Covered Entity Details

CAH381315-01 ST. ALPHONSUS MEDICAL CENTER BAKER CITY (Active) - information as of 6/25/2025 12:54:43 AM

Main Details

Name

ST. ALPHONSUS MEDICAL CENTER BAKER CITY

Subdivision Name

SAMG Baker Clinic Family Practice

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH381315-01

Medicare Provider Number

381315

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/15/2016

Participating Start Date

10/1/2016

Participating Approval Date

8/23/2016

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Saint Alphonsus Health System
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347

Primary Contact

Trinity Health
Carisa Ann McGehee, 340B Analyst
(208) 367-2087

Addresses

Street Address

3325 Pocahontas Road
Baker City, OR 97814-1434

Billing Address

Saint Alphonsus Medical Center Baker City
3325 Pocahontas Road
Baker City, OR 97814-1464

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

Saint Alphonsus Medical Center Baker City
3325 Pocahontas Road
Baker City, OR 97814-1464

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
CAH381315-01	Child	CAH	ST. ALPHONSUS MEDICAL CENTER BAKER CITY	SAMG Baker Clinic Family Practice	3325 Pocahontas Road	Baker City	OR	Active
CAH381315-02	Child	CAH	ST. ALPHONSUS MEDICAL CENTER BAKER CITY	SAMG / Rheumatology	3325 Pocahontas Road	Baker City	OR	Terminated
CAH381315-03	Child	CAH	ST. ALPHONSUS MEDICAL CENTER BAKER CITY	SAMG Valley Medical / Urgent Care	3820 17th Street	Baker City	OR	Terminated
CAH381315-04	Child	CAH	ST. ALPHONSUS MEDICAL CENTER BAKER CITY	SAMG Valley Medical Clinic / Family Practice	3820 17th Street	Baker City	OR	Terminated
CAH381315-05	Child	CAH	ST. ALPHONSUS MEDICAL CENTER BAKER CITY	SAMG Orthopedics Baker City / Orthopedics	3325 Pocahontas Road	Baker City	OR	Active
CAH381315-06	Child	CAH	ST. ALPHONSUS MEDICAL CENTER BAKER CITY	SAMG General Surgery Baker City / General Surgery	3325 Pocahontas Road	Baker City	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Change Request	3175 Pocahontas Road Baker City, OR 97814-1434	3325 Pocahontas Road Baker City, OR 97814-1434	1/16/2025 1:19 PM
Details	Last Recertification Date	Update	Recertification	8/24/2023 6:13:15 PM	8/20/2024 2:23:05 PM	8/20/2024 2:23 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 12:08:07 PM	8/24/2023 6:13:15 PM	8/24/2023 6:13 PM
Details	Last Recertification Date	Update	Recertification	9/13/2021 10:34:38 AM	9/14/2022 12:08:07 PM	9/14/2022 12:08 PM
Details	Last Recertification Date	Update	Recertification	9/2/2020 3:23:35 PM	9/13/2021 10:34:38 AM	9/13/2021 10:34 AM
Details	Last Recertification Date	Update	Recertification	9/4/2019 2:27:04 PM	9/2/2020 3:23:35 PM	9/2/2020 3:23 PM
Details	Last Recertification Date	Update	Recertification	8/30/2018 12:25:15 PM	9/4/2019 2:27:04 PM	9/4/2019 2:27 PM
Contacts	Primary Contact	Update	Change Request	Phillips, Mark AVP Prof Services/Director SAHS Pharmacy Saint Alphonsus Health System 2083674943	McGehee, Carisa Ann 340B Analyst Trinity Health 2083672087	1/21/2019 2:16 PM
Details	Last Recertification Date	Update	Recertification	11/3/2017 1:16:54 PM	8/30/2018 12:25:15 PM	8/30/2018 12:25 PM
Details	Last Recertification Date	Update	Recertification		11/3/2017 1:16:54 PM	11/3/2017 1:16 PM
Contacts	Primary Contact	Update	New Registration	Phillips, Mark AVP Prof Services/Director SAHS Pharmacy 2083674943	Phillips, Mark AVP Prof Services/Director SAHS Pharmacy Saint Alphonsus Health System 2083674943	10/13/2017 9:51 AM
Contacts	Authorizing Official	Update		Checketts, Lannie RHM CFO Idaho Oregon Region 2083677347	Checketts, Lannie RHM CFO Idaho Oregon Region Saint Alphonsus Health System 2083677347	10/11/2017 12:18 PM
Contacts	Authorizing Official	Insert			Checketts, Lannie RHM CFO Idaho Oregon Region 2083677347	8/4/2017 10:49 AM
Contacts	Primary Contact	Insert			Phillips, Mark AVP Prof Services/Director SAHS Pharmacy 2083674943	8/4/2017 10:49 AM
Contacts	Signed By	Insert			GIBBONS, RAY CEO 5415232965	1/31/2017 8:02 PM
Addresses	Main Address	Insert			3175 Pocahontas Road Baker City, OR 97814-1434	1/31/2017 8:02 PM
Addresses	Billing Address	Insert			Saint Alphonsus Medical Center Baker City 3325 Pocahontas Road Baker City, OR 97814-1464	1/31/2017 8:02 PM
Addresses	Shipping Address	Insert			Saint Alphonsus Medical Center Baker City 3325 Pocahontas Road Baker City, OR 97814-1464	1/31/2017 8:02 PM
Dates	Participating Approval Date	Update			8/23/2016 12:00:00 AM	8/23/2016 10:17 AM
Details	State	Update		Pending	Active	8/23/2016 10:17 AM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	8/23/2016 10:17 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_71848	CAH381315-01	7/15/2016 10:34 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_71848	7/15/2016 9:43 AM
Details	Last Recertification Date	Insert				7/15/2016 9:43 AM
Details	Grant Number	Insert				7/15/2016 9:43 AM
Details	340B ID	Insert				7/15/2016 9:43 AM
Details	Is Authorizing Official EHB Data	Insert				7/15/2016 9:43 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2016 9:43 AM
Details	Medicare Provider Number	Insert			381315	7/15/2016 9:43 AM
Details	Entity Name	Insert			ST. ALPHONSUS MEDICAL CENTER BAKER CITY	7/15/2016 9:43 AM
Details	Program Code	Insert			CAH	7/15/2016 9:43 AM
Details	Entity Subname	Insert			SAMG Baker Clinic Family Practice	7/15/2016 9:43 AM
Dates	Participating Approval Date	Insert				7/15/2016 9:43 AM
Details	State	Insert			Pending	7/15/2016 9:43 AM
Dates	Registration Date	Insert			7/15/2016 12:00:00 AM	7/15/2016 9:43 AM
Dates	Signed By Date	Insert			7/15/2016 12:00:00 AM	7/15/2016 9:43 AM
Dates	Start Date	Insert				7/15/2016 9:43 AM
Terminations	Termination Comments	Insert				7/15/2016 9:43 AM
Terminations	Termination Date	Insert				7/15/2016 9:43 AM
Terminations	Termination Effective Date	Insert				7/15/2016 9:43 AM
Terminations	Termination Reason	Insert				7/15/2016 9:43 AM