Covered Entity Details

SCH060071-01 DELTA COUNTY MEMORIAL HOSPITAL (Approved) - information as of 5/15/2025 11:37:48 PM

Main Details

Name

DELTA COUNTY MEMORIAL HOSPITAL

Subdivision Name

DELTA INTERNAL MEDICINE CLINIC - ADULT PRIMARY CARE

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH060071-01

Medicare Provider Number

060071

Outpatient Facility Provider Number

068525

Additional Details

Current Program Status

Approved

Registration Date

4/1/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/15/2025

Last Recertification Date

Contacts

Authorizing Official

Delta Health
Jonathan Cohee, Chief Executive Officer
(970) 874-2285

Primary Contact

Delta Health
Cari Dillon, Director of Pharmacy
(970) 874-2433

Addresses

Street Address

1450 BURGESS STREET
Delta, CO 81416

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating Start Date 6/22/2022, Termination 7/1/2024, Reinstatement 7/1/2025	04/14/2025

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
CO	9000199757	1275209009

Shipping Addresses

Shipping Address 1

Delta County Memorial Hospital
1501 E 3rd Street
Attn: Pharmacy
Delta, CO 81416

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
SCH060071-01	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	DELTA INTERNAL MEDICINE CLINIC - ADULT PRIMARY CARE	1450 BURGESS STREET	Delta	CO	Approved
SCH060071-02	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	DCMH WEST ELK CLINIC HOTCHKISS - Primary Care	230 E HOTCHKISS AVENUE	HOTCHKISS	CO	Approved
SCH060071-03	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	DELTA FAMILY MEDICINE - Primary Care	70 Stafford Lane	Delta	CO	Approved
SCH060071-04	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	ONCOLOGY CLINIC - Oncology	1501 E 3rd Street	Delta	CO	Approved
SCH060071-05	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	DELTA HEALTH UROLOGY - Urology	1501 E 3RD ST	DELTA	CO	Approved
SCH060071-06	Child	SCH	DELTA COUNTY MEMORIAL HOSPITAL	DELTA HEALTH SURGICAL - Surgery	95 STAFFORD LN	DELTA	CO	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Reinstatement	Huffman, Julie Interim CEO/ Chief Legal Officer Delta Health 9708742245	Cohee, Jonathan Chief Executive Officer Delta Health 9708742285	4/15/2025 11:10 AM
Contacts	Signed By	Update	Reinstatement	Heyn, Matthew CEO Delta County Memorial Hospital 9708742229	Cohee, Jonathan Chief Executive Officer Delta Health 9708742285	4/15/2025 11:10 AM
Details	Last Recertification Date	Update	Reinstatement	8/30/2023 12:57:19 PM		4/15/2025 11:10 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	6/28/2024 12:00:00 AM		4/15/2025 11:10 AM
Details	Entity Name	Update	Reinstatement	DELTA HEALTH	DELTA COUNTY MEMORIAL HOSPITAL	4/15/2025 11:10 AM
Dates	Participating Approval Date	Update	Reinstatement	6/16/2022 7:37:09 AM	4/15/2025 11:10:41 AM	4/15/2025 11:10 AM
Details	State	Update	Reinstatement	Terminated	Approved	4/15/2025 11:10 AM
Dates	Registration Date	Update	Reinstatement	6/15/2022 1:27:08 PM	4/1/2025 4:48:24 PM	4/15/2025 11:10 AM
Dates	Signed By Date	Update	Reinstatement	6/15/2022 2:29:51 PM	4/9/2025 11:56:18 AM	4/15/2025 11:10 AM
Dates	Start Date	Update	Reinstatement	6/22/2022 12:00:00 AM	7/1/2025 12:00:00 AM	4/15/2025 11:10 AM
Terminations	Termination Comments	Update	Reinstatement	DSH 6.82		4/15/2025 11:10 AM
Terminations	Termination Date	Update	Reinstatement	7/1/2024 12:00:00 AM		4/15/2025 11:10 AM
Terminations	Termination Effective Date	Update	Reinstatement	5/31/2024 12:00:00 AM		4/15/2025 11:10 AM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		4/15/2025 11:10 AM
Details	Comments Public	Insert	Reinstatement		Participating Start Date 6/22/2022, Termination 7/1/2024, Reinstatement 7/1/2025	4/14/2025 7:19 AM
Details	State	Update		To Be Terminated	Terminated	7/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		6/28/2024 12:00:00 AM	6/13/2024 1:42 PM
Details	State	Update	Termination Request	Active	To Be Terminated	6/13/2024 1:42 PM
Terminations	Termination Comments	Update	Termination Request		DSH 6.82	6/13/2024 1:42 PM
Terminations	Termination Date	Update	Termination Request		7/1/2024 12:00:00 AM	6/13/2024 1:42 PM
