Covered Entity Details

CAH271320-03 ST. JOHN'S LUTHERAN HOSPITAL DBA CABINET PEAKS MEDICAL CENTER (Active) - information as of 4/27/2025 1:46:31 AM

Main Details

Name

ST. JOHN'S LUTHERAN HOSPITAL DBA CABINET PEAKS MEDICAL CENTER

Subdivision Name

Cabinet Peaks Medical Group

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH271320-03

Medicare Provider Number

271320

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/9/2015

Participating Start Date

1/1/2016

Participating Approval Date

12/2/2015

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

St. John's Lutheran Hospital DBA Cabinet Peaks Medical Center
Gayl Smith, Controller
(406) 283-7139

Primary Contact

Cabinet Peaks Medical Center
Amie Wells, Pharmacy Manager
(406) 283-7189

Addresses

Street Address

350 LOUISIANA AVE
LIBBY, MT 59923

Billing Address

Cabinet Peaks Medical Center
209 Health Park Drive
Libby, MT 59923

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

Cabinet Peaks Medical Center
209 Health Park Drive
Libby, MT 59923

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
CAH271320-01	Child	CAH	ST. JOHN'S LUTHERAN HOSPITAL DBA CABINET PEAKS MEDICAL CENTER	OBSERVATION/EMERGENCY ROOM/AMBULATORY SURGERY	209 Health Park Drive	LIBBY	MT	Active
CAH271320-02	Child	CAH	St. John's Lutheran Hospital DBA Cabinet Peaks Medical Center	PHYSICIANS AND SURGEONS GROUP	401 Louisiana Ave	LIBBY	MT	Terminated
CAH271320-03	Child	CAH	ST. JOHN'S LUTHERAN HOSPITAL DBA CABINET PEAKS MEDICAL CENTER	Cabinet Peaks Medical Group	350 LOUISIANA AVE	LIBBY	MT	Active
CAH271320-04	Child	CAH	ST. JOHN'S LUTHERAN HOSPITAL DBA CABINET PEAKS MEDICAL CENTER	CABINET PEAKS MEDICAL CENTER - Cabinet Peaks Clinic-General Surgery	308 LOUISIANA AVE	LIBBY	MT	Active
CAH271320-05	Child	CAH	ST. JOHN'S LUTHERAN HOSPITAL DBA CABINET PEAKS MEDICAL CENTER	Cabinet Peaks Clinic - Orthopedics	308 LOUISIANA AVE	LIBBY	MT	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/22/2023 12:51:58 PM	8/19/2024 3:24:34 PM	8/19/2024 3:24 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 11:10:21 AM	8/22/2023 12:51:58 PM	8/22/2023 12:51 PM
Details	Last Recertification Date	Update	Recertification	9/1/2021 5:20:59 PM	8/29/2022 11:10:21 AM	8/29/2022 11:10 AM
Contacts	Authorizing Official	Update	AO Change Request	Burke, Brigid CFO Cabinet Peaks Medical Center 4062837219	Smith, Gayl Controller St. John's Lutheran Hospital DBA Cabinet Peaks Medical Center 4062837139	8/25/2022 6:38 AM
Details	Last Recertification Date	Update	Recertification	8/28/2020 5:37:11 PM	9/1/2021 5:20:59 PM	9/1/2021 5:20 PM
Details	Last Recertification Date	Update	Recertification	8/29/2019 9:53:18 AM	8/28/2020 5:37:11 PM	8/28/2020 5:37 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 11:23:51 AM	8/29/2019 9:53:18 AM	8/29/2019 9:53 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 10:53:29 AM	8/17/2018 11:23:51 AM	8/17/2018 11:23 AM
Details	Entity Name	Update	Recertification	CABINET PEAKS MEDICAL CENTER	ST. JOHN'S LUTHERAN HOSPITAL DBA CABINET PEAKS MEDICAL CENTER	11/15/2017 12:57 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/15/2017 10:53:29 AM	11/15/2017 10:53 AM
