Covered Entity Details

CAH061322-08 Salida Hospital District DBA Heart of the Rockies Regional Medical Center (Terminated) - information as of 6/23/2025 11:56:59 PM

Main Details

Name

Salida Hospital District DBA Heart of the Rockies Regional Medical Center

Subdivision Name

CLINIC - SALIDA HOSPITAL DISTRICT / PAIN CLINIC

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH061322-08

Medicare Provider Number

061322

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/13/2018

Participating Start Date

7/1/2018

Participating Approval Date

4/19/2018

Last Recertification Date

8/27/2018

Termination Date
Termination Reason

10/1/2019
Other

Contacts

Authorizing Official

Salida Hospital District
Lesley Fagerberg, VP Finance
(719) 530-2213

Primary Contact

Salida Hospital District
Mark Ceglowski, Pharmacy Director
(719) 530-2290

Addresses

Street Address

550 W HIGHWAY 50
SALIDA, CO 81201

Billing Address

SALIDA HOSPITAL DISTRICT
PO BOX 429
PO BOX 429
SALIDA, CO 81201

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

SALIDA HOSPITAL DISTRICT DBA HEART OF THE ROCKIES REGIONAL MEDICAL CENTER
1000 RUSH DRIVE
SALIDA, CO 81201

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
CAH061322-01	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	Buena Vista Health Center	28374 County Road 317	Buena Vista	CO	Active
CAH061322-02	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	SALIDA HOSPITAL DISTRICT / Gynecology	550 W HWY 50	SALIDA	CO	Terminated
CAH061322-03	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	SALIDA HOSPITAL DISTRICT / Neurology	550 W HWY 50	SALIDA	CO	Terminated
CAH061322-04	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	SALIDA HOSPITAL DISTRICT / Orthopedic Total Joint	550 W HWY 50	SALIDA	CO	Terminated
CAH061322-05	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	SALIDA HOSPITAL DISTRICT / Orthopedic Sports Medicine	550 W HWY 50	SALIDA	CO	Terminated
CAH061322-06	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	SALIDA HOSPITAL DISTRICT / Urology	550 W HWY 50	SALIDA	CO	Terminated
CAH061322-07	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	SALIDA HOSPITAL DISTRICT / Psychiatry	550 W HWY 50	SALIDA	CO	Terminated
CAH061322-08	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	CLINIC - SALIDA HOSPITAL DISTRICT / PAIN CLINIC	550 W HIGHWAY 50	SALIDA	CO	Terminated
CAH061322-09	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	SALIDA HOSPITAL DISTRICT - HRRMC Salida Health Center	550 W Highway 50	SALIDA	CO	Active
CAH061322-10	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	SALIDA HOSPITAL DISTRICT - SAGUACHE HEALTH CENTER	405 DENVER AVENUE	SAGUACHE	CO	Active
CAH061322-11	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	SALIDA HOSPITAL DISTRICT - Custer County Health Center	704 EDWARDS AVE	WESTCLIFFE	CO	Active
CAH061322-12	Child	CAH	Salida Hospital District DBA Heart of the Rockies Regional Medical Center	Antero Pavilion - Multi-specialty Clinic	910 Rush Drive	Salida	CO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		11/24/2015 12:00:00 AM	8/27/2019 3:50 PM
Details	State	Update	Recertification	Active	To Be Terminated	8/27/2019 3:50 PM
Terminations	Termination Comments	Update	Recertification		were not able use 340B at this site due to inability to capture dispensations. No purchases made.	8/27/2019 3:50 PM
Terminations	Termination Date	Update	Recertification		10/1/2019 12:00:00 AM	8/27/2019 3:50 PM