Terminations	Termination Effective Date	Update	Termination Request		5/31/2024 12:00:00 AM	6/13/2024 1:42 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	6/13/2024 1:42 PM
Details	Last Recertification Date	Update	Recertification	8/25/2022 11:29:20 AM	8/30/2023 12:57:19 PM	8/30/2023 12:57 PM
Contacts	Primary Contact	Update	Profile Change Request	Dillon, Cari Director of Pharmacy Delta County Memorial Hospital 9708742433	Dillon, Cari Director of Pharmacy Delta Health 9708742433	8/18/2023 6:38 AM
Contacts	Authorizing Official	Update	Change Request	Heyn, Matthew CEO Delta County Memorial Hospital 9708742229	Huffman, Julie Interim CEO/ Chief Legal Officer Delta Health 9708742245	4/3/2023 10:38 AM
Details	Last Recertification Date	Update	Recertification		8/25/2022 11:29:20 AM	8/25/2022 11:29 AM
Details	Entity Name	Update	Change Request	DELTA COUNTY MEMORIAL HOSPITAL	DELTA HEALTH	8/16/2022 1:10 PM
Details	State	Update	OPA Edit	Approved	Active	6/22/2022 7:56 AM
Dates	Start Date	Update	OPA Edit	7/1/2022 12:00:00 AM	6/22/2022 12:00:00 AM	6/22/2022 7:56 AM
Contacts	Signed By	Insert	New Registration		Heyn, Matthew CEO Delta County Memorial Hospital 9708742229	6/16/2022 7:37 AM
Details	340B ID	Update	New Registration		SCH060071-01	6/16/2022 7:37 AM
Details	Entity Subname	Update	New Registration	DELTA INTERNAL MEDICINE CLINIC	DELTA INTERNAL MEDICINE CLINIC - ADULT PRIMARY CARE	6/16/2022 7:37 AM
Dates	Participating Approval Date	Update	New Registration		6/16/2022 7:37:09 AM	6/16/2022 7:37 AM
Details	State	Update	New Registration	Pending	Approved	6/16/2022 7:37 AM
Dates	Signed By Date	Update	New Registration		6/15/2022 2:29:51 PM	6/16/2022 7:37 AM
Dates	Start Date	Update	New Registration		7/1/2022 12:00:00 AM	6/16/2022 7:37 AM
Addresses	Main Address	Insert	New Registration		1450 BURGESS STREET Delta, CO 81416	6/15/2022 1:27 PM
Addresses	Shipping Address	Insert	New Registration		Delta County Memorial Hospital 1501 E 3rd Street Attn: Pharmacy Delta, CO 81416	6/15/2022 1:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	6/15/2022 1:27 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		9000199757	6/15/2022 1:27 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	6/15/2022 1:27 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275209009	6/15/2022 1:27 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	6/15/2022 1:27 PM
Contacts	Primary Contact	Insert	New Registration		Dillon, Cari Director of Pharmacy Delta County Memorial Hospital 9708742433	6/15/2022 1:27 PM
Contacts	Authorizing Official	Insert	New Registration		Heyn, Matthew CEO Delta County Memorial Hospital 9708742229	6/15/2022 1:27 PM
Details	Assistance Received From Date	Insert	New Registration			6/15/2022 1:27 PM
Details	Assistance Received To Date	Insert	New Registration			6/15/2022 1:27 PM
Details	Last Recertification Date	Insert	New Registration			6/15/2022 1:27 PM
Details	Grant Number	Insert	New Registration			6/15/2022 1:27 PM
Details	340B ID	Insert	New Registration			6/15/2022 1:27 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			6/15/2022 1:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			6/15/2022 1:27 PM
Details	Medicare Provider Number	Insert	New Registration		060071	6/15/2022 1:27 PM
Details	Entity Name	Insert	New Registration		DELTA COUNTY MEMORIAL HOSPITAL	6/15/2022 1:27 PM
Details	NOFO Number	Insert	New Registration			6/15/2022 1:27 PM
Details	Program Code	Insert	New Registration		SCH	6/15/2022 1:27 PM
Details	Entity Subname	Insert	New Registration		DELTA INTERNAL MEDICINE CLINIC	6/15/2022 1:27 PM
Dates	Participating Approval Date	Insert	New Registration			6/15/2022 1:27 PM
Details	State	Insert	New Registration		Pending	6/15/2022 1:27 PM
Dates	Registration Date	Insert	New Registration		6/15/2022 1:27:08 PM	6/15/2022 1:27 PM
Dates	Signed By Date	Insert	New Registration			6/15/2022 1:27 PM
Dates	Start Date	Insert	New Registration			6/15/2022 1:27 PM
Terminations	Termination Comments	Insert	New Registration			6/15/2022 1:27 PM
Terminations	Termination Date	Insert	New Registration			6/15/2022 1:27 PM
Terminations	Termination Effective Date	Insert	New Registration			6/15/2022 1:27 PM
Terminations	Termination Reason	Insert	New Registration			6/15/2022 1:27 PM