Covered Entity Details

DSH380018B ASANTE ROGUE REGIONAL MEDICAL CENTER (Active) - information as of 4/30/2025 10:56:05 PM

Main Details

Name

ASANTE ROGUE REGIONAL MEDICAL CENTER

Subdivision Name

Mary & Dick Heimann Cancer Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH380018B

Medicare Provider Number

380018

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/2/2021

Participating Start Date

7/1/2021

Participating Approval Date

4/23/2021

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Asante
Heather Rowenhorst, CFO
(541) 789-5098

Primary Contact

Asante
Ruthie Nguyen, Manager Pharmacy Shared Services
(541) 789-5379

Addresses

Street Address

3011 E. Barnett Rd
Medford, OR 97504

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?
Yes

State	Medicaid Number	NPI Number
OR	162008	1770587107

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
DSH380018A	Child	DSH	ASANTE ROGUE REGIONAL MEDICAL CENTER	RVMC CARDIOVASCULAR LAB / CVI Cath Lab	520 MEDICAL CENTER DRIVE	MEDFORD	OR	Terminated
DSH380018B	Child	DSH	ASANTE ROGUE REGIONAL MEDICAL CENTER	Mary & Dick Heimann Cancer Center	3011 E. Barnett Rd	Medford	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Watson, Amy Director of Pharmacy Asante 5417895031	Nguyen, Ruthie Manager Pharmacy Shared Services Asante 5417895379	3/7/2025 7:08 AM
Details	Last Recertification Date	Update	Recertification	8/21/2023 8:07:56 PM	8/13/2024 8:10:21 AM	8/13/2024 8:10 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 3:43:44 PM	8/21/2023 8:07:56 PM	8/21/2023 8:07 PM
Contacts	Authorizing Official	Update	Change Request	Wojtal, Greg Chief Administrative and Finance Officer Asante 5417894549	Rowenhorst, Heather CFO Asante 5417895098	5/24/2023 9:13 AM
Details	Last Recertification Date	Update	Recertification	8/17/2021 2:24:57 PM	8/29/2022 3:43:44 PM	8/29/2022 3:43 PM
Addresses	Main Address	Update	Change Request	2825 E. Barnett Rd., Ste 1336 Medford, OR 97504	3011 E. Barnett Rd Medford, OR 97504	1/28/2022 2:11 PM
Details	Entity Subname	Update	Change Request	Rogue Regional Medical Center - Asante Infusion Service	Mary & Dick Heimann Cancer Center	1/28/2022 2:11 PM
Details	Last Recertification Date	Update	Recertification		8/17/2021 2:24:57 PM	8/17/2021 2:24 PM
Details	State	Update		Approved	Active	7/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Wojtal, Greg Chief Administrative and Finance Officer Asante 5417894549	4/23/2021 6:59 AM
Details	340B ID	Update	New Registration		DSH380018B	4/23/2021 6:59 AM
Details	Entity Name	Update	New Registration	ROGUE REGIONAL MEDICAL CENTER	ASANTE ROGUE REGIONAL MEDICAL CENTER	4/23/2021 6:59 AM
Details	Entity Subname	Update	New Registration	Rogue Regional Medical Center	Rogue Regional Medical Center - Asante Infusion Service	4/23/2021 6:59 AM
Dates	Participating Approval Date	Update	New Registration		4/23/2021 6:59:08 AM	4/23/2021 6:59 AM
Details	State	Update	New Registration	Pending	Approved	4/23/2021 6:59 AM
Dates	Signed By Date	Update	New Registration		4/22/2021 5:19:39 PM	4/23/2021 6:59 AM
Dates	Start Date	Update	New Registration		7/1/2021 12:00:00 AM	4/23/2021 6:59 AM
Addresses	Main Address	Insert	New Registration		2825 E. Barnett Rd., Ste 1336 Medford, OR 97504	4/2/2021 6:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2021 6:48 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		162008	4/2/2021 6:48 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	4/2/2021 6:48 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1770587107	4/2/2021 6:48 PM
Medicaid Billing	NPI: State	Insert	New Registration		OR	4/2/2021 6:48 PM
Contacts	Primary Contact	Insert	New Registration		Watson, Amy Director of Pharmacy Asante 5417895031	4/2/2021 6:48 PM
Contacts	Authorizing Official	Insert	New Registration		Wojtal, Greg Chief Administrative and Finance Officer Asante 5417894549	4/2/2021 6:48 PM
Details	Assistance Received From Date	Insert	New Registration			4/2/2021 6:48 PM
Details	Assistance Received To Date	Insert	New Registration			4/2/2021 6:48 PM
Details	Last Recertification Date	Insert	New Registration			4/2/2021 6:48 PM
Details	Grant Number	Insert	New Registration			4/2/2021 6:48 PM
Details	340B ID	Insert	New Registration			4/2/2021 6:48 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2021 6:48 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2021 6:48 PM
Details	Medicare Provider Number	Insert	New Registration		380018	4/2/2021 6:48 PM
Details	Entity Name	Insert	New Registration		ROGUE REGIONAL MEDICAL CENTER	4/2/2021 6:48 PM
Details	NOFO Number	Insert	New Registration			4/2/2021 6:48 PM
Details	Program Code	Insert	New Registration		DSH	4/2/2021 6:48 PM
Details	Entity Subname	Insert	New Registration		Rogue Regional Medical Center	4/2/2021 6:48 PM
Dates	Participating Approval Date	Insert	New Registration			4/2/2021 6:48 PM
Details	State	Insert	New Registration		Pending	4/2/2021 6:48 PM
Dates	Registration Date	Insert	New Registration		4/2/2021 6:48:27 PM	4/2/2021 6:48 PM
Dates	Signed By Date	Insert	New Registration			4/2/2021 6:48 PM
Dates	Start Date	Insert	New Registration			4/2/2021 6:48 PM
Terminations	Termination Comments	Insert	New Registration			4/2/2021 6:48 PM
Terminations	Termination Date	Insert	New Registration			4/2/2021 6:48 PM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2021 6:48 PM
Terminations	Termination Reason	Insert	New Registration			4/2/2021 6:48 PM