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DSH130049F KOOTENAI HOSPITAL DISTRICT (Terminated)
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Main Details
Name
KOOTENAI HOSPITAL DISTRICT
Subdivision Name
KOOTENAI CLINIC EAR NOSE THROAT & ALLERGY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130049F
Medicare Provider Number
130049
Outpatient Facility Provider Number
130049
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/10/2014
Last Recertification Date
8/23/2018
Termination Date
Termination Reason
4/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Kootenai Health
Kim Webb, CFO
(208) 625-4001
Primary Contact
Kootenai Health
Timothy J. Chapman, Pharmacy Business Manager
(208) 625-5651
Addresses
Street Address
420 N 2ND AVE STE #300
SANDPOINT, ID 83864
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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