Covered Entity Details

SCH270003-24 ST. PETERS HEALTH (Active) - information as of 5/10/2025 10:56:02 PM

Main Details

Name

ST. PETERS HEALTH

Subdivision Name

St. Peter's Health Medical Group - Physical Medicine Rehab Clinic

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH270003-24

Medicare Provider Number

270003

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/6/2023

Participating Start Date

7/1/2023

Participating Approval Date

4/18/2023

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

St. Peters Health
Nathan M Coburn, CFO
(406) 444-2122

Primary Contact

St. Peter's Health
Starla Marie Blank, Director of Pharmacy
(406) 444-2355

Addresses

Street Address

2550 E Broadway St
Helena, MT 59601

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?
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
SCH270003-01	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH ENT	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-02	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG ENDOCRINOLOGY	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-03	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH NMC	3330 Ptarmigan Ln	HELENA	MT	Active
SCH270003-04	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH PLASTIC SURGERY	2728 Colonial Drive	Helena	MT	Active
SCH270003-05	Child	SCH	ST. PETERS HEALTH	ST PETERS COMMUNITY HOSPITAL - SPH CARD	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-06	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMGB INFUSION	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-07	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG NEPHROLOGY	2525 E BROADWAY ST	HELENA	MT	Active
SCH270003-08	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG GASTRO	2525 E Broadway St	HELENA	MT	Active
SCH270003-09	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG FAMILY PRACTICE	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-10	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG ORTHO	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-11	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG ALLERGY	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-12	Child	SCH	ST. PETERS HEALTH	ST PETERS COMMUNITY HOSPITAL - SPH HOME HEALTH	201 S CALIFORNIA ST	HELENA	MT	Active
SCH270003-13	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG PSYCHIATRY	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-14	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG NEUROLOGY	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-15	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG INTERN MEDICINE	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-16	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG RHEUMETOLOGY	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-17	Child	SCH	ST. PETERS HEALTH	ST PETERS HOSPITAL - SPH SPMG UROLOGY	2550 E BROADWAY ST	HELENA	MT	Active
SCH270003-18	Child	SCH	ST. PETERS HEALTH	St. Peter's Health Medical Group - SPHMG General Surgery	2525 E Broadway St	Helena	MT	Active
SCH270003-19	Child	SCH	ST. PETERS HEALTH	St. Peter's Health - Wound Care Center	2525 E Broadway St	Helena	MT	Active
SCH270003-20	Child	SCH	ST. PETERS HEALTH	St. Peter's Health - Townsend Clinic Primary Care	515 S Front Street	Townsend	MT	Active
SCH270003-21	Child	SCH	ST. PETERS HEALTH	St. Peter's Health Medical Group - PULMONOLOGY	2550 E Broadway St	Helena	MT	Active
SCH270003-22	Child	SCH	ST. PETERS HEALTH	St. Peter's Health - Urgent Care North	3330 Ptarmigan Lane	Helena	MT	Active
SCH270003-23	Child	SCH	ST. PETERS HEALTH	St. Peter's Health - Urgent Care South	2475 E Broadway St	Helena	MT	Active
SCH270003-24	Child	SCH	ST. PETERS HEALTH	St. Peter's Health Medical Group - Physical Medicine Rehab Clinic	2550 E Broadway St	Helena	MT	Active
SCH270003-25	Child	SCH	ST. PETERS HEALTH	SPH SPMG Palliative Care - Palliative Care	2550 E Broadway St	Helena	MT	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/16/2023 10:44:15 AM	8/23/2024 2:18:43 PM	8/23/2024 2:18 PM
Details	Entity Name	Update	Change Request	ST. PETERS HOSPITAL	ST. PETERS HEALTH	12/11/2023 6:54 AM
Contacts	Authorizing Official	Update	Change Request	Coburn, Nathan CFO St. Peters Health 4064442122	Coburn, Nathan M CFO St. Peters Health 4064442122	9/6/2023 10:54 AM
Contacts	Signed By	Update	Change Request	Coburn, Nathan CFO St. Peters Health 4064442122	Coburn, Nathan M CFO St. Peters Health 4064442122	9/6/2023 10:54 AM
Details	Last Recertification Date	Update	Recertification		8/16/2023 10:44:15 AM	8/16/2023 10:44 AM
Details	State	Update		Approved	Active	7/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Coburn, Nathan CFO St. Peters Health 4064442122	4/18/2023 1:05 PM
Details	340B ID	Update	New Registration		SCH270003-24	4/18/2023 1:05 PM
Details	Entity Subname	Update	New Registration	St. Peter's Health Medical Group	St. Peter's Health Medical Group - Physical Medicine Rehab Clinic	4/18/2023 1:05 PM
Dates	Participating Approval Date	Update	New Registration		4/18/2023 1:05:19 PM	4/18/2023 1:05 PM
Details	State	Update	New Registration	Pending	Approved	4/18/2023 1:05 PM
Dates	Signed By Date	Update	New Registration		4/10/2023 10:56:42 AM	4/18/2023 1:05 PM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	4/18/2023 1:05 PM
Addresses	Main Address	Insert	New Registration		2550 E Broadway St Helena, MT 59601	4/6/2023 3:34 PM
Contacts	Authorizing Official	Insert	New Registration		Coburn, Nathan CFO St. Peters Health 4064442122	4/6/2023 3:34 PM
Contacts	Primary Contact	Insert	New Registration		Blank, Starla Marie Director of Pharmacy St. Peter's Health 4064442355	4/6/2023 3:34 PM
Details	Assistance Received From Date	Insert	New Registration			4/6/2023 3:34 PM
Details	Assistance Received To Date	Insert	New Registration			4/6/2023 3:34 PM
Details	Last Recertification Date	Insert	New Registration			4/6/2023 3:34 PM
Details	Grant Number	Insert	New Registration			4/6/2023 3:34 PM
Details	340B ID	Insert	New Registration			4/6/2023 3:34 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/6/2023 3:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/6/2023 3:34 PM
Details	Medicare Provider Number	Insert	New Registration		270003	4/6/2023 3:34 PM
Details	Entity Name	Insert	New Registration		ST. PETERS HOSPITAL	4/6/2023 3:34 PM
Details	NOFO Number	Insert	New Registration			4/6/2023 3:34 PM
Details	Program Code	Insert	New Registration		SCH	4/6/2023 3:34 PM
Details	Entity Subname	Insert	New Registration		St. Peter's Health Medical Group	4/6/2023 3:34 PM
Dates	Participating Approval Date	Insert	New Registration			4/6/2023 3:34 PM
Details	State	Insert	New Registration		Pending	4/6/2023 3:34 PM
Dates	Registration Date	Insert	New Registration		4/6/2023 3:34:25 PM	4/6/2023 3:34 PM
Dates	Signed By Date	Insert	New Registration			4/6/2023 3:34 PM
Dates	Start Date	Insert	New Registration			4/6/2023 3:34 PM
Terminations	Termination Comments	Insert	New Registration			4/6/2023 3:34 PM
Terminations	Termination Date	Insert	New Registration			4/6/2023 3:34 PM
Terminations	Termination Effective Date	Insert	New Registration			4/6/2023 3:34 PM
Terminations	Termination Reason	Insert	New Registration			4/6/2023 3:34 PM