Covered Entity Details

DSH270051G KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER (Active) - information as of 5/7/2025 10:48:05 PM

Main Details

Name

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

Subdivision Name

Logan Health Nephrology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH270051G

Medicare Provider Number

270051

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/7/2020

Participating Start Date

1/1/2021

Participating Approval Date

11/4/2020

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

75 Claremont
Suite H
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	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
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 6:40:55 PM	8/14/2024 12:13:00 PM	8/14/2024 12:13 PM
Contacts	Primary Contact	Update	PC Change Request	Easley, Hugh Director of Pharmacy Logan Health Medical Center 4067564701	Godfrey, Landon Dean Director of Pharmacy Logan Health 4067521761	7/5/2024 10:24 AM
Details	Last Recertification Date	Update	Recertification	9/14/2022 10:16:27 AM	8/28/2023 6:40:55 PM	8/28/2023 6:40 PM
Contacts	Primary Contact	Update	Group Change Request	Thorderson, Tera Pharmacist Logan Health Medical Center 4066078004	Easley, Hugh Director of Pharmacy Logan Health Medical Center 4067564701	3/8/2023 7:45 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	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 2:37:16 PM	9/14/2022 10:16:27 AM	9/14/2022 10:16 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 2:37:16 PM	9/10/2021 2:37 PM
Details	Entity Subname	Update	Change Request	GREATER FLATHEAD RENAL - Greater Flathead Renal	Logan Health Nephrology	6/29/2021 8:40 AM
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	New Registration		Boyer, Craig O Chief Financial Officer Kalispell Regional Healthcare 4067525111	11/4/2020 8:44 AM
Details	340B ID	Update	New Registration		DSH270051G	11/4/2020 8:44 AM
Details	Entity Subname	Update	New Registration	GREATER FLATHEAD RENAL	GREATER FLATHEAD RENAL - Greater Flathead Renal	11/4/2020 8:44 AM
Dates	Participating Approval Date	Update	New Registration		11/4/2020 8:44:42 AM	11/4/2020 8:44 AM
Details	State	Update	New Registration	Pending	Approved	11/4/2020 8:44 AM
Dates	Signed By Date	Update	New Registration		10/9/2020 11:45:13 AM	11/4/2020 8:44 AM
Dates	Start Date	Update	New Registration		1/1/2021 12:00:00 AM	11/4/2020 8:44 AM
Addresses	Main Address	Insert	New Registration		75 Claremont Suite H Kalispell, MT 59901	10/7/2020 3:57 PM
Contacts	Primary Contact	Insert	New Registration		Thorderson, Tera Pharmacist Kalispell Regional Medical Center 4066078004	10/7/2020 3:57 PM
Contacts	Authorizing Official	Insert	New Registration		Boyer, Craig O Chief Financial Officer Kalispell Regional Healthcare 4067525111	10/7/2020 3:57 PM
Details	Assistance Received From Date	Insert	New Registration			10/7/2020 3:57 PM
Details	Assistance Received To Date	Insert	New Registration			10/7/2020 3:57 PM
Details	Last Recertification Date	Insert	New Registration			10/7/2020 3:57 PM
Details	Grant Number	Insert	New Registration			10/7/2020 3:57 PM
Details	340B ID	Insert	New Registration			10/7/2020 3:57 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/7/2020 3:57 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/7/2020 3:57 PM
Details	Medicare Provider Number	Insert	New Registration		270051	10/7/2020 3:57 PM
Details	Entity Name	Insert	New Registration		KALISPELL REGIONAL MEDICAL CENTER	10/7/2020 3:57 PM
Details	NOFO Number	Insert	New Registration			10/7/2020 3:57 PM
Details	Program Code	Insert	New Registration		DSH	10/7/2020 3:57 PM
Details	Entity Subname	Insert	New Registration		GREATER FLATHEAD RENAL	10/7/2020 3:57 PM
Dates	Participating Approval Date	Insert	New Registration			10/7/2020 3:57 PM
Details	State	Insert	New Registration		Pending	10/7/2020 3:57 PM
Dates	Registration Date	Insert	New Registration		10/7/2020 3:57:31 PM	10/7/2020 3:57 PM
Dates	Signed By Date	Insert	New Registration			10/7/2020 3:57 PM
Dates	Start Date	Insert	New Registration			10/7/2020 3:57 PM
Terminations	Termination Comments	Insert	New Registration			10/7/2020 3:57 PM
Terminations	Termination Date	Insert	New Registration			10/7/2020 3:57 PM
Terminations	Termination Effective Date	Insert	New Registration			10/7/2020 3:57 PM
Terminations	Termination Reason	Insert	New Registration			10/7/2020 3:57 PM