Covered Entity Details

CAH381325-04 GOOD SHEPHERD MEDICAL CENTER (Active) - information as of 5/20/2025 12:51:34 AM

Main Details

Name

GOOD SHEPHERD MEDICAL CENTER

Subdivision Name

GOOD SHEPHERD MEDICAL GROUP / CARDIOLOGY

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH381325-04

Medicare Provider Number

381325

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/11/2016

Participating Start Date

1/1/2017

Participating Approval Date

10/21/2016

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

Good Shepherd Medical Center
Art Mathisen, President/CEO
(541) 667-3409

Primary Contact

Good Shepherd Medical Center
John Eric Adams, Director of Pharmacy Services
(541) 667-3647

Addresses

Street Address

600 N.W. 11TH STREET
GSMG CARDIOLOGY
SUITE E-23
HERMISTON, OR 97838

Billing Address

Good Shepherd Medical Center
610 N.W. 11th Street
Pharmacy Department
Hermiston, OR 97838

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

Good Shepherd Medical Center
610 N.W. 11th Street
Pharmacy Department
Hermiston, OR 97838

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
CAH381325-01	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP / OB/GYN	620 N.W. 11TH STREET	HERMISTON	OR	Active
CAH381325-02	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP / UROLOGY	620 N.W. 11TH STREET	HERMISTON	OR	Active
CAH381325-03	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP / SURGERY	620 N.W. 11TH STREET	HERMISTON	OR	Active
CAH381325-04	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP / CARDIOLOGY	600 N.W. 11TH STREET	HERMISTON	OR	Active
CAH381325-05	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP / PAIN MANAGEMENT	600 N.W. 11TH STREET	HERMISTON	OR	Terminated
CAH381325-06	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP / RURAL HEALTH CLINIC - PEDIATRICS	600 N.W. 11TH STREET	HERMISTON	OR	Terminated
CAH381325-07	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP / INTERNAL MEDICINE	620 N.W. 11TH STREET	HERMISTON	OR	Active
CAH381325-08	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	VANGE JOHN MEMORIAL HOSPICE	645 W. ORCHARD AVE	HERMISTON	OR	Active
CAH381325-09	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP FAMILY NURSE PRACTITIONERS / FAMILY NURSE PRACTITIONERS	600 N.W. 11TH STREET	HERMISTON	OR	Terminated
CAH381325-10	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP PEDIATRICS	600 N.W. 11TH STREET	HERMISTON	OR	Active
CAH381325-11	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP - ORTHOPEDICS	620 N.W. 11TH STREET	HERMISTON	OR	Active
CAH381325-12	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP PHYSICAL MEDICINE AND REHABILITATION CLINIC - PHYSICAL MEDICINE AND REHABILITATION CLINIC	1050 W. Elm	HERMISTON	OR	Active
CAH381325-13	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	GOOD SHEPHERD MEDICAL GROUP PRIMARY CARE CLINIC - PRIMARY CARE/FAMILY PRACTICE	600 N.W. 11TH STREET	HERMISTON	OR	Active
CAH381325-14	Child	CAH	GOOD SHEPHERD MEDICAL CENTER	Good Shepherd Cancer Center - Hematology and Oncology	620 N.W. 11th ST	Hermiston	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Mathisen, Art President/CEO Good Shepherd Medical Center 5416673609	Mathisen, Art President/CEO Good Shepherd Medical Center 5416673409	10/9/2024 8:20 PM
Details	Last Recertification Date	Update	Recertification	8/30/2023 1:37:48 PM	9/4/2024 11:08:55 AM	9/4/2024 11:08 AM
Details	Last Recertification Date	Update	Recertification	9/8/2022 12:07:30 PM	8/30/2023 1:37:48 PM	8/30/2023 1:37 PM
Contacts	Authorizing Official	Update	Change Request	Schuster, Emmett C Interim CEO Good Shepherd Medical Center 5416673409	Mathisen, Art President/CEO Good Shepherd Medical Center 5416673609	8/14/2023 6:15 AM
Contacts	Authorizing Official	Update	Change Request	Sims, Brian S. President/CEO Good Shepherd Medical Center 5416673409	Schuster, Emmett C Interim CEO Good Shepherd Medical Center 5416673409	2/14/2023 6:56 AM
