Covered Entity Details

CH10291F KLAMATH HEALTH PARTNERSHIP, INC (Active) - information as of 6/2/2025 8:31:07 AM

Main Details

Name

KLAMATH HEALTH PARTNERSHIP, INC

Subdivision Name

Pine Street Open Door

Type

HRSA-Funded Health Center

Site ID

BPS-H80-035264

340B ID

CH10291F

Grant Number

H80CS00233

Additional Details

Current Program Status

Active

Registration Date

10/7/2022

Participating Start Date

1/1/2023

Participating Approval Date

10/11/2022

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Klamath Health Partnership
Erich Koch, CEO
(541) 810-2040

Primary Contact

Klamath Health Partnership, Inc
Marcus Cox, Chief Pharmacy Officer
(541) 887-8188

Addresses

Street Address

403 Pine St
Klamath Falls, OR 97601-6020

Billing Address

KLAMATH HEALTH PARTNERSHIP, INC
2074 S 6th Street
Klamath Falls, OR 97601

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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	500719898,170061	1548999667,1689023780

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
Contract Detail	MEYER	2655 SHASTA WAY		KLAMATH FALLS	OR	97603	10/13/2023	01/01/2024			01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH102910	Active	BPS-H80-005244	KLAMATH HEALTH PARTNERSHIP, INC	Klamath Open Door Family Practice	2074 S 6th St	Klamath Falls	OR
CH10291A	Active	BPS-H80-000776	KLAMATH HEALTH PARTNERSHIP, INC	CHILOQUIN OPEN DOOR FAMILY PRACTICE	103 WASCO STREET	CHILOQUIN	OR
CH10291C	Terminated	BPS-H80-015260	KLAMATH HEALTH PARTNERSHIP INC	Klamath Open Door - Campus Clinic	2684 CAMPUS DR	KLAMATH FALLS	OR
CH10291D	Active	BPS-H80-024900	KLAMATH HEALTH PARTNERSHIP, INC	SBHC-Mazama High	3009 Summers Ln	Klamath Falls	OR
CH10291E	Terminated	BPS-H80-027269	KLAMATH HEALTH PARTNERSHIP, INC	KOD @ KBBH	2210 N. Eldorado Ave. STE 1	Klamath Falls	OR
CH10291F	Active	BPS-H80-035264	KLAMATH HEALTH PARTNERSHIP, INC	Pine Street Open Door	403 Pine St	Klamath Falls	OR

