Covered Entity Details

CAH291313-02 Banner Churchill Community Hospital (Terminated) - information as of 5/14/2025 10:49:13 PM

Main Details

Name

Banner Churchill Community Hospital

Subdivision Name

Fernley HC OB GYN RHC - Obstetrics/Gynecology Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH291313-02

Medicare Provider Number

291313

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/4/2021

Participating Start Date

1/1/2022

Participating Approval Date

10/13/2021

Last Recertification Date

8/31/2023

Termination Date
Termination Reason

1/1/2024
Business decision by the Covered Entity

Contacts

Authorizing Official

Banner Payson Medical Center
Matthew K King, Senior Finance Director
(801) 682-9661

Primary Contact

Banner Churchill Community Hospital
Alison S. Toigo, Associate Director of Pharmacy
(775) 867-7123

Addresses

Street Address

1260 Nevada Pacific Blvd.
Fernley, NV 89408

Billing Address

Banner Health Accounts Payable
PO Box 2977
Phoenix, AZ 85062

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
NV	1548780554	1548780554,1265811251

Shipping Addresses

Shipping Address 1

Banner Churchill Community Hospital
1260 Nevada Pacific Blvd
Fernley, NV 89408

Shipping Address 2

Banner Churchill Community Hospital
801 East Williams
Fallon, NV 89406

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
CAH291313-01	Child	CAH	Banner Churchill Community Hospital	BANNER CHURCHILL COMMUNITY HOSPITAL - Fernley HC PCP RHC - Clinic	1260 NEVADA PACIFIC BLVD	FERNLEY	NV	Active
CAH291313-02	Child	CAH	Banner Churchill Community Hospital	Fernley HC OB GYN RHC - Obstetrics/Gynecology Clinic	1260 Nevada Pacific Blvd.	Fernley	NV	Terminated
CAH291313-03	Child	CAH	Banner Churchill Community Hospital	Fernley HC Gen Surg PBC - General Surgery Clinic	1260 Nevada Pacific Blvd	Fernley	NV	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Toigo, Alison S. Pharmacy Senior Manager Banner Churchill Community Hospital 7758677123	Toigo, Alison S. Associate Director of Pharmacy Banner Churchill Community Hospital 7758677123	7/23/2024 4:12 PM
Details	State	Update		To Be Terminated	Terminated	1/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/11/2023 12:00:00 AM	10/17/2023 1:01 PM
Details	State	Update	Termination Request	Active	To Be Terminated	10/17/2023 1:01 PM
Terminations	Termination Date	Update	Termination Request		1/1/2024 12:00:00 AM	10/17/2023 1:01 PM
Terminations	Termination Effective Date	Update	Termination Request		10/11/2023 12:00:00 AM	10/17/2023 1:01 PM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	10/17/2023 1:01 PM
Contacts	Authorizing Official	Update	Change Request	Schultz, Lorena CFO Banner Health 9708101573	King, Matthew K Senior Finance Director Banner Payson Medical Center 8016829661	10/12/2023 4:23 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 11:49:38 AM	8/31/2023 6:00:51 PM	8/31/2023 6:00 PM
Contacts	Authorizing Official	Update	Profile Change Request	Schultz, Lorena CFO Banner Churchill Community Hospital 5302522239	Schultz, Lorena CFO Banner Health 9708101573	8/15/2023 9:56 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1265811251	3/15/2023 1:12 PM
Medicaid Billing	NPI: State	Insert	Change Request		NV	3/15/2023 1:12 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	291313 (NV)		12/12/2022 5:37 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/12/2022 5:37 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1548780554	12/12/2022 5:37 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NV	12/12/2022 5:37 PM
Details	Last Recertification Date	Update	Recertification		8/30/2022 11:49:38 AM	8/30/2022 11:49 AM
