340B Drug Pricing Program Database
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CAH131321-00 ST. MARYS HOSPITAL (Active)
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Main Details
Name
ST. MARYS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131321-00
Medicare Provider Number
131321
Additional Details
Current Program Status
Active
Registration Date
1/10/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/14/2019
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Clearwater Valley Hospital/St. Mary's Hospital
Jyl Lyn Ruland, CFO
(208) 476-8062
Primary Contact
Kootenai Health
Jim McDonald, Pharmacy - 340B Program Manager
(208) 625-5653
Addresses
Street Address
701 LEWISTON ST.
COTTONWOOD, ID 83522-0137
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Initial start date 9/30/2010, Termination 4/1/2018, reinstatement 4/1/2019
01/14/2019
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