Covered Entity Details

CAH271332-01 GLENDIVE MEDICAL CENTER INC (Active) - information as of 5/20/2025 12:53:16 AM

Main Details

Name

GLENDIVE MEDICAL CENTER INC

Subdivision Name

Gabert Clinic

Type

Critical Access Hospital

Rural

340B ID

CAH271332-01

Medicare Provider Number

271332

Outpatient Facility Provider Number

273411

Additional Details

Current Program Status

Active

Registration Date

7/7/2017

Participating Start Date

10/1/2017

Participating Approval Date

7/7/2017

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Glendive Medical Center
Parker Powell, CEO
(406) 345-3302

Primary Contact

Glendive Medical Center
Bill Robinson, VP of Finance
(406) 345-8924

Addresses

Street Address

107 Dilworth Street
Glendive, MT 59330

Billing Address

Glendive Medical Center
202 Prospect Drive
Glendive, MT 59330

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

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
CAH271332-01	Child	CAH	GLENDIVE MEDICAL CENTER INC	Gabert Clinic	107 Dilworth Street	Glendive	MT	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 4:27:29 PM	9/3/2024 5:02:06 PM	9/3/2024 5:02 PM
Details	Last Recertification Date	Update	Recertification	9/12/2022 12:45:41 PM	8/29/2023 4:27:29 PM	8/29/2023 4:27 PM
Details	Last Recertification Date	Update	Recertification	8/31/2021 3:35:48 PM	9/12/2022 12:45:41 PM	9/12/2022 12:45 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 3:42:49 PM	8/31/2021 3:35:48 PM	8/31/2021 3:35 PM
Details	Last Recertification Date	Update	Recertification	9/4/2019 12:59:46 PM	8/19/2020 3:42:49 PM	8/19/2020 3:42 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 10:39:55 AM	9/4/2019 12:59:46 PM	9/4/2019 12:59 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 10:40:01 AM	8/22/2018 10:39:55 AM	8/22/2018 10:39 AM
Details	Last Recertification Date	Update	Recertification		11/15/2017 10:40:01 AM	11/15/2017 10:40 AM
Contacts	Authorizing Official	Update		Powell, Parker CEO 4063453302	Powell, Parker CEO Glendive Medical Center 4063453302	11/15/2017 10:29 AM
Contacts	Signed By	Update		Powell, Parker CEO 4063453302	Powell, Parker CEO Glendive Medical Center 4063453302	11/15/2017 10:29 AM
Contacts	Primary Contact	Update		Robinson, Bill VP of Finance 4063458924	Robinson, Bill VP of Finance Glendive Medical Center 4063458924	11/1/2017 6:49 PM
Addresses	Main Address	Insert			107 Dilworth Street Glendive, MT 59330	7/7/2017 5:32 PM
Addresses	Billing Address	Insert			Glendive Medical Center 202 Prospect Drive Glendive, MT 59330	7/7/2017 5:32 PM
Contacts	Authorizing Official	Insert			Powell, Parker CEO 4063453302	7/7/2017 5:32 PM
Contacts	Signed By	Insert			Powell, Parker CEO 4063453302	7/7/2017 5:32 PM
Contacts	Primary Contact	Insert			Robinson, Bill VP of Finance 4063458924	7/7/2017 5:32 PM
Details	State	Update		Approved	Active	7/7/2017 5:32 PM
Dates	Participating Approval Date	Update			7/7/2017 12:00:00 AM	7/7/2017 5:32 PM
Details	State	Update		Pending	Approved	7/7/2017 5:32 PM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/7/2017 5:32 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_77943	CAH271332-01	7/7/2017 1:59 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_77943	7/7/2017 11:31 AM
Details	Last Recertification Date	Insert				7/7/2017 11:31 AM
Details	Grant Number	Insert				7/7/2017 11:31 AM
Details	340B ID	Insert				7/7/2017 11:31 AM
Details	Is Authorizing Official EHB Data	Insert				7/7/2017 11:31 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/7/2017 11:31 AM
Details	Medicare Provider Number	Insert			271332	7/7/2017 11:31 AM
Details	Entity Name	Insert			GLENDIVE MEDICAL CENTER INC	7/7/2017 11:31 AM
Details	Program Code	Insert			CAH	7/7/2017 11:31 AM
Details	Entity Subname	Insert			Gabert Clinic	7/7/2017 11:31 AM
Dates	Participating Approval Date	Insert				7/7/2017 11:31 AM
Details	State	Insert			Pending	7/7/2017 11:31 AM
Dates	Registration Date	Insert			7/7/2017 12:00:00 AM	7/7/2017 11:31 AM
Dates	Signed By Date	Insert			7/7/2017 12:00:00 AM	7/7/2017 11:31 AM
Dates	Start Date	Insert				7/7/2017 11:31 AM
Terminations	Termination Comments	Insert				7/7/2017 11:31 AM
Terminations	Termination Date	Insert				7/7/2017 11:31 AM
Terminations	Termination Effective Date	Insert				7/7/2017 11:31 AM
Terminations	Termination Reason	Insert				7/7/2017 11:31 AM