Covered Entity Details

CAH241306-03 HealthPartners RC dba Olivia Hospital & Clinic (Active) - information as of 5/13/2025 1:42:17 AM

Main Details

Name

HealthPartners RC dba Olivia Hospital & Clinic

Subdivision Name

Renville Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH241306-03

Medicare Provider Number

241306

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/17/2017

Participating Start Date

10/1/2017

Participating Approval Date

7/25/2017

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Hutchinson Health
Pamela J. Larson, CFO
(320) 484-4472

Primary Contact

HealthPartners RC
Michelle Golden, 340B Manager
(715) 531-6371

Addresses

Street Address

420 MAIN STREET N
RENVILLE, MN 56284

Billing Address

HealthPartners RC dba Olivia Hospital & Clinic
100 Healthy Way
Olivia, MN 56277

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
MN		1730352675

Shipping Addresses

Shipping Address 1

HealthPartners RC dba Olivia Hospital & Clinic
100 Healthy Way
Olivia, MN 56277

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
CAH241306-01	Child	CAH	Renville County Hospital & Clinics	Renville County Hospital & Clinics - Olivia Clinic	100 Healthy Way	Olivia	MN	Terminated
CAH241306-02	Child	CAH	HealthPartners RC dba Olivia Hospital & Clinic	Hector Clinic	131 Birch Ave W	Hector	MN	Active
CAH241306-03	Child	CAH	HealthPartners RC dba Olivia Hospital & Clinic	Renville Clinic	420 MAIN STREET N	RENVILLE	MN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Anderson, Nancy Ann Chief Financial Officer HealthPartners RC 3205233477	Larson, Pamela J. CFO Hutchinson Health 3204844472	11/8/2024 8:46 AM
Addresses	Shipping Address	Insert	Recertification		HealthPartners RC dba Olivia Hospital & Clinic 100 Healthy Way Olivia, MN 56277	8/14/2024 3:16 PM
Addresses	Main Address	Update	Recertification	420 MAIN STREET N RENVILLE, MN 56284-0606	420 MAIN STREET N RENVILLE, MN 56284	8/14/2024 3:16 PM
Details	Last Recertification Date	Update	Recertification	8/21/2023 11:26:40 AM	8/14/2024 3:16:23 PM	8/14/2024 3:16 PM
Details	Last Recertification Date	Update	Recertification	8/26/2022 1:27:55 PM	8/21/2023 11:26:40 AM	8/21/2023 11:26 AM
Details	Last Recertification Date	Update	Recertification	8/31/2021 2:19:17 PM	8/26/2022 1:27:55 PM	8/26/2022 1:27 PM
Contacts	Primary Contact	Update	Profile Change Request	Golden, Michelle 340B Coordinator HealthPartners RC 7155316371	Golden, Michelle 340B Manager HealthPartners RC 7155316371	7/8/2022 11:56 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1730352675	9/22/2021 9:41 AM
Medicaid Billing	NPI: State	Insert	Change Request		MN	9/22/2021 9:41 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 7:38:48 AM	8/31/2021 2:19:17 PM	8/31/2021 2:19 PM
Addresses	Billing Address	Insert	Change Request		HealthPartners RC dba Olivia Hospital & Clinic 100 Healthy Way Olivia, MN 56277	4/20/2021 3:28 PM
Contacts	Primary Contact	Update	Change Request	Anderson, Nancy Ann Chief Financial Officer HealthPartners RC 3205233477	Golden, Michelle 340B Coordinator HealthPartners RC 7155316371	1/29/2021 2:56 PM
Contacts	Authorizing Official	Update	Change Request	Blad, Nathan President HealthPartners RC 3205233575	Anderson, Nancy Ann Chief Financial Officer HealthPartners RC 3205233477	1/29/2021 1:21 PM
Contacts	Authorizing Official	Update	AO Change Request	Blad, Nathan President Olivia Hospital & Clinic 3205233575	Blad, Nathan President HealthPartners RC 3205233575	9/9/2020 8:41 AM
Contacts	Primary Contact	Update	Recertification	Anderson, Nancy Chief Financial Officer Olivia Hospital & Clinic 3205233477	Anderson, Nancy Ann Chief Financial Officer HealthPartners RC 3205233477	9/9/2020 7:38 AM
