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RRC130049-34 KOOTENAI HEALTH INC (Approved)
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Main Details
Name
KOOTENAI HEALTH INC
Subdivision Name
KOOTENAI CLINIC NEUROLOGY - NEUROLOGY
Type
Rural Referral Center
Rural
No
340B ID
RRC130049-34
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
700 Ironwood Dr. #158
Coeur d'Alene, ID 83814
Billing Address
Kootenai Health
2003 Kootenai Health Way
Coeur D Alene, ID 83814
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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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
May 2025
May 2025
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