Covered Entity Details

SCH380001-07 Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge (Active) - information as of 5/6/2025 11:04:56 PM

Main Details

Name

Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge

Subdivision Name

Celilo Cancer Center

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH380001-07

Medicare Provider Number

380001

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/13/2017

Participating Start Date

10/1/2017

Participating Approval Date

7/20/2017

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

Adventist Health Columbia Gorge
Jayme Beth Thompson, Administrator
(541) 506-6941

Primary Contact

Adventist Health Columbia Gorge
Amanda Dawn Cummings, PharmD, Director of Pharmacy
(541) 296-7526

Addresses

Street Address

1800 E. 19th Street
The Dalles, OR 97058

Billing Address

MID-COLUMBIA MEDICAL CENTER
1700 E 19th Street
The Dalles, OR 97058

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	70115,000070	1306842752,1053409599
WA	2008493,3347606	1306842752,1053409599

Shipping Addresses

Shipping Address 1

MID-COLUMBIA MEDICAL CENTER
1700 E 19th Street
The Dalles, OR 97058

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
SCH380001-01	Child	SCH	MID-COLUMBIA MEDICAL CENTER	MID-COLUMBIA MEDICAL CENTER- RIVERVIEW CLINIC RURAL HEALTH CLINIC	1825 E 19TH STREET	THE DALLES	OR	Terminated
SCH380001-02	Child	SCH	Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge	MID-COLUMBIA MEDICAL CENTER-WATER'S EDGE MEDICAL CLINIC - RURAL HEALTH CLINIC	551 LONE PINE BLVD	THE DALLES	OR	Active
SCH380001-03	Child	SCH	MID-COLUMBIA MEDICAL CENTER	MID-COLUMBIA MEDICAL CENTER-INTERNAL MEDICINE RURAL HEALTH CLINIC	1815 E 19TH STREET	THE DALLES	OR	Terminated
SCH380001-04	Child	SCH	Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge	MCMC FAMILY MEDICINE - RURAL HEALTH CLINIC	1620 E 12TH STREET	THE DALLES	OR	Active
SCH380001-06	Child	SCH	Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge	MCMC PEDIATRICS - RURAL HEALTH CLINIC	1935 East 19th Street	The Dalles	OR	Active
SCH380001-07	Child	SCH	Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge	Celilo Cancer Center	1800 E. 19th Street	The Dalles	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Apland, Wendy CFO MCMC d/b/a Adventist Health Columbia Gorge 5415065929	Thompson, Jayme Beth Administrator Adventist Health Columbia Gorge 5415066941	2/25/2025 7:25 AM
Details	Last Recertification Date	Update	Recertification	8/17/2023 1:10:10 PM	8/23/2024 4:28:32 PM	8/23/2024 4:28 PM
Details	Entity Name	Update	Change Request	MID-COLUMBIA MEDICAL CENTER	Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge	8/9/2024 8:42 AM
Contacts	Primary Contact	Update	Change Request	Cummings, Amanda Dawn Pharmacy Director MCMC DBA Adventist Health Columbia Gorge 5412967526	Cummings, Amanda Dawn PharmD, Director of Pharmacy Adventist Health Columbia Gorge 5412967526	6/18/2024 7:26 AM
Contacts	Authorizing Official	Update	AO Change Request	KNOX, DENNIS CEO Mid-Columbia Medical Center 5412967272	Apland, Wendy CFO MCMC d/b/a Adventist Health Columbia Gorge 5415065929	5/7/2024 8:32 AM
Contacts	Primary Contact	Update	Profile Change Request	Cummings, Amanda Dawn Pharmacy Director Mid-Columbia Medical Center 5412967526	Cummings, Amanda Dawn Pharmacy Director MCMC DBA Adventist Health Columbia Gorge 5412967526	5/7/2024 6:23 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 1:08:16 PM	8/17/2023 1:10:10 PM	8/17/2023 1:10 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 12:33:46 PM	9/1/2022 1:08:16 PM	9/1/2022 1:08 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 4:47:46 PM	8/23/2021 12:33:46 PM	8/23/2021 12:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/18/2020 4:47 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3347606	8/18/2020 4:47 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	8/18/2020 4:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/18/2020 4:47 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000070	8/18/2020 4:47 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	8/18/2020 4:47 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1053409599 ( )		8/18/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1306842752	8/18/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/18/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1306842752	8/18/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	8/18/2020 4:47 PM
