Covered Entity Details

DSH270051 KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER (Active) - information as of 4/29/2025 1:40:28 AM

Main Details

Name

KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH270051

Medicare Provider Number

270051

Additional Details

Current Program Status

Active

Registration Date

10/7/2020

Participating Start Date

1/1/2021

Participating Approval Date

11/3/2020

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Logan Health-Whitefish
Kevin Abel, President
(406) 863-3500

Primary Contact

Logan Health
Landon Dean Godfrey, Director of Pharmacy
(406) 756-4701

Addresses

Street Address

310 SUNNYVIEW LANE
KALISPELL, MT 59901

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	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	11/03/2020	01/01/2021		01/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	11/03/2020	01/01/2021		01/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	11/03/2020	01/01/2021		01/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	11/03/2020	01/01/2021		01/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	11/03/2020	01/01/2021		01/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	11/03/2020	01/01/2021		01/01/2021
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/07/2023	07/01/2023		07/01/2023
Contract Detail	AHS 2 LLC	DBA LOGAN HEALTH PHARMACY MEDICAL ARTS	209 CONWAY DR	KALISPELL	MT	59901	03/25/2022	03/25/2022	08/01/2023	10/13/2023
Contract Detail	ALBERTSONS LLC	OSCO PHARMACY #18	900 WEST IDAHO	KALISPELL	MT	59901	11/03/2020	01/01/2021		01/01/2021
Contract Detail	ALBERTSONS LLC	OSCO PHARMACY #33	501 WEST MAIN STREET	CUT BANK	MT	59427	04/12/2022	07/01/2022	03/01/2024	07/02/2024
Contract Detail	BIGFORK DRUG INC.	8111 MT HIGHWAY 35		BIGFORK	MT	59911-3588	11/03/2020	01/01/2021		01/01/2021
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	01/07/2021	04/01/2021	07/01/2024	07/02/2024
Contract Detail	CENTERWELL PHARMACY, INC.	10737 MARKS WAY		MIRAMAR	FL	33025	01/07/2021	04/01/2021	07/01/2024	07/02/2024
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/07/2021	04/01/2021		04/01/2021
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	11/03/2020	01/01/2021		01/01/2021
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	11/03/2020	01/01/2021	04/13/2022	07/13/2022
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	11/03/2020	01/01/2021		01/01/2021
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	11/03/2020	01/01/2021		01/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	11/03/2020	01/01/2021		01/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	11/03/2020	01/01/2021		01/01/2021
Contract Detail	LOGAN HEALTH - WHITEFISH	DBA LOGAN HEALTH PHARMACY - COLUMBIA FAL	2100 9TH ST W	COLUMBIA FALLS	MT	59912	11/03/2020	01/01/2021		01/01/2021
Contract Detail	LOGAN HEALTH PHARMACY CLINICAL	200 CONWAY DR		KALISPELL	MT	59901	11/03/2020	01/01/2021		01/01/2021
Contract Detail	MEDICAL ARTS PHARMACY		209 CONWAY DRIVE	KALISPELL	MT	59901	11/03/2020	01/01/2021	03/25/2022	03/25/2022
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	01/07/2021	04/01/2021		04/01/2021
Contract Detail	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	11/03/2020	01/01/2021		01/01/2021
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/11/2022	04/13/2022		04/19/2022
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	11/03/2020	01/01/2021		01/01/2021
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	11/03/2020	01/01/2021		01/01/2021
Contract Detail	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	11/03/2020	01/01/2021		01/01/2021
Contract Detail	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	07/14/2022	10/01/2022		10/01/2022
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	11/03/2020	01/01/2021		01/01/2021
Contract Detail	OPTUM PHARMACY 806, INC.	2288 AUBURN BLVD	STE. 102	SACRAMENTO	CA	95821-1618	11/03/2020	01/01/2021	09/01/2021	10/04/2021
