Covered Entity Details

CAH271340-11 Marcus Daly Memorial Hospital Corp (Active) - information as of 4/25/2025 5:41:06 PM

Main Details

Name

Marcus Daly Memorial Hospital Corp

Subdivision Name

Bitterroot Health Victor

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH271340-11

Medicare Provider Number

271340

Outpatient Facility Provider Number

273429

Additional Details

Current Program Status

Active

Registration Date

1/2/2019

Participating Start Date

4/1/2019

Participating Approval Date

1/31/2019

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Marcus Daly Memorial Hospital
John Bishop, CEO
(406) 375-4409

Primary Contact

Marcus Daly Memorial Hospital
Kellie Jones, Clinical Pharmacist
(406) 375-4461

Addresses

Street Address

2386 US HIGHWAY 93 N
VICTOR, MT 59875-9211

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?
No

Shipping Addresses

Shipping Address 1

Marcus Daly Memorial Hospital
1200 Westwood Drive
Hamilton, MT 59840

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
CAH271340-01	Child	CAH	Marcus Daly Memorial Hospital Corp	Bitterroot Health Corvallis	1037 Main St	Corvallis	MT	Active
CAH271340-02	Child	CAH	Marcus Daly Memorial Hospital Corp	Bitterroot Health Stevensville	3975 US HWY 93 N	Stevensville	MT	Active
CAH271340-03	Child	CAH	Marcus Daly Memorial Hospital Corp	Bitterroot Health Hamilton	1200 Westwood Dr	Hamilton	MT	Active
CAH271340-04	Child	CAH	Marcus Daly Memorial Hospital Corp	BITTERROOT HEALTH NEUROSURGERY	1190 Westwood Dr	HAMILTON	MT	Active
CAH271340-05	Child	CAH	Marcus Daly Memorial Hospital Corp	BITTERROOT HEALTH ORTHOPEDICS & SPORTS MEDICINE	1200 WESTWOOD DR	HAMILTON	MT	Active
CAH271340-06	Child	CAH	Marcus Daly Memorial Hospital Corp	BITTERROOT GENERAL & VASCULAR SURGERY	1150 WESTWOOD DR STE C	HAMILTON	MT	Terminated
CAH271340-07	Child	CAH	Marcus Daly Memorial Hospital Corp	BITTERROOT HEALTH OBSTETRICS & GYNECOLOGY	1150 WESTWOOD DRIVE STE G	HAMILTON	MT	Active
CAH271340-08	Child	CAH	Marcus Daly Memorial Hospital Corp	Bitterroot Health Eye Clinic	300 N 10TH STREET STE A	HAMILTON	MT	Active
CAH271340-09	Child	CAH	Marcus Daly Memorial Hospital Corp	Bitterroot Health Surgical Associates	215 North 10th Street	HAMILTON	MT	Active
CAH271340-10	Child	CAH	Marcus Daly Memorial Hospital Corp	Bitterroot Health Darby	3334 DVN LN	DARBY	MT	Active
CAH271340-11	Child	CAH	Marcus Daly Memorial Hospital Corp	Bitterroot Health Victor	2386 US HIGHWAY 93 N	VICTOR	MT	Active
CAH271340-12	Child	CAH	Marcus Daly Memorial Hospital Corp	Bitterroot Health Dermatology	1103 WESTWOOD DR	HAMILTON	MT	Active
CAH271340-13	Child	CAH	Marcus Daly Memorial Hospital Corp	Bitterroot Health Pain Management - pain clinic	1103 Westwood Drive	Hamilton	MT	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Dates	Last Date That 340B Drugs Purchased	Update	OPA Cancel Termination Request	8/21/2024 12:00:00 AM		8/21/2024 12:35 PM
Details	State	Update	OPA Cancel Termination Request	To Be Terminated	Active	8/21/2024 12:35 PM
Terminations	Termination Comments	Update	OPA Cancel Termination Request	Communication from contract pharmacy of no longer wanting to participate and business decision by covered entity		8/21/2024 12:35 PM
Terminations	Termination Date	Update	OPA Cancel Termination Request	10/1/2024 12:00:00 AM		8/21/2024 12:35 PM
Terminations	Termination Effective Date	Update	OPA Cancel Termination Request	8/22/2024 12:00:00 AM		8/21/2024 12:35 PM
Terminations	Termination Reason	Update	OPA Cancel Termination Request	Business decision by the Covered Entity		8/21/2024 12:35 PM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		8/21/2024 12:00:00 AM	8/21/2024 7:24 AM
Details	State	Update	Termination Request	Active	To Be Terminated	8/21/2024 7:24 AM
Terminations	Termination Comments	Update	Termination Request		Communication from contract pharmacy of no longer wanting to participate and business decision by covered entity	8/21/2024 7:24 AM
Terminations	Termination Date	Update	Termination Request		10/1/2024 12:00:00 AM	8/21/2024 7:24 AM