Medicaid Billing	NPI: Number	Update	Recertification	1053409599	1053409599	8/18/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1053409599	8/18/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/18/2020 4:47 PM
Medicaid Billing	NPI: Number	Update	Recertification	1053409599	1053409599	8/18/2020 4:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1053409599	8/18/2020 4:47 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	8/18/2020 4:47 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 12:15:43 PM	8/18/2020 4:47:46 PM	8/18/2020 4:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/10/2020 6:02 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		70115	3/10/2020 6:02 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	3/10/2020 6:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/10/2020 6:02 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2008493	3/10/2020 6:02 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	3/10/2020 6:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1053409599	3/10/2020 6:02 PM
Details	Last Recertification Date	Update	Recertification	9/6/2018 6:25:26 PM	8/21/2019 12:15:43 PM	8/21/2019 12:15 PM
Contacts	Primary Contact	Update	Change Request	POLLARD, ROBERT PHARMACY DIRECTOR Mid Columbia Medical Center 5412967525	Cummings, Amanda Dawn Pharmacy Director Mid-Columbia Medical Center 5412967526	7/3/2019 10:47 AM
Addresses	Billing Address	Insert	Change Request		MID-COLUMBIA MEDICAL CENTER 1700 E 19th Street The Dalles, OR 97058	12/11/2018 7:59 AM
Addresses	Shipping Address	Insert	Change Request		MID-COLUMBIA MEDICAL CENTER 1700 E 19th Street The Dalles, OR 97058	12/11/2018 7:59 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 10:11:02 AM	9/6/2018 6:25:26 PM	9/6/2018 6:25 PM
Details	Entity Subname	Update	Change Request	Celilo Oncology	Celilo Cancer Center	4/10/2018 3:13 PM
Details	Last Recertification Date	Update	Recertification	10/25/2017 11:32:21 AM	11/15/2017 10:11:02 AM	11/15/2017 10:11 AM
Details	Last Recertification Date	Update	Recertification		10/25/2017 11:32:21 AM	10/25/2017 11:32 AM
Contacts	Primary Contact	Update		POLLARD, ROBERT PHARMACY DIRECTOR 5412967525	POLLARD, ROBERT PHARMACY DIRECTOR Mid Columbia Medical Center 5412967525	10/19/2017 1:25 PM
Contacts	Authorizing Official	Update		KNOX, DENNIS CEO 5412967272	KNOX, DENNIS CEO Mid-Columbia Medical Center 5412967272	10/12/2017 11:01 AM
Contacts	Signed By	Update		KNOX, DENNIS CEO 5412967272	KNOX, DENNIS CEO Mid-Columbia Medical Center 5412967272	10/12/2017 11:01 AM
Contacts	Primary Contact	Insert			POLLARD, ROBERT PHARMACY DIRECTOR 5412967525	7/20/2017 1:47 PM
Contacts	Authorizing Official	Insert			KNOX, DENNIS CEO 5412967272	7/20/2017 1:47 PM
Contacts	Signed By	Insert			KNOX, DENNIS CEO 5412967272	7/20/2017 1:47 PM
Addresses	Main Address	Insert			1800 E. 19th Street The Dalles, OR 97058	7/20/2017 1:47 PM
Details	State	Update		Approved	Active	7/20/2017 1:47 PM
Dates	Participating Approval Date	Update			7/20/2017 12:00:00 AM	7/20/2017 1:46 PM
Details	State	Update		Pending	Approved	7/20/2017 1:46 PM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/20/2017 1:46 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_78466	SCH380001-07	7/14/2017 1:36 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_78466	7/13/2017 2:29 PM
Details	Last Recertification Date	Insert				7/13/2017 2:29 PM
Details	Grant Number	Insert				7/13/2017 2:29 PM
Details	340B ID	Insert				7/13/2017 2:29 PM
Details	Is Authorizing Official EHB Data	Insert				7/13/2017 2:29 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/13/2017 2:29 PM
Details	Medicare Provider Number	Insert			380001	7/13/2017 2:29 PM
Details	Entity Name	Insert			MID-COLUMBIA MEDICAL CENTER	7/13/2017 2:29 PM
Details	Program Code	Insert			SCH	7/13/2017 2:29 PM
Details	Entity Subname	Insert			Celilo Oncology	7/13/2017 2:29 PM
Dates	Participating Approval Date	Insert				7/13/2017 2:29 PM
Details	State	Insert			Pending	7/13/2017 2:29 PM
Dates	Registration Date	Insert			7/13/2017 12:00:00 AM	7/13/2017 2:29 PM
Dates	Signed By Date	Insert			7/13/2017 12:00:00 AM	7/13/2017 2:29 PM
Dates	Start Date	Insert				7/13/2017 2:29 PM
Terminations	Termination Comments	Insert				7/13/2017 2:29 PM
Terminations	Termination Date	Insert				7/13/2017 2:29 PM
Terminations	Termination Effective Date	Insert				7/13/2017 2:29 PM
Terminations	Termination Reason	Insert				7/13/2017 2:29 PM