Covered Entity Details

CAH161309-06 ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley (Active) - information as of 5/11/2025 11:42:35 PM

Main Details

Name

ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley

Subdivision Name

ALEGENT HEALTH COMMUNITY MEMORIAL H - Oakland RHC

Type

Critical Access Hospital

Rural

340B ID

CAH161309-06

Medicare Provider Number

161309

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/11/2022

Participating Start Date

7/1/2022

Participating Approval Date

4/26/2022

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Missouri Valley
David J Jones, President
(816) 244-3695

Primary Contact

CommonSpirit Health - Central Region
Mitchell Schultz, RPh, 340b Regional Manager
(701) 928-0620

Addresses

Street Address

700 S HIGHWAY ST
OAKLAND, IA 51560-4357

Billing Address

ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley
ATTN: 2210-5100146
PO Box 2400
Phoenix, AZ 85002

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
CAH161309-01	Child	CAH	ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley	CHI Health Dunlap Clinic	704 Iowa Avenue	Dunlap	IA	Active
CAH161309-02	Child	CAH	ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley	CHI Health Woodbine Clinic	518 Lincoln Way	Woodbine	IA	Active
CAH161309-03	Child	CAH	ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley	CHI Health Logan Clinic	118 S. 1st Ave	Logan	IA	Active
CAH161309-04	Child	CAH	ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley	CHI Health Missouri Valley Clinic	809 East Elm Street	Missouri Valley	IA	Active
CAH161309-05	Child	CAH	ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley	CHI Health Missouri Valley After Hours Clinic - After Hours	809 East Elm Street	Missouri Valley	IA	Terminated
CAH161309-06	Child	CAH	ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley	ALEGENT HEALTH COMMUNITY MEMORIAL H - Oakland RHC	700 S HIGHWAY ST	OAKLAND	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 9:59:57 AM	8/28/2024 9:13:31 AM	8/28/2024 9:13 AM
Contacts	Primary Contact	Update	Profile Change Request	Schultz, Mitchell RPh, 340b Division Manager CommonSpirit Health - Midwest Division 7019280620	Schultz, Mitchell RPh, 340b Regional Manager CommonSpirit Health - Central Region 7019280620	8/6/2024 1:57 PM
Addresses	Billing Address	Update	Change Request	CHI HEALTH MISSOURI VALLEY CHI ACCTS PAY SUPPORT 2210-5100146 PO BOX 636000 LITTLETON, CO 80163	ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley ATTN: 2210-5100146 PO Box 2400 Phoenix, AZ 85002	10/2/2023 8:36 AM
Contacts	Primary Contact	Update	Profile Change Request	Schultz, Mitchell RPh CommonSpirit Health - Midwest Division 7019280620	Schultz, Mitchell RPh, 340b Division Manager CommonSpirit Health - Midwest Division 7019280620	9/27/2023 5:22 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 10:11:00 AM	8/15/2023 9:59:57 AM	8/15/2023 9:59 AM
Details	Last Recertification Date	Update	Recertification		8/30/2022 10:11:00 AM	8/30/2022 10:11 AM
Details	State	Update		Approved	Active	7/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Jones, David J President Missouri Valley 8162443695	4/26/2022 9:04 AM
Details	340B ID	Update	New Registration		CAH161309-06	4/26/2022 9:04 AM
Details	Entity Name	Update	New Registration	CHI HEALTH - MISSOURI VALLEY	ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley	4/26/2022 9:04 AM
Details	Entity Subname	Update	New Registration	ALEGENT HEALTH COMMUNITY MEMORIAL H	ALEGENT HEALTH COMMUNITY MEMORIAL H - Oakland RHC	4/26/2022 9:04 AM
Dates	Participating Approval Date	Update	New Registration		4/26/2022 9:04:43 AM	4/26/2022 9:04 AM
Details	State	Update	New Registration	Pending	Approved	4/26/2022 9:04 AM
Dates	Signed By Date	Update	New Registration		4/25/2022 11:51:58 AM	4/26/2022 9:04 AM
Dates	Start Date	Update	New Registration		7/1/2022 12:00:00 AM	4/26/2022 9:04 AM
Addresses	Main Address	Insert	New Registration		700 S HIGHWAY ST OAKLAND, IA 51560-4357	4/11/2022 1:43 PM
Addresses	Billing Address	Insert	New Registration		CHI HEALTH MISSOURI VALLEY CHI ACCTS PAY SUPPORT 2210-5100146 PO BOX 636000 LITTLETON, CO 80163	4/11/2022 1:43 PM
Contacts	Primary Contact	Insert	New Registration		Schultz, Mitchell RPh CommonSpirit Health - Midwest Division 7019280620	4/11/2022 1:43 PM
Contacts	Authorizing Official	Insert	New Registration		Jones, David J President Missouri Valley 8162443695	4/11/2022 1:43 PM
Details	Assistance Received From Date	Insert	New Registration			4/11/2022 1:43 PM
Details	Assistance Received To Date	Insert	New Registration			4/11/2022 1:43 PM
Details	Last Recertification Date	Insert	New Registration			4/11/2022 1:43 PM
Details	Grant Number	Insert	New Registration			4/11/2022 1:43 PM
Details	340B ID	Insert	New Registration			4/11/2022 1:43 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2022 1:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2022 1:43 PM
Details	Medicare Provider Number	Insert	New Registration		161309	4/11/2022 1:43 PM
Details	Entity Name	Insert	New Registration		CHI HEALTH - MISSOURI VALLEY	4/11/2022 1:43 PM
Details	NOFO Number	Insert	New Registration			4/11/2022 1:43 PM
Details	Program Code	Insert	New Registration		CAH	4/11/2022 1:43 PM
Details	Entity Subname	Insert	New Registration		ALEGENT HEALTH COMMUNITY MEMORIAL H	4/11/2022 1:43 PM
Dates	Participating Approval Date	Insert	New Registration			4/11/2022 1:43 PM
Details	State	Insert	New Registration		Pending	4/11/2022 1:43 PM
Dates	Registration Date	Insert	New Registration		4/11/2022 1:43:16 PM	4/11/2022 1:43 PM
Dates	Signed By Date	Insert	New Registration			4/11/2022 1:43 PM
Dates	Start Date	Insert	New Registration			4/11/2022 1:43 PM
Terminations	Termination Comments	Insert	New Registration			4/11/2022 1:43 PM
Terminations	Termination Date	Insert	New Registration			4/11/2022 1:43 PM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2022 1:43 PM
Terminations	Termination Reason	Insert	New Registration			4/11/2022 1:43 PM