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	11/03/2020	01/01/2021	10/24/2022	10/27/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/07/2021	04/01/2021		04/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/07/2021	04/01/2021		04/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/07/2021	04/01/2021		04/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/07/2021	04/01/2021		04/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2926	1001 MADISON ST.	SEATTLE	WA	98104	07/14/2022	10/01/2022	07/01/2024	07/02/2024
Contract Detail	REMEDIES LAKESIDE	206 STONER LOOP		LAKESIDE	MT	59922	11/03/2020	01/01/2021	10/01/2021	10/04/2021
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #2106	6580 HIGHWAY 93 SOUTH	WHITEFISH	MT	59937	11/03/2020	01/01/2021		01/01/2021
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1646	40774 MT HIGHWAY 35	POLSON	MT	59860	04/12/2022	07/01/2022	03/01/2024	07/02/2024
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	01/07/2021	04/01/2021		04/01/2021
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	01/07/2021	04/01/2021		04/01/2021
Contract Detail	SMITH'S FOOD/DRUG CENTERS	SMITH'S PHARMACY #172	195 3RD AVENUE NE	KALISPELL	MT	59901	11/03/2020	01/01/2021		01/01/2021
Contract Detail	SMITH'S PHARMACY # 168	419 NUCLEUS AVE.	PO BOX 159	COLUMBIA FALLS	MT	59912	11/03/2020	01/01/2021		01/01/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	11/03/2020	01/01/2021		01/01/2021
Contract Detail	WAL-MART PHARMACY 10-2259	170 HUTTON RANCH ROAD		KALISPELL	MT	59901	11/03/2020	01/01/2021		01/01/2021
Contract Detail	WAL-MART PHARMACY 10-2607	36318 MEMORY LANE		POLSON	MT	59860	11/03/2020	01/01/2021	01/01/2024	07/02/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	11/03/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09242	40 W IDAHO ST	KALISPELL	MT	59901	11/03/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS #16084	40770 MT HWY 35	POLSON	MT	59860	11/03/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12347	700 13TH ST E	WHITEFISH	MT	59937	11/03/2020	01/01/2021		01/01/2021
Contract Detail	Walgreens #21435	Walgreens Central Fill #21435	6306 S Airport Rd	West Jordan	UT	84084-5601	01/17/2024	04/01/2024		04/01/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	11/03/2020	01/01/2021		01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	11/03/2020	01/01/2021	10/01/2021	10/04/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/15/2021	10/01/2021		10/01/2021
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/07/2023	07/01/2023		07/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/13/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH270051A	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Primary Care - Bigfork	8299 MT HIGHWAY 35	BIGFORK	MT	Active
DSH270051AA	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Endocrinology & Infectious Disease	430 Windward Way	Kalispell	MT	Active
DSH270051AB	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Rheumatology	150 Commons Way	Kalispell	MT	Active
DSH270051AC	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Wellness & Pain Management	245 Windward Way	Kalispell	MT	Active
DSH270051AD	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Maternal-Fetal Medicine	210 Sunnyview Lane	Kalispell	MT	Active
DSH270051AE	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Digestive Center	320 Sunnyview Lane	Kalispell	MT	Active
DSH270051AF	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Neuroscience & Spine - Department of Neurological Surgery	200 Commons Way	Kalispell	MT	Active
DSH270051AG	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Neuroscience & Spine - Department of Physical Medicine & Rehabilitation	205 Sunnyview Lane	Kalispell	MT	Active
DSH270051AH	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	KALISPELL REGIONAL MEDICAL CTR INC - Logan Health Primary Care - Village Loop	70 VILLAGE LOOP RD	KALISPELL	MT	Active
DSH270051AJ	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health OB/GYN - OB/GYN	210 Sunnyview Lane	Kalispell	MT	Active