Contacts	Authorizing Official	Update		Burke, Brigid CFO 4062837219	Burke, Brigid CFO Cabinet Peaks Medical Center 4062837219	11/15/2017 10:45 AM
Contacts	Signed By	Update		Burke, Brigid CFO 4062837219	Burke, Brigid CFO Cabinet Peaks Medical Center 4062837219	11/15/2017 10:45 AM
Contacts	Primary Contact	Update		Wells, Amie Pharmacy Manager 4062837189	Wells, Amie Pharmacy Manager Cabinet Peaks Medical Center 4062837189	10/25/2017 1:23 PM
Addresses	Main Address	Insert			350 LOUISIANA AVE LIBBY, MT 59923	8/10/2016 5:40 PM
Contacts	Primary Contact	Insert			Wells, Amie Pharmacy Manager 4062837189	8/10/2016 5:40 PM
Contacts	Authorizing Official	Insert			Burke, Brigid CFO 4062837219	8/10/2016 5:40 PM
Contacts	Signed By	Insert			Burke, Brigid CFO 4062837219	8/10/2016 5:40 PM
Details	Last Recertification Date	Update			8/10/2016 12:00:00 AM	8/10/2016 5:40 PM
Details	Entity Subname	Update		St. John's Lutheran Hospital Walk-in Clinic	Cabinet Peaks Medical Group	8/10/2016 5:40 PM
Addresses	Billing Address	Insert			Cabinet Peaks Medical Center 209 Health Park Drive Libby, MT 59923	12/2/2015 2:08 PM
Addresses	Shipping Address	Insert			Cabinet Peaks Medical Center 209 Health Park Drive Libby, MT 59923	12/2/2015 2:08 PM
Dates	Participating Approval Date	Update			12/2/2015 12:00:00 AM	12/2/2015 2:08 PM
Details	State	Update		Pending	Active	12/2/2015 2:08 PM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	12/2/2015 2:08 PM
Details	340B ID	Update		DEL_11122015_54925	CAH271320-03	12/2/2015 10:43 AM
Details	Entity Subname	Update		St. John's Lutheran Hospital	St. John's Lutheran Hospital Walk-in Clinic	12/2/2015 10:43 AM
Details	State	Update		Rejected	Pending	12/2/2015 10:43 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_54925	DEL_11122015_54925	11/12/2015 9:45 AM
Details	State	Update		Pending	Rejected	11/12/2015 9:45 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_54925	10/9/2015 4:06 PM
Details	Last Recertification Date	Insert				10/9/2015 4:06 PM
Details	Grant Number	Insert				10/9/2015 4:06 PM
Details	340B ID	Insert				10/9/2015 4:06 PM
Details	Is Authorizing Official EHB Data	Insert				10/9/2015 4:06 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/9/2015 4:06 PM
Details	Medicare Provider Number	Insert			271320	10/9/2015 4:06 PM
Details	Entity Name	Insert			CABINET PEAKS MEDICAL CENTER	10/9/2015 4:06 PM
Details	Program Code	Insert			CAH	10/9/2015 4:06 PM
Details	Entity Subname	Insert			St. John's Lutheran Hospital	10/9/2015 4:06 PM
Dates	Participating Approval Date	Insert				10/9/2015 4:06 PM
Details	State	Insert			Pending	10/9/2015 4:06 PM
Dates	Registration Date	Insert			10/9/2015 12:00:00 AM	10/9/2015 4:06 PM
Dates	Signed By Date	Insert			10/9/2015 12:00:00 AM	10/9/2015 4:06 PM
Dates	Start Date	Insert				10/9/2015 4:06 PM
Terminations	Termination Comments	Insert				10/9/2015 4:06 PM
Terminations	Termination Date	Insert				10/9/2015 4:06 PM
Terminations	Termination Effective Date	Insert				10/9/2015 4:06 PM
Terminations	Termination Reason	Insert				10/9/2015 4:06 PM