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DSH270017A St. James Healthcare dba Intermountain Health St. James Hospital (ToBeTerminated)
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Main Details
Name
St. James Healthcare dba Intermountain Health St. James Hospital
Subdivision Name
SAINT JAMES HEALTHCARE - PAIN TREATMENT CLINIC - SAINT JAMES HEALTHCARE - PAIN TREATMENT CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH270017A
Medicare Provider Number
270017
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
1/4/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/10/2023
Last Recertification Date
8/19/2024
Termination Date
Termination Reason
7/1/2025
Change of covered entity type
Contacts
Authorizing Official
SCL Health Montana Region
Pam Palagi, VP Financial Services
(406) 723-2414
Primary Contact
Intermountain Health
Ben Landry, 340B Pharmacist
(207) 200-5264
Addresses
Street Address
435 S Crystal St.
Suite 150
Butte, MT 59701
Billing Address
Intermountain Health St. James Hospital
Attn: Accounting
P.O. Box 1010
Lafayette, CO 80026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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