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DSH130049AV KOOTENAI HOSPITAL DISTRICT (Terminated)
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Main Details
Name
KOOTENAI HOSPITAL DISTRICT
Subdivision Name
Kootenai Clinic Neurosurgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130049AV
Medicare Provider Number
130049
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/17/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/28/2017
Last Recertification Date
8/29/2018
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
700 W Ironwood Dr Ste 258
Coeur d' Alene, ID 83814
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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