| Addresses | Billing Address | Update | Change Request | SCL HEALTH/St. Vincent
Attn: Accounts Payable
P.O. Box 1010
Lafayette, CO 80026 | Intermountain Health St Vincent Regional Hospital
Attn: Accounts Payable
P.O. Box 1010
Lafayette, CO 80026 | 1/22/2025 12:15 PM |
| Addresses | Shipping Address | Update | Change Request | SCL Health/St Vincent Pharmacy
1233 N 30th Street
Billings, MT 59101 | Intermountain Health St Vincent Regional Hospital Inpatient Pharmacy
1233 N 30th Street
Billings, MT 59101 | 1/22/2025 12:15 PM |
| Details | Entity Subname | Update | Change Request | ST VINCENT HEALTHCARE OUTPATIENT / Neurology | Neurology | 1/22/2025 12:15 PM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2023 3:54:20 PM | 8/19/2024 12:46:48 PM | 8/19/2024 12:46 PM |
| Details | Entity Name | Update | Change Request | St. Vincent Healthcare | Intermountain Health St Vincent Regional Hospital | 8/12/2024 1:00 PM |
| Contacts | Primary Contact | Update | Group Change Request | Stubbs, Charles B.
340B Pharmacist
Intermountain Healthcare
8012841113 | Landry, Ben
340B Pharmacist
Intermountain Health
2072005264 | 4/30/2024 8:04 AM |
| Details | Last Recertification Date | Update | Recertification | 9/8/2022 1:28:28 PM | 8/25/2023 3:54:20 PM | 8/25/2023 3:54 PM |
| Contacts | Primary Contact | Update | Group Change Request | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | Stubbs, Charles B.
340B Pharmacist
Intermountain Healthcare
8012841113 | 7/5/2023 8:35 AM |
| Contacts | Primary Contact | Update | Group Change Request | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | 2/22/2023 6:57 AM |
| Addresses | Billing Address | Update | Recertification | SCL Health
1233 North 30th Street
Billings, MT 59101 | SCL HEALTH/St. Vincent
Attn: Accounts Payable
P.O. Box 1010
Lafayette, CO 80026 | 9/8/2022 1:28 PM |
| Addresses | Shipping Address | Insert | Recertification | | SCL Health/St Vincent Pharmacy
1233 N 30th Street
Billings, MT 59101 | 9/8/2022 1:28 PM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2021 11:40:52 AM | 9/8/2022 1:28:28 PM | 9/8/2022 1:28 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Palagi, Pam
VP of Finacial Services
SCL Health
4067232414 | Palagi, Pam
VP Financial Services
SCL Health Montana Region
4067232414 | 9/6/2022 6:52 AM |
| Contacts | Primary Contact | Update | PC Change Request | Mains, Ashley
Director of Pharmacy Business Services
SCL Health
3038135016 | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | 6/21/2022 7:37 AM |
| Details | Last Recertification Date | Update | Recertification | 9/10/2020 10:20:03 AM | 9/2/2021 11:40:52 AM | 9/2/2021 11:40 AM |
| Addresses | Billing Address | Update | Change Request | SCL Health
PO Box 1010
Lafayette, CO 80026 | SCL Health
1233 North 30th Street
Billings, MT 59101 | 8/17/2021 7:16 PM |
| Addresses | Billing Address | Insert | Recertification | | SCL Health
PO Box 1010
Lafayette, CO 80026 | 9/10/2020 10:20 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1083655997 | 9/10/2020 10:20 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | WY | 9/10/2020 10:20 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | MT | 9/10/2020 10:20 AM |
| Contacts | Primary Contact | Update | Recertification | Finneman, Lonnye
Director of Pharmacy
SCL Health
4062378100 | Mains, Ashley
Director of Pharmacy Business Services
SCL Health
3038135016 | 9/10/2020 10:20 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2019 11:21:34 AM | 9/10/2020 10:20:03 AM | 9/10/2020 10:20 AM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2018 9:17:50 AM | 8/26/2019 11:21:34 AM | 8/26/2019 11:21 AM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2016 12:00:00 AM | 8/16/2018 9:17:50 AM | 8/16/2018 9:17 AM |
| Terminations | Termination Reason | Update | | Site closure | | 7/21/2018 12:21 PM |
| Details | State | Update | | Approved | Active | 7/1/2018 12:00 AM |
| Contacts | Signed By | Update | Reinstatement | Oldfield, Ron
CFO
4062373314 | Palagi, Pam
VP of Finacial Services
SCL Health
4067232414 | 6/4/2018 10:41 AM |
| Details | Entity Name | Update | Reinstatement | ST VINCENT HEALTHCARE | St. Vincent Healthcare | 6/4/2018 10:41 AM |
| Dates | Participating Approval Date | Update | Reinstatement | | 6/4/2018 10:41:27 AM | 6/4/2018 10:41 AM |
| Details | State | Update | Reinstatement | Pending | Approved | 6/4/2018 10:41 AM |
| Dates | Signed By Date | Update | Reinstatement | 10/15/2015 12:00:00 AM | 5/25/2018 5:09:54 PM | 6/4/2018 10:41 AM |
| Dates | Start Date | Update | Reinstatement | | 7/1/2018 12:00:00 AM | 6/4/2018 10:41 AM |
| Terminations | Termination Reason | Update | Reinstatement | | Site closure | 6/4/2018 10:41 AM |
