340B Drug Pricing Program Database


CAH291309-00 BOULDER CITY HOSPITAL (Active) - information as of 5/6/2025 11:10:24 PM

Main Details
BOULDER CITY HOSPITAL
Critical Access Hospital
No
CAH291309-00
291309


Additional Details
Active
7/20/2015
10/1/2015
8/7/2015
8/22/2024

Contacts

Boulder City Hospital
Douglas B. Lewis, CFO
(702) 293-4111 Ext: 6509

Boulder City Hospital
Roger Kent Waddington, Pharmacy Manager
(702) 293-4111 Ext: 1517

Addresses

901 ADAMS BLVD
BOULDER CITY, NV 89005-2247

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09548 2501 ANTHEM VILLAGE DR
HENDERSONNV8905207/12/201910/01/2019 04/11/202204/11/2022
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01507 2935 S. HOLLYWOOD BLVD
LAS VEGASNV8912207/12/201910/01/2019 04/11/202204/11/2022
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08799 1360 E. FLAMINGO RD.
LAS VEGASNV8911907/12/201910/01/2019 01/01/202001/07/2021
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08800 6705 E. LAKE MEAD BLVD
LAS VEGASNV8915607/12/201910/01/2019 04/11/202204/11/2022
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08803 2855 S NELLIS BLVD
LAS VEGASNV8912107/12/201910/01/2019 04/11/202204/11/2022
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08813 1017 NEVADA HIGHWAY
BOULDER CITYNV8900507/12/201910/01/2019 04/11/202204/11/2022
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08824 4411 E. BONANZA RD
LAS VEGASNV8911007/12/201910/01/2019 04/11/202204/11/2022
Contract DetailNEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 09770 2830 BICENTENNIAL PKWY.
HENDERSONNV8904407/12/201910/01/2019 04/11/202204/11/2022
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 05286 21 W. HORIZON RIDGE PARKWAY
HENDERSONNV8901207/12/201910/01/2019 04/11/202204/11/2022
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 05792 2425 E. DESERT INN RD.
LAS VEGASNV8912107/12/201910/01/2019 04/11/202204/11/2022
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 16079 4001 S MARYLAND PKWY
LAS VEGASNV8911907/12/201910/01/2019 04/11/202204/11/2022
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.CVS PHARMACY # 16531 9725 S EASTERN AVE
LAS VEGASNV8918307/12/201910/01/2019 04/11/202204/11/2022
Contract DetailWARM SPRINGS ROAD CVS, L.L.C.DBA: CVS/PHARMACY # 02930 4595 E. FLAMINGO RD.
LAS VEGASNV8912110/10/201901/01/2020 04/11/202204/11/2022
Contract DetailWASHINGTON LAMB CVS, L.L.C.DBA: CVS/PHARMACY # 03172 4391 E. WASHINGTON AVE.
LAS VEGASNV8911007/12/201910/01/2019 04/11/202204/11/2022
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/17/2023 3:13:49 PM8/22/2024 7:51:41 AM8/22/2024 7:51 AM
DetailsLast Recertification DateUpdateRecertification8/30/2022 10:30:51 AM8/17/2023 3:13:49 PM8/17/2023 3:13 PM
DetailsLast Recertification DateUpdateRecertification8/23/2021 11:08:05 AM8/30/2022 10:30:51 AM8/30/2022 10:30 AM
DetailsLast Recertification DateUpdateRecertification9/4/2020 11:24:32 AM8/23/2021 11:08:05 AM8/23/2021 11:08 AM
ContactsPrimary ContactUpdateChange RequestPastian, Andre Rene CNO Boulder City Hospital 7022934111-6512Waddington, Roger Kent Pharmacy Manager Boulder City Hospital 7022934111-15177/19/2021 7:32 AM
ContactsPrimary ContactUpdateChange RequestWest, Stephanie Pharmacy Manager Boulder City Hospital 7022945708Pastian, Andre Rene CNO Boulder City Hospital 7022934111-65121/25/2021 10:35 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestLewis, Douglas B. CFO Boulder City Hospital 7022945709Lewis, Douglas B. CFO Boulder City Hospital 7022934111-65091/7/2021 12:49 PM