Details	Last Recertification Date	Update	Recertification	8/22/2019 1:53:49 PM	9/9/2020 7:38:48 AM	9/9/2020 7:38 AM
Details	Entity Name	Update	Change Request	Renville County Hospital & Clinics	HealthPartners RC dba Olivia Hospital & Clinic	5/1/2020 5:28 PM
Details	Entity Subname	Update	Change Request	RENVILL CO HOSP & CLNC - RENVILLE	Renville Clinic	4/27/2020 4:20 PM
Contacts	Primary Contact	Update	Profile Change Request	Anderson, Nancy Chief Financial Officer RC Hospital & Clinics 3205233477	Anderson, Nancy Chief Financial Officer Olivia Hospital & Clinic 3205233477	4/22/2020 3:15 PM
Contacts	Authorizing Official	Update	Profile Change Request	Blad, Nathan CEO RC Hospital & Clinics 3205233575	Blad, Nathan President Olivia Hospital & Clinic 3205233575	4/22/2020 3:06 PM
Contacts	Signed By	Update	Profile Change Request	Blad, Nathan CEO RC Hospital & Clinics 3205233575	Blad, Nathan President Olivia Hospital & Clinic 3205233575	4/22/2020 3:06 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 4:21:26 PM	8/22/2019 1:53:49 PM	8/22/2019 1:53 PM
Details	Last Recertification Date	Update	Recertification	11/10/2017 1:34:40 PM	8/20/2018 4:21:26 PM	8/20/2018 4:21 PM
Details	Entity Name	Update	Recertification	RENVILLE COUNTY HOSPITAL AND CLINICS	Renville County Hospital & Clinics	11/15/2017 12:44 PM
Details	Last Recertification Date	Update	Recertification		11/10/2017 1:34:40 PM	11/10/2017 1:34 PM
Contacts	Authorizing Official	Update		Blad, Nathan CEO 3205233575	Blad, Nathan CEO RC Hospital & Clinics 3205233575	10/30/2017 11:15 AM
Contacts	Signed By	Update		Blad, Nathan CEO 3205233575	Blad, Nathan CEO RC Hospital & Clinics 3205233575	10/30/2017 11:15 AM
Contacts	Primary Contact	Update		Anderson, Nancy Chief Financial Officer 3205233477	Anderson, Nancy Chief Financial Officer RC Hospital & Clinics 3205233477	10/20/2017 1:55 PM
Addresses	Main Address	Insert			420 MAIN STREET N RENVILLE, MN 56284-0606	7/25/2017 10:09 AM
Contacts	Primary Contact	Insert			Anderson, Nancy Chief Financial Officer 3205233477	7/25/2017 10:09 AM
Contacts	Authorizing Official	Insert			Blad, Nathan CEO 3205233575	7/25/2017 10:09 AM
Contacts	Signed By	Insert			Blad, Nathan CEO 3205233575	7/25/2017 10:09 AM
Details	State	Update		Approved	Active	7/25/2017 10:09 AM
Dates	Participating Approval Date	Update			7/25/2017 12:00:00 AM	7/25/2017 10:08 AM
Details	State	Update		Pending	Approved	7/25/2017 10:08 AM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/25/2017 10:08 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_79073	CAH241306-03	7/24/2017 9:35 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_79073	7/17/2017 4:45 PM
Details	Last Recertification Date	Insert				7/17/2017 4:45 PM
Details	Grant Number	Insert				7/17/2017 4:45 PM
Details	340B ID	Insert				7/17/2017 4:45 PM
Details	Is Authorizing Official EHB Data	Insert				7/17/2017 4:45 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/17/2017 4:45 PM
Details	Medicare Provider Number	Insert			241306	7/17/2017 4:45 PM
Details	Entity Name	Insert			RENVILLE COUNTY HOSPITAL AND CLINICS	7/17/2017 4:45 PM
Details	Program Code	Insert			CAH	7/17/2017 4:45 PM
Details	Entity Subname	Insert			RENVILL CO HOSP & CLNC - RENVILLE	7/17/2017 4:45 PM
Dates	Participating Approval Date	Insert				7/17/2017 4:45 PM
Details	State	Insert			Pending	7/17/2017 4:45 PM
Dates	Registration Date	Insert			7/17/2017 12:00:00 AM	7/17/2017 4:45 PM
Dates	Signed By Date	Insert			7/17/2017 12:00:00 AM	7/17/2017 4:45 PM
Dates	Start Date	Insert				7/17/2017 4:45 PM
Terminations	Termination Comments	Insert				7/17/2017 4:45 PM
Terminations	Termination Date	Insert				7/17/2017 4:45 PM
Terminations	Termination Effective Date	Insert				7/17/2017 4:45 PM
Terminations	Termination Reason	Insert				7/17/2017 4:45 PM