340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH130049AA KOOTENAI HEALTH INC (ToBeTerminated)
Print
Main Details
Name
KOOTENAI HEALTH INC
Subdivision Name
Kootenai Clinic Neurology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130049AA
Medicare Provider Number
130049
Outpatient Facility Provider Number
130049
Additional Details
Current Program Status
ToBeTerminated
Registration Date
6/16/2021
Participating Start Date
7/1/2021
Participating Approval Date
6/24/2021
Last Recertification Date
8/20/2024
Termination Date
Termination Reason
7/1/2025
Change of covered entity type
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
700 Ironwood Dr. #158
Coeur d'Alene, ID 83814
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
1
to
2
of
2
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
1
to
2
of
2
Page:
of 1
Go
Page size:
Change
Participated starting 10/1/2014; Terminated 4/1/2019; Reinstated 7/1/2021.
06/24/2021
Participating from effective date: (10/1/2014) until terminated effective date: (4/1/2019), reinstatement effective date: (07/01/2021)
06/24/2021
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session