Details	Last Recertification Date	Update	Recertification	9/9/2021 5:03:25 PM	9/8/2022 12:07:30 PM	9/8/2022 12:07 PM
Addresses	Billing Address	Insert	Recertification		Good Shepherd Medical Center 610 N.W. 11th Street Pharmacy Department Hermiston, OR 97838	9/9/2021 5:03 PM
Addresses	Shipping Address	Insert	Recertification		Good Shepherd Medical Center 610 N.W. 11th Street Pharmacy Department Hermiston, OR 97838	9/9/2021 5:03 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 5:20:05 PM	9/9/2021 5:03:25 PM	9/9/2021 5:03 PM
Contacts	Authorizing Official	Update	Change Request	BURKE, DENNIS PRESIDENT/CEO Good Shepherd Health Care System 5416673409	Sims, Brian S. President/CEO Good Shepherd Medical Center 5416673409	10/7/2020 5:07 PM
Details	Last Recertification Date	Update	Recertification	9/5/2019 6:42:33 AM	9/9/2020 5:20:05 PM	9/9/2020 5:20 PM
Addresses	Main Address	Update	Recertification	600 N.W. 11TH STREET SUITE E-37 HERMISTON, OR 97838	600 N.W. 11TH STREET GSMG CARDIOLOGY SUITE E-23 HERMISTON, OR 97838	9/5/2019 6:42 AM
Details	Last Recertification Date	Update	Recertification	8/29/2018 7:31:58 PM	9/5/2019 6:42:33 AM	9/5/2019 6:42 AM
Details	Last Recertification Date	Update	Recertification	12/4/2017 4:06:54 PM	8/29/2018 7:31:58 PM	8/29/2018 7:31 PM
Details	Last Recertification Date	Update	Recertification		12/4/2017 4:06:54 PM	12/4/2017 4:06 PM
Contacts	Authorizing Official	Update		BURKE, DENNIS PRESIDENT/CEO 5416673409	BURKE, DENNIS PRESIDENT/CEO Good Shepherd Health Care System 5416673409	12/4/2017 1:19 PM
Contacts	Signed By	Update		BURKE, DENNIS PRESIDENT/CEO 5416673409	BURKE, DENNIS PRESIDENT/CEO Good Shepherd Health Care System 5416673409	12/4/2017 1:19 PM
Contacts	Primary Contact	Update		Adams, John Director of Pharmacy Services 5416673647	Adams, John Eric Director of Pharmacy Services Good Shepherd Medical Center 5416673647	9/27/2017 11:55 AM
Contacts	Primary Contact	Insert			Adams, John Director of Pharmacy Services 5416673647	7/25/2017 10:11 AM
Contacts	Authorizing Official	Insert			BURKE, DENNIS PRESIDENT/CEO 5416673409	7/25/2017 10:11 AM
Contacts	Signed By	Insert			BURKE, DENNIS PRESIDENT/CEO 5416673409	7/25/2017 10:11 AM
Addresses	Main Address	Insert			600 N.W. 11TH STREET SUITE E-37 HERMISTON, OR 97838	7/25/2017 10:11 AM
Dates	Participating Approval Date	Update			10/21/2016 12:00:00 AM	10/21/2016 11:34 AM
Details	State	Update		Pending	Active	10/21/2016 11:34 AM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	10/21/2016 11:34 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_72829	CAH381325-04	10/11/2016 2:51 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_72829	10/11/2016 11:41 AM
Details	Last Recertification Date	Insert				10/11/2016 11:41 AM
Details	Grant Number	Insert				10/11/2016 11:41 AM
Details	340B ID	Insert				10/11/2016 11:41 AM
Details	Is Authorizing Official EHB Data	Insert				10/11/2016 11:41 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/11/2016 11:41 AM
Details	Medicare Provider Number	Insert			381325	10/11/2016 11:41 AM
Details	Entity Name	Insert			GOOD SHEPHERD MEDICAL CENTER	10/11/2016 11:41 AM
Details	Program Code	Insert			CAH	10/11/2016 11:41 AM
Details	Entity Subname	Insert			GOOD SHEPHERD MEDICAL GROUP / CARDIOLOGY	10/11/2016 11:41 AM
Dates	Participating Approval Date	Insert				10/11/2016 11:41 AM
Details	State	Insert			Pending	10/11/2016 11:41 AM
Dates	Registration Date	Insert			10/11/2016 12:00:00 AM	10/11/2016 11:41 AM
Dates	Signed By Date	Insert			10/11/2016 12:00:00 AM	10/11/2016 11:41 AM
Dates	Start Date	Insert				10/11/2016 11:41 AM
Terminations	Termination Comments	Insert				10/11/2016 11:41 AM
Terminations	Termination Date	Insert				10/11/2016 11:41 AM
Terminations	Termination Effective Date	Insert				10/11/2016 11:41 AM
Terminations	Termination Reason	Insert				10/11/2016 11:41 AM