Covered Entity Details

DSH060001F Banner North Colorado Medical Center (Active) - information as of 5/2/2025 10:42:14 PM

Main Details

Name

Banner North Colorado Medical Center

Subdivision Name

Banner North Colorado Medical Center - Banner Infusion Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH060001F

Medicare Provider Number

060001

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/9/2023

Participating Start Date

1/1/2024

Participating Approval Date

10/11/2023

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Banner Health
Patricia Gibson, Western Division Senior Finance Director
(970) 810-6140

Primary Contact

BannerHealth
Natalie Louise Yount, Director of Pharmacy
(970) 810-6901

Addresses

Street Address

2000 Boise Ave
B
Loveland, CO 80538

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
CO	9000214532	1700668183,1720004450
NE	10026075201	1720004450,1700668183
WY	109616800	1720004450,1700668183

Shipping Addresses

Shipping Address 1

Banner McKee Medical Center
2000 Boise Ave
Loveland, CO 80538

Shipping Address 2

Banner North Colorado Medical Center
1801 16th
Greeley, CO 80631

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
DSH060001A	Child	DSH	North Colorado Medical Center	SUMMIT VIEW MEDICAL COMMONS-RADIOLOGY	2001 70TH AVE	GREELEY	CO	Terminated
DSH060001B	Child	DSH	Banner North Colorado Medical Center	BANNER NORTH COLORADO EMERGENCY CARE	2000 70th Ave	Greeley	CO	Active
DSH060001C	Child	DSH	Banner North Colorado Medical Center	Banner MD Anderson Cancer Center - OP Oncology Clinic	1801 16th Street	Greeley	CO	Active
DSH060001D	Child	DSH	Banner North Colorado Medical Center	Banner NCMC MedCare Clinic - Anticoagulation Clinic	1517 16th Ave. Court	Greeley	CO	Terminated
DSH060001E	Child	DSH	Banner North Colorado Medical Center	North Colorado Medical Center - Banner MD Anderson Cancer Center	2000 Boise Ave	Loveland	CO	Active
DSH060001F	Child	DSH	Banner North Colorado Medical Center	Banner North Colorado Medical Center - Banner Infusion Center	2000 Boise Ave	Loveland	CO	Active
DSH060001G	Child	DSH	Banner North Colorado Medical Center	Banner MD Anderson Cancer Center Plastic Surgery at Banner North Colorado Medical Center - Surgical Oncology	1801 16th Street	Greeley	CO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Schultz, Lorena CFO Banner Health 9708101573	Gibson, Patricia Western Division Senior Finance Director Banner Health 9708106140	12/5/2024 2:30 PM
Details	Last Recertification Date	Update	Recertification		9/3/2024 1:42:58 PM	9/3/2024 1:42 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1720004450	4/17/2024 10:16 AM
Medicaid Billing	NPI: State	Insert	Change Request		CO	4/17/2024 10:16 AM
Details	Entity Subname	Update	Change Request	Banner McKee Infusion Center a department of Banner North Colorado Medical Center-Loveland - OP Infusion-Satellite	Banner North Colorado Medical Center - Banner Infusion Center	4/4/2024 3:47 PM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Addresses	Shipping Address	Insert	Change Request		Banner North Colorado Medical Center 1801 16th Greeley, CO 80631	11/14/2023 8:36 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1174231682 (CO)		11/14/2023 8:36 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1720004450 (CO)		11/14/2023 8:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1700668183	11/14/2023 8:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		CO	11/14/2023 8:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1700668183	11/14/2023 8:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		WY	11/14/2023 8:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1700668183	11/14/2023 8:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		NE	11/14/2023 8:36 AM
Contacts	Signed By	Insert	New Registration		Schultz, Lorena CFO Banner Health 9708101573	10/11/2023 11:26 AM
Details	340B ID	Update	New Registration		DSH060001F	10/11/2023 11:26 AM
Details	Entity Name	Update	New Registration	NORTH COLORADO MEDICAL CENTER	Banner North Colorado Medical Center	10/11/2023 11:26 AM