Contacts	Authorizing Official	Update	Change Request	Fraker, Steven Chief Financial Officer Banner Churchill Community Hospital 7758677002	Schultz, Lorena CFO Banner Churchill Community Hospital 5302522239	6/9/2022 12:31 PM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Fraker, Steven Chief Financial Officer Banner Churchill Community Hospital 7758677002	10/13/2021 10:58 AM
Details	340B ID	Update	New Registration		CAH291313-02	10/13/2021 10:58 AM
Details	Entity Name	Update	New Registration	BANNER CHURCHILL COMMUNITY HOSPITAL	Banner Churchill Community Hospital	10/13/2021 10:58 AM
Details	Entity Subname	Update	New Registration	Fernley HC OB GYN RHC	Fernley HC OB GYN RHC - Obstetrics/Gynecology Clinic	10/13/2021 10:58 AM
Dates	Participating Approval Date	Update	New Registration		10/13/2021 10:58:30 AM	10/13/2021 10:58 AM
Details	State	Update	New Registration	Pending	Approved	10/13/2021 10:58 AM
Dates	Signed By Date	Update	New Registration		10/6/2021 8:17:28 PM	10/13/2021 10:58 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	10/13/2021 10:58 AM
Addresses	Main Address	Insert	New Registration		1260 Nevada Pacific Blvd. Fernley, NV 89408	10/4/2021 1:45 PM
Addresses	Billing Address	Insert	New Registration		Banner Health Accounts Payable PO Box 2977 Phoenix, AZ 85062	10/4/2021 1:45 PM
Addresses	Shipping Address	Insert	New Registration		Banner Churchill Community Hospital 1260 Nevada Pacific Blvd Fernley, NV 89408	10/4/2021 1:45 PM
Addresses	Shipping Address	Insert	New Registration		Banner Churchill Community Hospital 801 East Williams Fallon, NV 89406	10/4/2021 1:45 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/4/2021 1:45 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		291313	10/4/2021 1:45 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NV	10/4/2021 1:45 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548780554	10/4/2021 1:45 PM
Medicaid Billing	NPI: State	Insert	New Registration		NV	10/4/2021 1:45 PM
Contacts	Authorizing Official	Insert	New Registration		Fraker, Steven Chief Financial Officer Banner Churchill Community Hospital 7758677002	10/4/2021 1:45 PM
Contacts	Primary Contact	Insert	New Registration		Toigo, Alison S. Pharmacy Senior Manager Banner Churchill Community Hospital 7758677123	10/4/2021 1:45 PM
Details	Assistance Received From Date	Insert	New Registration			10/4/2021 1:45 PM
Details	Assistance Received To Date	Insert	New Registration			10/4/2021 1:45 PM
Details	Last Recertification Date	Insert	New Registration			10/4/2021 1:45 PM
Details	Grant Number	Insert	New Registration			10/4/2021 1:45 PM
Details	340B ID	Insert	New Registration			10/4/2021 1:45 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/4/2021 1:45 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/4/2021 1:45 PM
Details	Medicare Provider Number	Insert	New Registration		291313	10/4/2021 1:45 PM
Details	Entity Name	Insert	New Registration		BANNER CHURCHILL COMMUNITY HOSPITAL	10/4/2021 1:45 PM
Details	NOFO Number	Insert	New Registration			10/4/2021 1:45 PM
Details	Program Code	Insert	New Registration		CAH	10/4/2021 1:45 PM
Details	Entity Subname	Insert	New Registration		Fernley HC OB GYN RHC	10/4/2021 1:45 PM
Dates	Participating Approval Date	Insert	New Registration			10/4/2021 1:45 PM
Details	State	Insert	New Registration		Pending	10/4/2021 1:45 PM
Dates	Registration Date	Insert	New Registration		10/4/2021 1:45:54 PM	10/4/2021 1:45 PM
Dates	Signed By Date	Insert	New Registration			10/4/2021 1:45 PM
Dates	Start Date	Insert	New Registration			10/4/2021 1:45 PM
Terminations	Termination Comments	Insert	New Registration			10/4/2021 1:45 PM
Terminations	Termination Date	Insert	New Registration			10/4/2021 1:45 PM
Terminations	Termination Effective Date	Insert	New Registration			10/4/2021 1:45 PM
Terminations	Termination Reason	Insert	New Registration			10/4/2021 1:45 PM