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH102910	ALBERTSONS LLC	SAV-ON PHARMACY #577	5500 SOUTH 6TH STREET	KLAMATH FALLS	OR	97603	01/01/2016
CH10291D	ALBERTSONS LLC	SAV-ON PHARMACY #577	5500 SOUTH 6TH STREET	KLAMATH FALLS	OR	97603	01/01/2024
CH102910	HAGGEN OPCO NORTH, LLC	HAGGEN PHARMACY #2122	2740 S 6TH	KLAMATH FALLS	OR	97603	08/05/2015	09/30/2015
CH102910	HAGGEN OPCO NORTH, LLC	HAGGEN PHARMACY #2114	211 NORTH 8TH STREET	KLAMATH FALLS	OR	97601	08/05/2015	09/30/2015
CH102910	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	07/01/2017
CH102910	MEYER	2655 SHASTA WAY		KLAMATH FALLS	OR	97603	04/01/2013
CH10291F	MEYER	2655 SHASTA WAY		KLAMATH FALLS	OR	97603	01/01/2024
CH102910	THRIFTY PAYLESS, INC.	RITE AID #5388	2521 SOUTH SIXTH STREET	KLAMATH FALLS	OR	97601	10/01/2013	04/23/2025
CH10291E	THRIFTY PAYLESS, INC.	RITE AID #5388	2521 SOUTH SIXTH STREET	KLAMATH FALLS	OR	97601	01/01/2024	04/01/2025
CH102910	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH102910	WAL-MART PHARMACY 10-1772	3600 WASHBURN WAY		KLAMATH FALLS	OR	97603	07/01/2014
CH10291A	WAL-MART PHARMACY 10-1772	3600 WASHBURN WAY		KLAMATH FALLS	OR	97603	01/01/2024
CH102910	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH102910	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH102910	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/5/2024 11:39:51 AM	2/11/2025 12:23:01 PM	2/11/2025 12:23 PM
Addresses	Billing Address	Update	Change Request	Klamath Health Partnership Inc 2074 South 6th Street Klamath Falls, OR 97601	KLAMATH HEALTH PARTNERSHIP, INC 2074 S 6th Street Klamath Falls, OR 97601	1/21/2025 7:42 AM
Contacts	Authorizing Official	Update	Change Request	Bland, Charles V. Chief Financial Officer Klamath Health Partnership, Inc. 8455416827	Koch, Erich CEO Klamath Health Partnership 5418102040	1/21/2025 7:42 AM
Details	Entity Name	Update	Change Request	Klamath Health Partners Inc	KLAMATH HEALTH PARTNERSHIP, INC	1/21/2025 7:42 AM
Addresses	Billing Address	Update	Recertification	Klamath Health Partnership Inc 2074S. 6th Street Klamath Falls, OR 97601	Klamath Health Partnership Inc 2074 South 6th Street Klamath Falls, OR 97601	2/5/2024 11:39 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1700661 (OR)		2/5/2024 11:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/5/2024 11:39 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		170061	2/5/2024 11:39 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/5/2024 11:39 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 2:37:32 PM	2/5/2024 11:39:51 AM	2/5/2024 11:39 AM
Contacts	Authorizing Official	Update	Change Request	Porter, Signe CFO Klamath Health Partnership Inc 5418518110-2022	Bland, Charles V. Chief Financial Officer Klamath Health Partnership, Inc. 8455416827	12/27/2023 6:02 PM
Contacts	Authorizing Official	Update	Profile Change Request	Porter, Signe CFO Klamath Heaalth Partnership Inc 5418518110-2022	Porter, Signe CFO Klamath Health Partnership Inc 5418518110-2022	10/10/2023 6:40 AM
Contacts	Signed By	Update	Profile Change Request	Porter, Signe CFO Klamath Heaalth Partnership Inc 5418518110-2022	Porter, Signe CFO Klamath Health Partnership Inc 5418518110-2022	10/10/2023 6:40 AM
Contacts	Primary Contact	Update	Profile Change Request	Cox, Marcus CPO Klamath Health Partnership Inc 5418518110-8188	Cox, Marcus Chief Pharmacy Officer Klamath Health Partnership, Inc 5418878188	10/10/2023 6:24 AM
Details	Last Recertification Date	Update	Recertification		1/31/2023 2:37:32 PM	1/31/2023 2:37 PM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/1/2022 5:23 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		500719898	11/1/2022 5:23 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	11/1/2022 5:23 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1689023780	11/1/2022 5:23 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	11/1/2022 5:23 PM
Contacts	Signed By	Insert	New Registration		Porter, Signe CFO Klamath Heaalth Partnership Inc 5418518110-2022	10/11/2022 9:53 AM
Details	340B ID	Update	New Registration		CH10291F	10/11/2022 9:53 AM
Dates	Participating Approval Date	Update	New Registration		10/11/2022 9:53:14 AM	10/11/2022 9:53 AM
Details	State	Update	New Registration	Pending	Approved	10/11/2022 9:53 AM
Dates	Signed By Date	Update	New Registration		10/7/2022 5:09:00 PM	10/11/2022 9:53 AM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	10/11/2022 9:53 AM
Addresses	Main Address	Insert	New Registration		403 Pine St Klamath Falls, OR 97601-6020	10/7/2022 5:08 PM
Addresses	Billing Address	Insert	New Registration		Klamath Health Partnership Inc 2074S. 6th Street Klamath Falls, OR 97601	10/7/2022 5:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/7/2022 5:08 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1700661	10/7/2022 5:08 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	10/7/2022 5:08 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548999667	10/7/2022 5:08 PM
Medicaid Billing	NPI: State	Insert	New Registration		OR	10/7/2022 5:08 PM
Contacts	Authorizing Official	Insert	New Registration		Porter, Signe CFO Klamath Heaalth Partnership Inc 5418518110-2022	10/7/2022 5:08 PM
Contacts	Primary Contact	Insert	New Registration		Cox, Marcus CPO Klamath Health Partnership Inc 5418518110-8188	10/7/2022 5:08 PM
Details	Assistance Received From Date	Insert	New Registration			10/7/2022 5:08 PM
Details	Assistance Received To Date	Insert	New Registration			10/7/2022 5:08 PM
Details	Last Recertification Date	Insert	New Registration			10/7/2022 5:08 PM
Details	Grant Number	Insert	New Registration		H80CS00233	10/7/2022 5:08 PM
Details	340B ID	Insert	New Registration			10/7/2022 5:08 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/7/2022 5:08 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/7/2022 5:08 PM
Details	Medicare Provider Number	Insert	New Registration			10/7/2022 5:08 PM
Details	Entity Name	Insert	New Registration		Klamath Health Partners Inc	10/7/2022 5:08 PM
Details	NOFO Number	Insert	New Registration			10/7/2022 5:08 PM
Details	Program Code	Insert	New Registration		CH	10/7/2022 5:08 PM
Details	Entity Subname	Insert	New Registration		Pine Street Open Door	10/7/2022 5:08 PM
Dates	Participating Approval Date	Insert	New Registration			10/7/2022 5:08 PM
Details	State	Insert	New Registration		Pending	10/7/2022 5:08 PM
Dates	Registration Date	Insert	New Registration		10/7/2022 5:08:57 PM	10/7/2022 5:08 PM
Dates	Signed By Date	Insert	New Registration			10/7/2022 5:08 PM
Dates	Start Date	Insert	New Registration			10/7/2022 5:08 PM
Terminations	Termination Comments	Insert	New Registration			10/7/2022 5:08 PM
Terminations	Termination Date	Insert	New Registration			10/7/2022 5:08 PM
Terminations	Termination Effective Date	Insert	New Registration			10/7/2022 5:08 PM
Terminations	Termination Reason	Insert	New Registration			10/7/2022 5:08 PM

340B Drug Pricing Program Database