340B Drug Pricing Program Database
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DSH130049AJ KOOTENAI HOSPITAL DISTRICT (Terminated)
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Main Details
Name
KOOTENAI HOSPITAL DISTRICT
Subdivision Name
KOOTENAI OUTPATIENT IMAGING
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130049AJ
Medicare Provider Number
130049
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/20/2015
Last Recertification Date
12/1/2017
Termination Date
Termination Reason
10/1/2018
Hospital Outpatient facility no longer eligible
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
1300 East Mullan Avenue STE 700
Post Falls, ID 83854
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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