Terminations	Termination Effective Date	Update	Termination Request		8/22/2024 12:00:00 AM	8/21/2024 7:24 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	8/21/2024 7:24 AM
Details	Last Recertification Date	Update	Recertification	8/24/2023 4:16:26 PM	8/13/2024 2:45:41 PM	8/13/2024 2:45 PM
Details	Last Recertification Date	Update	Recertification	9/6/2022 12:15:32 PM	8/24/2023 4:16:26 PM	8/24/2023 4:16 PM
Contacts	Primary Contact	Update	Profile Change Request	Jones, Kellie Pharmacy Department Head Marcus Daly Memorial Hospital 4063754461	Jones, Kellie Clinical Pharmacist Marcus Daly Memorial Hospital 4063754461	8/22/2023 11:46 AM
Details	Last Recertification Date	Update	Recertification	8/19/2021 6:25:04 PM	9/6/2022 12:15:32 PM	9/6/2022 12:15 PM
Details	Entity Subname	Update	Recertification	MARCUS DALY MEMORIAL HOSPITAL CORP - Bitterroot Physicians Clinic North	Bitterroot Health Victor	9/6/2022 12:15 PM
Details	Last Recertification Date	Update	Recertification	8/17/2020 11:22:09 AM	8/19/2021 6:25:04 PM	8/19/2021 6:25 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 4:44:46 PM	8/17/2020 11:22:09 AM	8/17/2020 11:22 AM
Contacts	Authorizing Official	Update	Change Request	Erdman, Donja C. CFO Marcus Daly Memorial Hospital 4063754609	Bishop, John CEO Marcus Daly Memorial Hospital 4063754409	3/24/2020 1:50 PM
Details	Last Recertification Date	Update	Recertification		8/21/2019 4:44:46 PM	8/21/2019 4:44 PM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Erdman, Donja C. CFO Marcus Daly Memorial Hospital 4063754609	1/31/2019 2:01 PM
Details	340B ID	Update	New Registration		CAH271340-11	1/31/2019 2:01 PM
Details	Entity Name	Update	New Registration	MARCUS DALY MEMORIAL HOSPITAL	Marcus Daly Memorial Hospital Corp	1/31/2019 2:01 PM
Details	Entity Subname	Update	New Registration	MARCUS DALY MEMORIAL HOSPITAL CORP	MARCUS DALY MEMORIAL HOSPITAL CORP - Bitterroot Physicians Clinic North	1/31/2019 2:01 PM
Dates	Participating Approval Date	Update	New Registration		1/31/2019 2:01:01 PM	1/31/2019 2:01 PM
Details	State	Update	New Registration	Pending	Approved	1/31/2019 2:01 PM
Dates	Signed By Date	Update	New Registration		1/4/2019 10:39:47 AM	1/31/2019 2:01 PM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	1/31/2019 2:01 PM
Addresses	Main Address	Insert	New Registration		2386 US HIGHWAY 93 N VICTOR, MT 59875-9211	1/2/2019 12:35 PM
Addresses	Shipping Address	Insert	New Registration		Marcus Daly Memorial Hospital 1200 Westwood Drive Hamilton, MT 59840	1/2/2019 12:35 PM
Contacts	Primary Contact	Insert	New Registration		Jones, Kellie Pharmacy Department Head Marcus Daly Memorial Hospital 4063754461	1/2/2019 12:35 PM
Contacts	Authorizing Official	Insert	New Registration		Erdman, Donja C. CFO Marcus Daly Memorial Hospital 4063754609	1/2/2019 12:35 PM
Details	Last Recertification Date	Insert	New Registration			1/2/2019 12:35 PM
Details	Grant Number	Insert	New Registration			1/2/2019 12:35 PM
Details	340B ID	Insert	New Registration			1/2/2019 12:35 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/2/2019 12:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/2/2019 12:35 PM
Details	Medicare Provider Number	Insert	New Registration		271340	1/2/2019 12:35 PM
Details	Entity Name	Insert	New Registration		MARCUS DALY MEMORIAL HOSPITAL	1/2/2019 12:35 PM
Details	Program Code	Insert	New Registration		CAH	1/2/2019 12:35 PM
Details	Entity Subname	Insert	New Registration		MARCUS DALY MEMORIAL HOSPITAL CORP	1/2/2019 12:35 PM
Dates	Participating Approval Date	Insert	New Registration			1/2/2019 12:35 PM
Details	State	Insert	New Registration		Pending	1/2/2019 12:35 PM
Dates	Registration Date	Insert	New Registration		1/2/2019 12:35:18 PM	1/2/2019 12:35 PM
Dates	Signed By Date	Insert	New Registration			1/2/2019 12:35 PM
Dates	Start Date	Insert	New Registration			1/2/2019 12:35 PM
Terminations	Termination Comments	Insert	New Registration			1/2/2019 12:35 PM
Terminations	Termination Date	Insert	New Registration			1/2/2019 12:35 PM
Terminations	Termination Effective Date	Insert	New Registration			1/2/2019 12:35 PM
Terminations	Termination Reason	Insert	New Registration			1/2/2019 12:35 PM