DSH270051B	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Wound Care	210 Sunnyview Lane	Kalispell	MT	Active
DSH270051C	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Primary Care - Lakeside	306 STONER LOOP	LAKESIDE	MT	Active
DSH270051D	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Home Care & Hospice	275 Corporate Drive	Kalispell	MT	Active
DSH270051E	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Hematology & Oncology	350 HERITAGE WAY STE 1100	KALISPELL	MT	Active
DSH270051F	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Primary Care - 705 6th Avenue	705 6TH AVE E	KALISPELL	MT	Active
DSH270051G	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Nephrology	75 Claremont	Kalispell	MT	Active
DSH270051H	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Heart & Lung - Pulmonology	350 HERITAGE WAY	KALISPELL	MT	Active
DSH270051J	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Primary Care - 160 Heritage Way	160 Heritage Way	KALISPELL	MT	Active
DSH270051K	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Surgical Clinic	1333 Surgical Services Drive	Kalispell	MT	Active
DSH270051L	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Primary Care - 1280 Burns Way	1280 BURNS WAY	KALISPELL	MT	Active
DSH270051M	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Heart & Lung	350 HERITAGE WAY STE 2100	KALISPELL	MT	Active
DSH270051N	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER	HOME OPTIONS - HOSPICE - Hospice	275 Corporate Drive	Kalispell	MT	Terminated
DSH270051P	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Urology	350 Heritage Way	Kalispell	MT	Active
DSH270051Q	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Surgery Center - Kalispell	111 Sunnyview Lane	Kalispell	MT	Active
DSH270051R	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Children's Primary Care	1273 Burns Way	Kalispell	MT	Active
DSH270051S	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Neuroscience & Spine	200 COMMONS WAY	KALISPELL	MT	Terminated
DSH270051T	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Children's Specialists	202 Conway Drive	Kalispell	MT	Active
DSH270051U	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Primary Care - 1287 Burns Way	1287 BURNS WAY	KALISPELL	MT	Active
DSH270051V	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Primary Care - Columbia Falls	1850 9TH ST W	COLUMBIA FALLS	MT	Active
DSH270051W	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Diabetes Education & Prevention	430 Windward Way	Kalispell	MT	Active
DSH270051X	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Neuroscience & Spine - Department of Neurology	200 Commons Way	Kalispell	MT	Active
DSH270051Y	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Women's Care	75 Claremont Street	Kalispell	MT	Active
DSH270051Z	Child	DSH	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	Logan Health Radiation Oncology	343 Sunnyview Lane	Kalispell	MT	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Godfrey, Landon Dean Director of Pharmacy Logan Health 4067521761	Godfrey, Landon Dean Director of Pharmacy Logan Health 4067564701	4/15/2025 1:29 PM
Details	Last Recertification Date	Update	Recertification	8/28/2023 6:34:01 PM	8/14/2024 12:12:24 PM	8/14/2024 12:12 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 10:33:25 AM	8/28/2023 6:34:01 PM	8/28/2023 6:34 PM
Contacts	Primary Contact	Update	Change Request	Easley, Hugh Director of Pharmacy Logan Health Medical Center 4067564701	Godfrey, Landon Dean Director of Pharmacy Logan Health 4067521761	6/7/2023 6:51 AM
Contacts	Authorizing Official	Update	Change Request	Turner, Cole Chief Financial Officier Logan Health Medical Center 4067521724	Abel, Kevin President Logan Health-Whitefish 4068633500	2/22/2023 12:24 PM
Contacts	Primary Contact	Update	Change Request	Thorderson, Tera Pharmacist Logan Health Medical Center 4066078004	Easley, Hugh Director of Pharmacy Logan Health Medical Center 4067564701	2/22/2023 12:24 PM