Terminations	Termination Effective Date	Update	Recertification		8/27/2019 12:00:00 AM	8/27/2019 3:50 PM
Terminations	Termination Reason	Update	Recertification		Other	8/27/2019 3:50 PM
Contacts	Authorizing Official	Update	Profile Change Request	Fagerberg, Lesley VP Finance SSalida Hospital District 7195302213	Fagerberg, Lesley VP Finance Salida Hospital District 7195302213	8/27/2018 3:28 PM
Contacts	Signed By	Update	Profile Change Request	Fagerberg, Lesley VP Finance SSalida Hospital District 7195302213	Fagerberg, Lesley VP Finance Salida Hospital District 7195302213	8/27/2018 3:28 PM
Details	Last Recertification Date	Update	Recertification		8/27/2018 3:24:04 PM	8/27/2018 3:24 PM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Fagerberg, Lesley VP Finance SSalida Hospital District 7195302213	4/19/2018 1:13 PM
Details	340B ID	Update	New Registration		CAH061322-08	4/19/2018 1:13 PM
Details	Entity Subname	Update	New Registration	CLINIC	CLINIC - SALIDA HOSPITAL DISTRICT / PAIN CLINIC	4/19/2018 1:13 PM
Dates	Participating Approval Date	Update	New Registration		4/19/2018 1:13:47 PM	4/19/2018 1:13 PM
Details	State	Update	New Registration	Pending	Approved	4/19/2018 1:13 PM
Dates	Signed By Date	Update	New Registration		4/13/2018 3:36:24 PM	4/19/2018 1:13 PM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	4/19/2018 1:13 PM
Addresses	Main Address	Insert	New Registration		550 W HIGHWAY 50 SALIDA, CO 81201	4/13/2018 3:36 PM
Addresses	Billing Address	Insert	New Registration		SALIDA HOSPITAL DISTRICT PO BOX 429 PO BOX 429 SALIDA, CO 81201	4/13/2018 3:36 PM
Addresses	Shipping Address	Insert	New Registration		SALIDA HOSPITAL DISTRICT DBA HEART OF THE ROCKIES REGIONAL MEDICAL CENTER 1000 RUSH DRIVE SALIDA, CO 81201	4/13/2018 3:36 PM
Contacts	Authorizing Official	Insert	New Registration		Fagerberg, Lesley VP Finance SSalida Hospital District 7195302213	4/13/2018 3:36 PM
Contacts	Primary Contact	Insert	New Registration		Ceglowski, Mark Pharmacy Director Salida Hospital District 7195302290	4/13/2018 3:36 PM
Details	Last Recertification Date	Insert	New Registration			4/13/2018 3:36 PM
Details	Grant Number	Insert	New Registration			4/13/2018 3:36 PM
Details	340B ID	Insert	New Registration			4/13/2018 3:36 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/13/2018 3:36 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/13/2018 3:36 PM
Details	Medicare Provider Number	Insert	New Registration		061322	4/13/2018 3:36 PM
Details	Entity Name	Insert	New Registration		Salida Hospital District DBA Heart of the Rockies Regional Medical Center	4/13/2018 3:36 PM
Details	Program Code	Insert	New Registration		CAH	4/13/2018 3:36 PM
Details	Entity Subname	Insert	New Registration		CLINIC	4/13/2018 3:36 PM
Dates	Participating Approval Date	Insert	New Registration			4/13/2018 3:36 PM
Details	State	Insert	New Registration		Pending	4/13/2018 3:36 PM
Dates	Registration Date	Insert	New Registration		4/13/2018 3:36:20 PM	4/13/2018 3:36 PM
Dates	Signed By Date	Insert	New Registration			4/13/2018 3:36 PM
Dates	Start Date	Insert	New Registration			4/13/2018 3:36 PM
Terminations	Termination Comments	Insert	New Registration			4/13/2018 3:36 PM
Terminations	Termination Date	Insert	New Registration			4/13/2018 3:36 PM
Terminations	Termination Effective Date	Insert	New Registration			4/13/2018 3:36 PM
Terminations	Termination Reason	Insert	New Registration			4/13/2018 3:36 PM