Covered Entity Details

CAH131327-06 Gritman Medical Center (Active) - information as of 6/1/2025 4:04:24 AM

Main Details

Name

Gritman Medical Center

Subdivision Name

Moscow Family Medicine Downtown Clinic - Moscow Family Medicine Clinic - Downtown

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH131327-06

Medicare Provider Number

131327

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/9/2019

Participating Start Date

10/1/2019

Participating Approval Date

8/13/2019

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

Gritman Medical Center Inc
Kara Besst, CEO
(208) 883-2220

Primary Contact

Gritman Medical Center
Danielle Lynas, Controller
(208) 883-6456

Addresses

Street Address

623 S Main St
Moscow, ID 83843

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

Same as Street Address

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
CAH131327-01	Child	CAH	Gritman Medical Center	RURAL HEALTH CLINIC	156 6TH ST	POTLATCH	ID	Active
CAH131327-02	Child	CAH	Gritman Medical Center	RURAL HEALTH CLINIC	606 E Main Street	Kendrick	ID	Active
CAH131327-03	Child	CAH	Gritman Medical Center	Internal Medicine	719 S. Main St.	Moscow	ID	Active
CAH131327-04	Child	CAH	Gritman Medical Center	Outpatient Infusion - Outpatient Infustion	700 S Main street	Moscow	ID	Active
CAH131327-05	Child	CAH	Gritman Medical Center	Oncology - Oncology	803 S Main Street	Moscow	ID	Active
CAH131327-06	Child	CAH	Gritman Medical Center	Moscow Family Medicine Downtown Clinic - Moscow Family Medicine Clinic - Downtown	623 S Main St	Moscow	ID	Active
CAH131327-07	Child	CAH	Gritman Medical Center	Troy Clinic - Rural Health Clinic	412 S Main Street	Troy	ID	Active
CAH131327-08	Child	CAH	Gritman Medical Center	Quickare/Westside - Rural Health Clinic	2500 W A Street	Moscow	ID	Active
CAH131327-09	Child	CAH	Gritman Medical Center	Gritman Interventional Pain Clinic - Gritman Interventional Pain Clinic	803 S Main St	Moscow	ID	Active
CAH131327-10	Child	CAH	Gritman Medical Center	Gritman Medical Center - Urology	803 S Main Street Suite 320	Moscow	ID	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 9:19:50 AM	8/23/2024 6:02:19 PM	8/23/2024 6:02 PM
Contacts	Primary Contact	Update	Profile Change Request	Lynas, Danielle Controller Gritman Medical Center 2088836167	Lynas, Danielle Controller Gritman Medical Center 2088836456	8/17/2024 2:00 PM
Contacts	Primary Contact	Update	Profile Change Request	Lynas, Danielle CFO Gritman Medical Center 2088836167	Lynas, Danielle Controller Gritman Medical Center 2088836167	8/17/2024 2:00 PM
Contacts	Primary Contact	Update	Recertification	Cochran, Colleen Pharmacy Director Gritman Medical Center 2088832236	Lynas, Danielle CFO Gritman Medical Center 2088836167	8/15/2023 9:19 AM
Details	Last Recertification Date	Update	Recertification	9/6/2022 12:03:42 PM	8/15/2023 9:19:50 AM	8/15/2023 9:19 AM
Details	Last Recertification Date	Update	Recertification	8/24/2021 4:25:45 PM	9/6/2022 12:03:42 PM	9/6/2022 12:03 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 3:23:02 PM	8/24/2021 4:25:45 PM	8/24/2021 4:25 PM
Details	Last Recertification Date	Update	Recertification		8/19/2020 3:23:02 PM	8/19/2020 3:23 PM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Contacts	Signed By	Insert	New Registration		Besst, Kara CEO Gritman Medical Center Inc 2088832220	8/13/2019 2:07 PM
Details	340B ID	Update	New Registration		CAH131327-06	8/13/2019 2:07 PM
Details	Entity Name	Update	New Registration	GRITMAN MEDICAL CENTER	Gritman Medical Center	8/13/2019 2:07 PM
Details	Entity Subname	Update	New Registration	Moscow Family Medicine Downtown Clinic	Moscow Family Medicine Downtown Clinic - Moscow Family Medicine Clinic - Downtown	8/13/2019 2:07 PM
Dates	Participating Approval Date	Update	New Registration		8/13/2019 2:07:10 PM	8/13/2019 2:07 PM
Details	State	Update	New Registration	Pending	Approved	8/13/2019 2:07 PM
Dates	Signed By Date	Update	New Registration		8/8/2019 5:29:28 PM	8/13/2019 2:07 PM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	8/13/2019 2:07 PM
Addresses	Main Address	Insert	New Registration		623 S Main St Moscow, ID 83843	7/9/2019 5:42 PM
Contacts	Authorizing Official	Insert	New Registration		Besst, Kara CEO Gritman Medical Center Inc 2088832220	7/9/2019 5:42 PM
Contacts	Primary Contact	Insert	New Registration		Cochran, Colleen Pharmacy Director Gritman Medical Center 2088832236	7/9/2019 5:42 PM
Details	Last Recertification Date	Insert	New Registration			7/9/2019 5:42 PM
Details	Grant Number	Insert	New Registration			7/9/2019 5:42 PM
Details	340B ID	Insert	New Registration			7/9/2019 5:42 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/9/2019 5:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/9/2019 5:42 PM
Details	Medicare Provider Number	Insert	New Registration		131327	7/9/2019 5:42 PM
Details	Entity Name	Insert	New Registration		GRITMAN MEDICAL CENTER	7/9/2019 5:42 PM
Details	Program Code	Insert	New Registration		CAH	7/9/2019 5:42 PM
Details	Entity Subname	Insert	New Registration		Moscow Family Medicine Downtown Clinic	7/9/2019 5:42 PM
Dates	Participating Approval Date	Insert	New Registration			7/9/2019 5:42 PM
Details	State	Insert	New Registration		Pending	7/9/2019 5:42 PM
Dates	Registration Date	Insert	New Registration		7/9/2019 5:42:33 PM	7/9/2019 5:42 PM
Dates	Signed By Date	Insert	New Registration			7/9/2019 5:42 PM
Dates	Start Date	Insert	New Registration			7/9/2019 5:42 PM
Terminations	Termination Comments	Insert	New Registration			7/9/2019 5:42 PM
Terminations	Termination Date	Insert	New Registration			7/9/2019 5:42 PM
Terminations	Termination Effective Date	Insert	New Registration			7/9/2019 5:42 PM
Terminations	Termination Reason	Insert	New Registration			7/9/2019 5:42 PM