Contacts	Authorizing Official	Update	Change Request	Hall, Brian Director of Finance Logan Health 4067515759	Turner, Cole Chief Financial Officier Logan Health Medical Center 4067521724	1/18/2023 6:52 AM
Details	Last Recertification Date	Update	Recertification	9/10/2021 3:01:04 PM	9/14/2022 10:33:25 AM	9/14/2022 10:33 AM
Contacts	Authorizing Official	Update	Change Request	BOYER, CRAIG O Chief Financial Officer DSH270051 4067515368	Hall, Brian Director of Finance Logan Health 4067515759	7/21/2022 7:05 AM
Contacts	Primary Contact	Update	Change Request	Thorderson, Tera Pharmacist Kalispell Regional Medical Center 4066078004	Thorderson, Tera Pharmacist Logan Health Medical Center 4066078004	11/22/2021 8:12 AM
Contacts	Authorizing Official	Update	AO Change Request	Boyer, Craig O Chief Financial Officer Kalispell Regional Healthcare 4067525111	BOYER, CRAIG O Chief Financial Officer DSH270051 4067515368	11/8/2021 7:24 AM
Details	Last Recertification Date	Update	Recertification		9/10/2021 3:01:04 PM	9/10/2021 3:01 PM
Details	Entity Name	Update	Change Request	KALISPELL REGIONAL MEDICAL CENTER	KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER	6/29/2021 8:35 AM
Details	State	Update		Approved	Active	1/1/2021 12:01 AM
Contacts	Signed By	Insert	Hospital Type Change Request		Boyer, Craig O Chief Financial Officer Kalispell Regional Healthcare 4067525111	11/3/2020 10:47 AM
Details	340B ID	Update	Hospital Type Change Request		DSH270051	11/3/2020 10:47 AM
Dates	Participating Approval Date	Update	Hospital Type Change Request		11/3/2020 10:47:05 AM	11/3/2020 10:47 AM
Details	State	Update	Hospital Type Change Request	Pending	Approved	11/3/2020 10:47 AM
Dates	Signed By Date	Update	Hospital Type Change Request		11/2/2020 6:28:39 PM	11/3/2020 10:47 AM
Dates	Start Date	Update	Hospital Type Change Request		1/1/2021 12:00:00 AM	11/3/2020 10:47 AM
Addresses	Main Address	Insert	Hospital Type Change Request		310 SUNNYVIEW LANE KALISPELL, MT 59901	10/7/2020 12:16 PM
Contacts	Primary Contact	Insert	Hospital Type Change Request		Thorderson, Tera Pharmacist Kalispell Regional Medical Center 4066078004	10/7/2020 12:16 PM
Contacts	Authorizing Official	Insert	Hospital Type Change Request		Boyer, Craig O Chief Financial Officer Kalispell Regional Healthcare 4067525111	10/7/2020 12:16 PM
Details	Assistance Received From Date	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Details	Assistance Received To Date	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Details	Last Recertification Date	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Details	Grant Number	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Details	340B ID	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Details	Is Authorizing Official EHB Data	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Dates	Last Date That 340B Drugs Purchased	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Details	Medicare Provider Number	Insert	Hospital Type Change Request		270051	10/7/2020 12:16 PM
Details	Entity Name	Insert	Hospital Type Change Request		KALISPELL REGIONAL MEDICAL CENTER	10/7/2020 12:16 PM
Details	NOFO Number	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Details	Program Code	Insert	Hospital Type Change Request		DSH	10/7/2020 12:16 PM
Details	Entity Subname	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Dates	Participating Approval Date	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Details	State	Insert	Hospital Type Change Request		Pending	10/7/2020 12:16 PM
Dates	Registration Date	Insert	Hospital Type Change Request		10/7/2020 12:16:54 PM	10/7/2020 12:16 PM
Dates	Signed By Date	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Dates	Start Date	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Terminations	Termination Comments	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Terminations	Termination Date	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Terminations	Termination Effective Date	Insert	Hospital Type Change Request			10/7/2020 12:16 PM
Terminations	Termination Reason	Insert	Hospital Type Change Request			10/7/2020 12:16 PM