Covered Entity Details

DSH380002B THREE RIVERS MEDICAL CENTER (Active) - information as of 5/13/2025 1:35:03 AM

Main Details

Name

THREE RIVERS MEDICAL CENTER

Subdivision Name

ASANTE THREE RIVERS MEDICAL CENTER / Outpatient surgery & Endoscopy

Type

Disproportionate Share Hospital

Rural

340B ID

DSH380002B

Medicare Provider Number

380002

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/11/2016

Participating Start Date

1/1/2017

Participating Approval Date

10/26/2016

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Asante
Heather Rowenhorst, CFO
(541) 789-5098

Primary Contact

Asante
Ruthie Nguyen, Manager Pharmacy Shared Services
(541) 789-5379

Addresses

Street Address

537 SW UNION AVE 3
GRANTS PASS, OR 97527-5543

Billing Address
Same as Street Address

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?
Yes

State	Medicaid Number	NPI Number
OR	022560	1801891809

Shipping Addresses

Same as Street Address

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
DSH380002A	Child	DSH	THREE RIVERS MEDICAL CENTER	Spears Cancer Center	510 SW Ramsey Avenue	Grants Pass	OR	Active
DSH380002B	Child	DSH	THREE RIVERS MEDICAL CENTER	ASANTE THREE RIVERS MEDICAL CENTER / Outpatient surgery & Endoscopy	537 SW UNION AVE 3	GRANTS PASS	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Watson, Amy Director of Pharmacy Asante 5417895031	Nguyen, Ruthie Manager Pharmacy Shared Services Asante 5417895379	3/12/2025 3:39 PM
Details	Last Recertification Date	Update	Recertification	8/21/2023 8:08:10 PM	8/13/2024 8:10:08 AM	8/13/2024 8:10 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 3:44:04 PM	8/21/2023 8:08:10 PM	8/21/2023 8:08 PM
Contacts	Authorizing Official	Update	Change Request	Wojtal, Greg Chief Administrative and Finance Officer Asante 5417894549	Rowenhorst, Heather CFO Asante 5417895098	5/25/2023 7:44 AM
Contacts	Primary Contact	Update	Change Request	Rowenhorst, Heather CFO Asante 5417895098	Watson, Amy Director of Pharmacy Asante 5417895031	5/25/2023 7:44 AM
Contacts	Primary Contact	Update	Group Change Request	Watson, Amy Director of Pharmacy Asante 5417895031	Rowenhorst, Heather CFO Asante 5417895098	5/23/2023 2:46 PM
Details	Last Recertification Date	Update	Recertification	8/17/2021 2:24:20 PM	8/29/2022 3:44:04 PM	8/29/2022 3:44 PM
Details	Last Recertification Date	Update	Recertification	8/17/2020 6:09:22 PM	8/17/2021 2:24:20 PM	8/17/2021 2:24 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1801891809 ( )		8/17/2020 6:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801891809	8/17/2020 6:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	8/17/2020 6:09 PM
Details	Last Recertification Date	Update	Recertification	9/4/2019 6:30:06 PM	8/17/2020 6:09:22 PM	8/17/2020 6:09 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 5:31:51 PM	9/4/2019 6:30:06 PM	9/4/2019 6:30 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/11/2019 12:03 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		022560	6/11/2019 12:03 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	6/11/2019 12:03 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1801891809	6/11/2019 12:03 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 12:11:56 PM	8/20/2018 5:31:51 PM	8/20/2018 5:31 PM
Details	Last Recertification Date	Update	Recertification		11/15/2017 12:11:56 PM	11/15/2017 12:11 PM
Contacts	Authorizing Official	Update		Wojtal, Greg Chief Administrative and Finance Officer 5417894549	Wojtal, Greg Chief Administrative and Finance Officer Asante 5417894549	9/21/2017 1:54 PM
Contacts	Primary Contact	Update		Watson, Amy Director of Pharmacy 5417895031	Watson, Amy Director of Pharmacy Asante 5417895031	9/20/2017 6:58 PM
Contacts	Primary Contact	Insert			Watson, Amy Director of Pharmacy 5417895031	1/24/2017 8:42 AM
Contacts	Authorizing Official	Insert			Wojtal, Greg Chief Administrative and Finance Officer 5417894549	1/24/2017 8:42 AM
Contacts	Signed By	Insert			Hocking, Patrick Chief Administrative and Finance Officer 5417894549	1/24/2017 8:42 AM
Addresses	Main Address	Insert			537 SW UNION AVE 3 GRANTS PASS, OR 97527-5543	1/17/2017 7:08 AM
Dates	Participating Approval Date	Update			10/26/2016 12:00:00 AM	10/26/2016 5:52 PM
Details	State	Update		Pending	Active	10/26/2016 5:52 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	10/26/2016 5:52 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_72855	DSH380002B	10/13/2016 8:17 AM
Details	Entity Subname	Update		ASANTE THREE RIVERS MEDICAL CENTER / Outpatient surgery	ASANTE THREE RIVERS MEDICAL CENTER / Outpatient surgery & Endoscopy	10/13/2016 8:13 AM
Details	Entity Subname	Update		ASANTE THREE RIVERS MEDICAL CENTER / Outpatient surgery & endoscopy	ASANTE THREE RIVERS MEDICAL CENTER / Outpatient surgery	10/11/2016 3:31 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_72855	10/11/2016 1:34 PM
Details	Last Recertification Date	Insert				10/11/2016 1:34 PM
Details	Grant Number	Insert				10/11/2016 1:34 PM
Details	340B ID	Insert				10/11/2016 1:34 PM
Details	Is Authorizing Official EHB Data	Insert				10/11/2016 1:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/11/2016 1:34 PM
Details	Medicare Provider Number	Insert			380002	10/11/2016 1:34 PM
Details	Entity Name	Insert			THREE RIVERS MEDICAL CENTER	10/11/2016 1:34 PM
Details	Program Code	Insert			DSH	10/11/2016 1:34 PM
Details	Entity Subname	Insert			ASANTE THREE RIVERS MEDICAL CENTER / Outpatient surgery & endoscopy	10/11/2016 1:34 PM
Dates	Participating Approval Date	Insert				10/11/2016 1:34 PM
Details	State	Insert			Pending	10/11/2016 1:34 PM
Dates	Registration Date	Insert			10/11/2016 12:00:00 AM	10/11/2016 1:34 PM
Dates	Signed By Date	Insert			10/11/2016 12:00:00 AM	10/11/2016 1:34 PM
Dates	Start Date	Insert				10/11/2016 1:34 PM
Terminations	Termination Comments	Insert				10/11/2016 1:34 PM
Terminations	Termination Date	Insert				10/11/2016 1:34 PM
Terminations	Termination Effective Date	Insert				10/11/2016 1:34 PM
Terminations	Termination Reason	Insert				10/11/2016 1:34 PM