Covered Entity Details

RRC130049-02 KOOTENAI HEALTH INC (Approved)

Main Details

Name

KOOTENAI HEALTH INC

Subdivision Name

KOOTENAI CANCER CENTER-POST FALLS

Type

Rural Referral Center

Rural

340B ID

RRC130049-02

Medicare Provider Number

130049

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/11/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/29/2025

Last Recertification Date

Contacts

Authorizing Official

Kootenai Health
Michele Bouit, CFO
(208) 625-4004

Primary Contact

Kootenai Health
Jim McDonald, Pharmacy - 340B Program Manager
(208) 625-5653

Addresses

Street Address

1440 EAST MULLAN AVE
POST FALLS, ID 83854

Billing Address

Kootenai Health
2003 Kootenai Health Way
Coeur D Alene, ID 83814

Comment	Last Updated On
1 Item 1 to 5 of 5 Page: of 1 Page size:

1 Item 1 to 5 of 5 Page: of 1 Page size:
Participating Start Date 4/1/2019, Termination Date 7/1/2021, Reinstatement 7/1/2025.	04/23/2025
Participating Start Date 4/1/2019, Termination Date 7/1/2021, Reinstatement 7/1/2024	04/30/2024
Participating start date 7/1/2011; Termination date 10/1/2014; Reinstated 4/1/2019.	01/17/2019
06/27/11,DOC RECD TO CONFIRM ELIG DSH ADJ %, PARTICIPATING FROM 08/30/10 TO 04/01/11, NOT PARTICIPATING FROM 04/01/11 TO 06/30/11;8/05/11 removed ship to addr.	08/05/2011
06/27/11,DOC RECD TO CONFIRM ELIG DSH ADJ %, PARTICIPATING FROM 08/30/10 TO 04/01/11, NOT PARTICIPATING FROM 04/01/11 TO 06/30/11	06/27/2011

340B Drug Pricing Program Database