 12:00:00 AM	8/10/2015 12:15 PM
Addresses	Billing Address	Insert			Kremmling Memorial Hospital District dba Middle Park Medical Center PO Box 399 Kremmling, CO 80459	5/20/2015 11:35 AM
Dates	Participating Approval Date	Update			5/20/2015 12:00:00 AM	5/20/2015 11:34 AM
Details	State	Update		Pending	Active	5/20/2015 11:34 AM
Dates	Start Date	Update			7/1/2015 12:00:00 AM	5/20/2015 11:34 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_51107	CAH061318-03	5/12/2015 5:05 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_51107	4/10/2015 3:34 PM
Details	Last Recertification Date	Insert				4/10/2015 3:34 PM
Details	Grant Number	Insert				4/10/2015 3:34 PM
Details	340B ID	Insert				4/10/2015 3:34 PM
Details	Is Authorizing Official EHB Data	Insert				4/10/2015 3:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/10/2015 3:34 PM
Details	Medicare Provider Number	Insert			061318	4/10/2015 3:34 PM
Details	Entity Name	Insert			KREMMLING MEMORIAL HOSPITAL DISTRICT	4/10/2015 3:34 PM
Details	Program Code	Insert			CAH	4/10/2015 3:34 PM
Details	Entity Subname	Insert			MIDDLE PARK MEDICAL CENTER GRANBY / OR department	4/10/2015 3:34 PM
Dates	Participating Approval Date	Insert				4/10/2015 3:34 PM
Details	State	Insert			Pending	4/10/2015 3:34 PM
Dates	Registration Date	Insert			4/10/2015 12:00:00 AM	4/10/2015 3:34 PM
Dates	Signed By Date	Insert			4/10/2015 12:00:00 AM	4/10/2015 3:34 PM
Dates	Start Date	Insert				4/10/2015 3:34 PM
Terminations	Termination Comments	Insert				4/10/2015 3:34 PM
Terminations	Termination Date	Insert				4/10/2015 3:34 PM
Terminations	Termination Effective Date	Insert				4/10/2015 3:34 PM
Terminations	Termination Reason	Insert				4/10/2015 3:34 PM