| Addresses | Billing Address | Update | Change Request | SCL Health/St. Vincent
Attn: Accounts Payable
P.O. Box 1010
Lafayette, CO 80026 | Intermountain Health St Vincent Regional Hospital
Attn: Accounts Payable
P.O. Box 1010
Lafayette, CO 80026 | 1/22/2025 12:10 PM |
| Addresses | Shipping Address | Update | Change Request | ST VINCENT PHARMACY
1233 North 30th Street
Billings, MT 59101 | Intermountain Health St Vincent Regional Hospital Inpatient Pharmacy
1233 North 30th Street
Billings, MT 59101 | 1/22/2025 12:10 PM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2023 3:56:42 PM | 8/19/2024 12:46:23 PM | 8/19/2024 12:46 PM |
| Details | Entity Name | Update | Change Request | St. Vincent Healthcare | Intermountain Health St Vincent Regional Hospital | 8/12/2024 1:00 PM |
| Contacts | Primary Contact | Update | Group Change Request | Stubbs, Charles B.
340B Pharmacist
Intermountain Healthcare
8012841113 | Landry, Ben
340B Pharmacist
Intermountain Health
2072005264 | 4/30/2024 8:04 AM |
| Details | Last Recertification Date | Update | Recertification | 9/6/2022 4:28:02 PM | 8/25/2023 3:56:42 PM | 8/25/2023 3:56 PM |
| Contacts | Primary Contact | Update | Group Change Request | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | Stubbs, Charles B.
340B Pharmacist
Intermountain Healthcare
8012841113 | 7/5/2023 8:35 AM |
| Contacts | Primary Contact | Update | Group Change Request | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | 2/22/2023 6:57 AM |
| Addresses | Billing Address | Update | Recertification | SCL Health
P.O. Box 1010
Lafayette, CO 80026 | SCL Health/St. Vincent
Attn: Accounts Payable
P.O. Box 1010
Lafayette, CO 80026 | 9/6/2022 4:28 PM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2021 11:39:02 AM | 9/6/2022 4:28:02 PM | 9/6/2022 4:28 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Palagi, Pam
VP of Finacial Services
SCL Health
4067232414 | Palagi, Pam
VP Financial Services
SCL Health Montana Region
4067232414 | 9/6/2022 6:52 AM |
| Contacts | Primary Contact | Update | PC Change Request | Mains, Ashley
Director of Pharmacy Business Services
SCL Health
3038135016 | Maurer, JoEllen
Director of Pharmacy
SCL Health/St Vincent
4062378111 | 6/21/2022 7:37 AM |
| Details | Last Recertification Date | Update | Recertification | 9/5/2020 12:36:06 AM | 9/2/2021 11:39:02 AM | 9/2/2021 11:39 AM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1134564255 (MT) | | 8/17/2021 7:15 PM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1134564255 (WY) | | 8/17/2021 7:15 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1083655997 ( ) | | 9/5/2020 12:36 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1134564255 ( ) | | 9/5/2020 12:36 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1083655997 | 9/5/2020 12:36 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | MT | 9/5/2020 12:36 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1134564255 | 9/5/2020 12:36 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | MT | 9/5/2020 12:36 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1083655997 | 9/5/2020 12:36 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | WY | 9/5/2020 12:36 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1134564255 | 9/5/2020 12:36 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | WY | 9/5/2020 12:36 AM |
| Contacts | Primary Contact | Update | Recertification | Finneman, Lonnye
Director of Pharmacy
SCL Health
4062378123 | Mains, Ashley
Director of Pharmacy Business Services
SCL Health
3038135016 | 9/5/2020 12:36 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2019 11:20:28 AM | 9/5/2020 12:36:06 AM | 9/5/2020 12:36 AM |
| Addresses | Main Address | Update | Change Request |
2900 12th Ave N
503E
Billings, MT 59101 |
2900 12th Ave N, Ste 503E
503E
Billings, MT 59101 | 9/17/2019 9:15 AM |
| Addresses | Shipping Address | Insert | Change Request | | ST VINCENT PHARMACY
1233 North 30th Street
Billings, MT 59101 | 9/17/2019 9:15 AM |
| Details | Last Recertification Date | Update | Recertification | | 8/26/2019 11:20:28 AM | 8/26/2019 11:20 AM |
| Details | State | Update | | Approved | Active | 7/1/2019 12:05 AM |
| Contacts | Signed By | Insert | New Registration | | Palagi, Pam
VP of Finacial Services
SCL Health
4067232414 | 4/23/2019 8:38 AM |
| Details | 340B ID | Update | New Registration | | DSH270049U | 4/23/2019 8:38 AM |
| Details | Entity Name | Update | New Registration | ST VINCENT HEALTHCARE | St. Vincent Healthcare | 4/23/2019 8:38 AM |
| Details | Entity Subname | Update | New Registration | Rheumatology | Rheumatology - Rheumatology Clinic | 4/23/2019 8:38 AM |
| Dates | Participating Approval Date | Update | New Registration | | 4/23/2019 8:38:36 AM | 4/23/2019 8:38 AM |
| Details | State | Update | New Registration | Pending | Approved | 4/23/2019 8:38 AM |
| Dates | Signed By Date | Update | New Registration | | 4/18/2019 10:52:21 AM | 4/23/2019 8:38 AM |
| Dates | Start Date | Update | New Registration | | 7/1/2019 12:00:00 AM | 4/23/2019 8:38 AM |
| Addresses | Main Address | Insert | New Registration | |
2900 12th Ave N
503E
Billings, MT 59101 | 4/17/2019 3:39 PM |
| Addresses | Billing Address | Insert | New Registration | | SCL Health
P.O. Box 1010
Lafayette, CO 80026 | 4/17/2019 3:39 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1083655997 | 4/17/2019 3:39 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1134564255 | 4/17/2019 3:39 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Palagi, Pam
VP of Finacial Services
SCL Health
4067232414 | 4/17/2019 3:39 PM |
| Contacts | Primary Contact | Insert | New Registration | | Finneman, Lonnye
Director of Pharmacy
SCL Health
4062378123 | 4/17/2019 3:39 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Details | Grant Number | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Details | 340B ID | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 270049 | 4/17/2019 3:39 PM |
| Details | Entity Name | Insert | New Registration | | ST VINCENT HEALTHCARE | 4/17/2019 3:39 PM |
| Details | Program Code | Insert | New Registration | | DSH | 4/17/2019 3:39 PM |
| Details | Entity Subname | Insert | New Registration | | Rheumatology | 4/17/2019 3:39 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Details | State | Insert | New Registration | | Pending | 4/17/2019 3:39 PM |
| Dates | Registration Date | Insert | New Registration | | 4/17/2019 3:39:37 PM | 4/17/2019 3:39 PM |
| Dates | Signed By Date | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Dates | Start Date | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Terminations | Termination Date | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 4/17/2019 3:39 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 4/17/2019 3:39 PM |