Details	Entity Subname	Update	New Registration	Banner McKee Infusion Center a department of Banner North Colorado Medical Center-Loveland	Banner McKee Infusion Center a department of Banner North Colorado Medical Center-Loveland - OP Infusion-Satellite	10/11/2023 11:26 AM
Dates	Participating Approval Date	Update	New Registration		10/11/2023 11:26:23 AM	10/11/2023 11:26 AM
Details	State	Update	New Registration	Pending	Approved	10/11/2023 11:26 AM
Dates	Signed By Date	Update	New Registration		10/11/2023 10:01:23 AM	10/11/2023 11:26 AM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	10/11/2023 11:26 AM
Addresses	Main Address	Insert	New Registration		2000 Boise Ave B Loveland, CO 80538	10/9/2023 12:39 PM
Addresses	Billing Address	Insert	New Registration		BANNER HEALTH ACCOUNTS PAYABLE PO BOX 2977 PHOENIX, AZ 85062	10/9/2023 12:39 PM
Addresses	Shipping Address	Insert	New Registration		Banner McKee Medical Center 2000 Boise Ave Loveland, CO 80538	10/9/2023 12:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/9/2023 12:39 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		9000214532	10/9/2023 12:39 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	10/9/2023 12:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/9/2023 12:39 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		10026075201	10/9/2023 12:39 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NE	10/9/2023 12:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/9/2023 12:39 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		109616800	10/9/2023 12:39 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WY	10/9/2023 12:39 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1174231682	10/9/2023 12:39 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	10/9/2023 12:39 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1720004450	10/9/2023 12:39 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	10/9/2023 12:39 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1720004450	10/9/2023 12:39 PM
Medicaid Billing	NPI: State	Insert	New Registration		NE	10/9/2023 12:39 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1720004450	10/9/2023 12:39 PM
Medicaid Billing	NPI: State	Insert	New Registration		WY	10/9/2023 12:39 PM
Contacts	Primary Contact	Insert	New Registration		Yount, Natalie Louise Director of Pharmacy BannerHealth 9708106901	10/9/2023 12:39 PM
Contacts	Authorizing Official	Insert	New Registration		Schultz, Lorena CFO Banner Health 9708101573	10/9/2023 12:39 PM
Details	Assistance Received From Date	Insert	New Registration			10/9/2023 12:39 PM
Details	Assistance Received To Date	Insert	New Registration			10/9/2023 12:39 PM
Details	Last Recertification Date	Insert	New Registration			10/9/2023 12:39 PM
Details	Grant Number	Insert	New Registration			10/9/2023 12:39 PM
Details	340B ID	Insert	New Registration			10/9/2023 12:39 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/9/2023 12:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/9/2023 12:39 PM
Details	Medicare Provider Number	Insert	New Registration		060001	10/9/2023 12:39 PM
Details	Entity Name	Insert	New Registration		NORTH COLORADO MEDICAL CENTER	10/9/2023 12:39 PM
Details	NOFO Number	Insert	New Registration			10/9/2023 12:39 PM
Details	Program Code	Insert	New Registration		DSH	10/9/2023 12:39 PM
Details	Entity Subname	Insert	New Registration		Banner McKee Infusion Center a department of Banner North Colorado Medical Center-Loveland	10/9/2023 12:39 PM
Dates	Participating Approval Date	Insert	New Registration			10/9/2023 12:39 PM
Details	State	Insert	New Registration		Pending	10/9/2023 12:39 PM
Dates	Registration Date	Insert	New Registration		10/9/2023 12:39:51 PM	10/9/2023 12:39 PM
Dates	Signed By Date	Insert	New Registration			10/9/2023 12:39 PM
Dates	Start Date	Insert	New Registration			10/9/2023 12:39 PM
Terminations	Termination Comments	Insert	New Registration			10/9/2023 12:39 PM
Terminations	Termination Date	Insert	New Registration			10/9/2023 12:39 PM
Terminations	Termination Effective Date	Insert	New Registration			10/9/2023 12:39 PM
Terminations	Termination Reason	Insert	New Registration			10/9/2023 12:39 PM