ContactsSigned ByUpdateProfile Change RequestLewis, Douglas B. CFO Boulder City Hospital 7022945709Lewis, Douglas B. CFO Boulder City Hospital 7022934111-65091/7/2021 12:49 PM
DetailsLast Recertification DateUpdateRecertification8/26/2019 10:19:39 AM9/4/2020 11:24:32 AM9/4/2020 11:24 AM
DetailsLast Recertification DateUpdateRecertification8/27/2018 9:13:16 AM8/26/2019 10:19:39 AM8/26/2019 10:19 AM
ContactsPrimary ContactUpdateChange RequestBelete, Frey Controller Boulder City Hospital 7022945711West, Stephanie Pharmacy Manager Boulder City Hospital 70229457088/29/2018 4:48 PM
DetailsLast Recertification DateUpdateRecertification11/15/2017 1:10:20 PM8/27/2018 9:13:16 AM8/27/2018 9:13 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1102839 (NV) 11/15/2017 1:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1881739613 ( ) 11/15/2017 1:10 PM
ContactsPrimary ContactUpdateRecertificationLewis, Douglas B. CFO 7022945709Belete, Frey Controller Boulder City Hospital 702294571111/15/2017 1:10 PM
DetailsLast Recertification DateUpdateRecertification8/15/2016 12:00:00 AM11/15/2017 1:10:20 PM11/15/2017 1:10 PM
ContactsAuthorizing OfficialUpdate Lewis, Douglas B. CFO 7022945709Lewis, Douglas B. CFO Boulder City Hospital 702294570910/30/2017 5:16 PM
ContactsSigned ByUpdate Lewis, Douglas B. CFO 7022945709Lewis, Douglas B. CFO Boulder City Hospital 702294570910/30/2017 5:16 PM
AddressesMain AddressInsert   901 ADAMS BLVD BOULDER CITY, NV 89005-22478/15/2016 6:47 PM
ContactsAuthorizing OfficialInsert  Lewis, Douglas B. CFO 70229457098/15/2016 6:47 PM
ContactsPrimary ContactInsert  Lewis, Douglas B. CFO 70229457098/15/2016 6:47 PM
ContactsSigned ByInsert  Lewis, Douglas B. CFO 70229457098/15/2016 6:47 PM
DetailsLast Recertification DateUpdate  8/15/2016 12:00:00 AM8/15/2016 6:47 PM
DatesParticipating Approval DateUpdate  8/7/2015 12:00:00 AM8/7/2015 10:50 AM
DetailsStateUpdate PendingActive8/7/2015 10:50 AM
DatesStart DateUpdate  10/1/2015 12:00:00 AM8/7/2015 10:50 AM
Details340B IDUpdate ONLINE_REG_54072CAH291309-008/7/2015 10:15 AM
Details340B IDUpdate  ONLINE_REG_540727/20/2015 5:19 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False7/20/2015 5:19 PM
Medicaid BillingMedicaid: NumberInsert  11028397/20/2015 5:19 PM
Medicaid BillingMedicaid: StateInsert  NV7/20/2015 5:19 PM
Medicaid BillingNPI: NumberInsert  18817396137/20/2015 5:19 PM
DetailsLast Recertification DateInsert   7/20/2015 5:19 PM
DetailsGrant NumberInsert   7/20/2015 5:19 PM
Details340B IDInsert   7/20/2015 5:19 PM
DetailsIs Authorizing Official EHB DataInsert   7/20/2015 5:19 PM
DatesLast Date That 340B Drugs PurchasedInsert   7/20/2015 5:19 PM
DetailsMedicare Provider NumberInsert  2913097/20/2015 5:19 PM
DetailsEntity NameInsert  BOULDER CITY HOSPITAL7/20/2015 5:19 PM
DetailsProgram CodeInsert  CAH7/20/2015 5:19 PM
DetailsEntity SubnameInsert   7/20/2015 5:19 PM
DatesParticipating Approval DateInsert   7/20/2015 5:19 PM
DetailsStateInsert  Pending7/20/2015 5:19 PM
DatesRegistration DateInsert  7/20/2015 12:00:00 AM7/20/2015 5:19 PM
DatesSigned By DateInsert  7/20/2015 12:00:00 AM7/20/2015 5:19 PM
DatesStart DateInsert   7/20/2015 5:19 PM
TerminationsTermination CommentsInsert   7/20/2015 5:19 PM
TerminationsTermination DateInsert   7/20/2015 5:19 PM
TerminationsTermination Effective DateInsert   7/20/2015 5:19 PM
TerminationsTermination ReasonInsert   7/20/2015 5:19 PM