Covered Entity Details

DSH060076A STERLING REGIONAL MEDCENTER (Active) - information as of 4/25/2025 6:31:30 PM

Main Details

Name

STERLING REGIONAL MEDCENTER

Subdivision Name

STERLING REGIONAL MEDCENTER - Banner Health Center- Sterling- Hays Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH060076A

Medicare Provider Number

060076

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/9/2023

Participating Start Date

1/1/2024

Participating Approval Date

10/31/2023

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

Ogallala Community Hospital
DENA KLOCKMAN, CHIEF FINANCIAL OFFICER
(308) 284-7263

Primary Contact

Banner
Michele Masters, Associate Director, Pharmacy
(970) 740-3177

Addresses

Street Address

102 HAYS AVE
BANNER HEALTH CENTER - STERLING
STERLING, CO 80751-2866

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?
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
DSH060076A	Child	DSH	STERLING REGIONAL MEDCENTER	STERLING REGIONAL MEDCENTER - Banner Health Center- Sterling- Hays Clinic	102 HAYS AVE	STERLING	CO	Active
DSH060076B	Child	DSH	STERLING REGIONAL MEDCENTER	STERLING REGIONAL MEDCENTER - Sterling Regional MedCenter- Family Care Clinic	615 FAIRHURST STREET	STERLING	CO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Change Request	9000221175 (CO)		9/5/2024 2:15 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	149115600 (WY)		9/5/2024 2:15 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	10025160601 (NE)		9/5/2024 2:15 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1922718113 (CO)		9/5/2024 2:15 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1225549389 (WY)		9/5/2024 2:15 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1225549389 (NE)		9/5/2024 2:15 PM
Addresses	Billing Address	Insert	Recertification		Banner Health Accounts Payable PO Box 2977 Phoenix, AZ 85062	8/23/2024 8:55 AM
Details	Last Recertification Date	Update	Recertification		8/23/2024 8:55:06 AM	8/23/2024 8:55 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	9000158972 (CO)		4/10/2024 6:16 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1225549389 (CO)		4/10/2024 6:16 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	5076005 (CO)		1/15/2024 6:33 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	84082633100 (NE)		1/15/2024 6:33 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	111131100 (WY)		1/15/2024 6:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9000158972	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9000221175	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		149115600	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WY	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10025160601	1/15/2024 6:33 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NE	1/15/2024 6:33 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1942238555 (CO)		1/15/2024 6:33 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1942238555 (NE)		1/15/2024 6:33 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1942238555 (WY)		1/15/2024 6:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1225549389	1/15/2024 6:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		CO	1/15/2024 6:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1922718113	1/15/2024 6:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		CO	1/15/2024 6:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1225549389	1/15/2024 6:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		WY	1/15/2024 6:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1225549389	1/15/2024 6:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		NE	1/15/2024 6:33 PM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		KLOCKMAN, DENA CHIEF FINANCIAL OFFICER Ogallala Community Hospital 3082847263	10/31/2023 10:52 AM
Details	340B ID	Update	New Registration		DSH060076A	10/31/2023 10:52 AM
Details	Entity Subname	Update	New Registration	STERLING REGIONAL MEDCENTER	STERLING REGIONAL MEDCENTER - Banner Health Center- Sterling- Hays Clinic	10/31/2023 10:52 AM
Dates	Participating Approval Date	Update	New Registration		10/31/2023 10:52:21 AM	10/31/2023 10:52 AM
Details	State	Update	New Registration	Pending	Approved	10/31/2023 10:52 AM
Dates	Signed By Date	Update	New Registration		10/9/2023 4:38:23 PM	10/31/2023 10:52 AM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	10/31/2023 10:52 AM
Addresses	Main Address	Insert	New Registration		102 HAYS AVE BANNER HEALTH CENTER - STERLING STERLING, CO 80751-2866	10/9/2023 1:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/9/2023 1:58 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		5076005	10/9/2023 1:58 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	10/9/2023 1:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/9/2023 1:58 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		84082633100	10/9/2023 1:58 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NE	10/9/2023 1:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/9/2023 1:58 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		111131100	10/9/2023 1:58 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WY	10/9/2023 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1942238555	10/9/2023 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	10/9/2023 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1942238555	10/9/2023 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		NE	10/9/2023 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1942238555	10/9/2023 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		WY	10/9/2023 1:58 PM
Contacts	Primary Contact	Insert	New Registration		Masters, Michele Associate Director, Pharmacy Banner 9707403177	10/9/2023 1:58 PM
Contacts	Authorizing Official	Insert	New Registration		KLOCKMAN, DENA CHIEF FINANCIAL OFFICER Ogallala Community Hospital 3082847263	10/9/2023 1:58 PM
Details	Assistance Received From Date	Insert	New Registration			10/9/2023 1:58 PM
Details	Assistance Received To Date	Insert	New Registration			10/9/2023 1:58 PM
Details	Last Recertification Date	Insert	New Registration			10/9/2023 1:58 PM
Details	Grant Number	Insert	New Registration			10/9/2023 1:58 PM
Details	340B ID	Insert	New Registration			10/9/2023 1:58 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/9/2023 1:58 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/9/2023 1:58 PM
Details	Medicare Provider Number	Insert	New Registration		060076	10/9/2023 1:58 PM
Details	Entity Name	Insert	New Registration		STERLING REGIONAL MEDCENTER	10/9/2023 1:58 PM
Details	NOFO Number	Insert	New Registration			10/9/2023 1:58 PM
Details	Program Code	Insert	New Registration		DSH	10/9/2023 1:58 PM
Details	Entity Subname	Insert	New Registration		STERLING REGIONAL MEDCENTER	10/9/2023 1:58 PM
Dates	Participating Approval Date	Insert	New Registration			10/9/2023 1:58 PM
Details	State	Insert	New Registration		Pending	10/9/2023 1:58 PM
Dates	Registration Date	Insert	New Registration		10/9/2023 1:58:09 PM	10/9/2023 1:58 PM
Dates	Signed By Date	Insert	New Registration			10/9/2023 1:58 PM
Dates	Start Date	Insert	New Registration			10/9/2023 1:58 PM
Terminations	Termination Comments	Insert	New Registration			10/9/2023 1:58 PM
Terminations	Termination Date	Insert	New Registration			10/9/2023 1:58 PM
Terminations	Termination Effective Date	Insert	New Registration			10/9/2023 1:58 PM
Terminations	Termination Reason	Insert	New Registration			10/9/2023 1:58 PM