| Details | Comments Public | Insert | Reinstatement | | Participated starting 1/1/2016; Terminated 7/1/2017; Reinstated 7/1/2018. | 6/1/2018 5:45 PM |
| Medicaid Billing | NPI: Number | Insert | Reinstatement | | 1083655997 | 5/25/2018 9:09 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 5/31/2017 12:00:00 AM | | 5/25/2018 5:09 PM |
| Dates | Participating Approval Date | Update | Reinstatement | 10/30/2015 12:00:00 AM | | 5/25/2018 5:09 PM |
| Details | State | Update | Reinstatement | Terminated | Pending | 5/25/2018 5:09 PM |
| Dates | Registration Date | Update | Reinstatement | 10/15/2015 12:00:00 AM | 5/25/2018 5:09:51 PM | 5/25/2018 5:09 PM |
| Dates | Start Date | Update | Reinstatement | 1/1/2016 12:00:00 AM | | 5/25/2018 5:09 PM |
| Terminations | Termination Comments | Update | Reinstatement | No longer in reimbursable section of cost report | | 5/25/2018 5:09 PM |
| Terminations | Termination Date | Update | Reinstatement | 7/1/2017 12:00:00 AM | | 5/25/2018 5:09 PM |
| Terminations | Termination Effective Date | Update | Reinstatement | 5/31/2017 12:00:00 AM | | 5/25/2018 5:09 PM |
| Terminations | Termination Reason | Update | Reinstatement | Site closure | | 5/25/2018 5:09 PM |
| Contacts | Primary Contact | Update | Reinstatement | Finneman, Lonnye
Director of Pharmacy
4062378100 | Finneman, Lonnye
Director of Pharmacy
SCL Health
4062378100 | 5/25/2018 5:05 PM |
| Contacts | Authorizing Official | Update | Change Request | Scremin, Karen
Interim CFO
SCL Health
3038135255 | Palagi, Pam
VP of Finacial Services
SCL Health
4067232414 | 2/12/2018 11:23 AM |
| Contacts | Authorizing Official | Update | | Scremin, Karen
Interim CFO
3038135255 | Scremin, Karen
Interim CFO
SCL Health
3038135255 | 10/11/2017 12:53 PM |
| Contacts | Signed By | Insert | | | Oldfield, Ron
CFO
4062373314 | 8/9/2017 11:45 AM |
| Contacts | Authorizing Official | Insert | | | Scremin, Karen
Interim CFO
3038135255 | 6/28/2017 12:44 PM |
| Contacts | Primary Contact | Insert | | | Finneman, Lonnye
Director of Pharmacy
4062378100 | 6/1/2017 1:48 PM |
| Addresses | Main Address | Insert | | |
1041 N 29TH ST
SVPN NEUROLOGY OUTPATIENT
BILLINGS, MT 59101-0731 | 6/1/2017 1:45 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 5/31/2017 12:00:00 AM | 6/1/2017 1:45 PM |
| Details | State | Update | | Active | Terminated | 6/1/2017 1:45 PM |
| Terminations | Termination Comments | Update | | | No longer in reimbursable section of cost report | 6/1/2017 1:45 PM |
| Terminations | Termination Date | Update | | | 7/1/2017 12:00:00 AM | 6/1/2017 1:45 PM |
| Terminations | Termination Effective Date | Update | | | 5/31/2017 12:00:00 AM | 6/1/2017 1:45 PM |
| Terminations | Termination Reason | Update | | | Site closure | 6/1/2017 1:45 PM |
| Details | Last Recertification Date | Update | | | 8/18/2016 12:00:00 AM | 8/18/2016 6:43 PM |
| Dates | Participating Approval Date | Update | | | 10/30/2015 12:00:00 AM | 10/30/2015 11:27 AM |
| Details | State | Update | | Pending | Active | 10/30/2015 11:27 AM |
| Dates | Start Date | Update | | | 1/1/2016 12:00:00 AM | 10/30/2015 11:27 AM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_55947 | DSH270049E | 10/29/2015 12:10 PM |
| Details | Entity Subname | Update | | ST VINCENT HEALTHCARE / SVB-SVPN-OP Neurology | ST VINCENT HEALTHCARE OUTPATIENT / Neurology | 10/29/2015 12:10 PM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_55947 | 10/15/2015 12:43 PM |
| Details | Last Recertification Date | Insert | | | | 10/15/2015 12:43 PM |
| Details | Grant Number | Insert | | | | 10/15/2015 12:43 PM |
| Details | 340B ID | Insert | | | | 10/15/2015 12:43 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/15/2015 12:43 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/15/2015 12:43 PM |
| Details | Medicare Provider Number | Insert | | | 270049 | 10/15/2015 12:43 PM |
| Details | Entity Name | Insert | | | ST VINCENT HEALTHCARE | 10/15/2015 12:43 PM |
| Details | Program Code | Insert | | | DSH | 10/15/2015 12:43 PM |
| Details | Entity Subname | Insert | | | ST VINCENT HEALTHCARE / SVB-SVPN-OP Neurology | 10/15/2015 12:43 PM |
| Dates | Participating Approval Date | Insert | | | | 10/15/2015 12:43 PM |
| Details | State | Insert | | | Pending | 10/15/2015 12:43 PM |
| Dates | Registration Date | Insert | | | 10/15/2015 12:00:00 AM | 10/15/2015 12:43 PM |
| Dates | Signed By Date | Insert | | | 10/15/2015 12:00:00 AM | 10/15/2015 12:43 PM |
| Dates | Start Date | Insert | | | | 10/15/2015 12:43 PM |
| Terminations | Termination Comments | Insert | | | | 10/15/2015 12:43 PM |
| Terminations | Termination Date | Insert | | | | 10/15/2015 12:43 PM |
| Terminations | Termination Effective Date | Insert | | | | 10/15/2015 12:43 PM |
| Terminations | Termination Reason | Insert | | | | 10/15/2015 12:43 PM |