Covered Entity Details

CAH371342-02 McCurtain Memorial Hospital (Active) - information as of 4/29/2025 11:53:54 PM

Main Details

Name

McCurtain Memorial Hospital

Subdivision Name

McCurtain Memorial Rural Health Clinic Valliant - Urgent Care

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH371342-02

Medicare Provider Number

371342

Outpatient Facility Provider Number

378553

Additional Details

Current Program Status

Active

Registration Date

1/12/2024

Participating Start Date

4/1/2024

Participating Approval Date

3/1/2024

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

McCurtain Memorial Hospital
Kena Allen, CFO
(580) 208-3103

Primary Contact

McCurtain Memorial Hospital
Julie Gail Matthews, Controller
(580) 208-3117

Addresses

Street Address

101 Teri Drive
Valliant, OK 74764

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH371342-01	Child	CAH	McCurtain Memorial Hospital	MCCURTAIN MEMORIAL MEDICAL MANAGEME - McCurtain Memorial Rural Health Clinic Hochatown	8901 N US HIGHWAY 259	BROKEN BOW	OK	Terminated
CAH371342-02	Child	CAH	McCurtain Memorial Hospital	McCurtain Memorial Rural Health Clinic Valliant - Urgent Care	101 Teri Drive	Valliant	OK	Active
CAH371342-03	Child	CAH	McCurtain Memorial Hospital	McCurtain Memorial Rural Health Clinic Idabel - Urgent Care	1425 EAST LINCOLN ROAD	IDABEL	OK	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		8/16/2024 1:32:36 PM	8/16/2024 1:32 PM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Addresses	Main Address	Insert	New Registration		101 Teri Drive Valliant, OK 74764	3/1/2024 2:09 PM
Contacts	Signed By	Insert	New Registration		Allen, Kena CFO McCurtain Memorial Hospital 5802083103	3/1/2024 2:09 PM
Details	340B ID	Update	New Registration		CAH371342-02	3/1/2024 2:09 PM
Details	Entity Name	Update	New Registration	MCCURTAIN MEMORIAL HOSPITAL	McCurtain Memorial Hospital	3/1/2024 2:09 PM
Details	Entity Subname	Update	New Registration	McCurtain Memorial Rural Health Clinic Valliant	McCurtain Memorial Rural Health Clinic Valliant - Urgent Care	3/1/2024 2:09 PM
Dates	Participating Approval Date	Update	New Registration		3/1/2024 2:09:15 PM	3/1/2024 2:09 PM
Details	State	Update	New Registration	Pending	Approved	3/1/2024 2:09 PM
Dates	Signed By Date	Update	New Registration		1/25/2024 12:37:41 PM	3/1/2024 2:09 PM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	3/1/2024 2:09 PM
Addresses	Main Address	Insert	New Registration		101 Teri Drive Valliant, OK 74764	1/25/2024 12:37 PM
Addresses	Main Address	Insert	New Registration		101 Teri Drive Valliant, OK 74764	1/15/2024 10:37 AM
Addresses	Main Address	Insert	New Registration		101 Teri Drive Valliant, OK 74764	1/12/2024 3:26 PM
Contacts	Authorizing Official	Insert	New Registration		Allen, Kena CFO McCurtain Memorial Hospital 5802083103	1/12/2024 3:26 PM
Contacts	Primary Contact	Insert	New Registration		Matthews, Julie Gail Controller McCurtain Memorial Hospital 5802083117	1/12/2024 3:26 PM
Details	Assistance Received From Date	Insert	New Registration			1/12/2024 3:26 PM
Details	Assistance Received To Date	Insert	New Registration			1/12/2024 3:26 PM
Details	Last Recertification Date	Insert	New Registration			1/12/2024 3:26 PM
Details	Grant Number	Insert	New Registration			1/12/2024 3:26 PM
Details	340B ID	Insert	New Registration			1/12/2024 3:26 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2024 3:26 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2024 3:26 PM
Details	Medicare Provider Number	Insert	New Registration		371342	1/12/2024 3:26 PM
Details	Entity Name	Insert	New Registration		MCCURTAIN MEMORIAL HOSPITAL	1/12/2024 3:26 PM
Details	NOFO Number	Insert	New Registration			1/12/2024 3:26 PM
Details	Program Code	Insert	New Registration		CAH	1/12/2024 3:26 PM
Details	Entity Subname	Insert	New Registration		McCurtain Memorial Rural Health Clinic Valliant	1/12/2024 3:26 PM
Dates	Participating Approval Date	Insert	New Registration			1/12/2024 3:26 PM
Details	State	Insert	New Registration		Pending	1/12/2024 3:26 PM
Dates	Registration Date	Insert	New Registration		1/12/2024 3:26:47 PM	1/12/2024 3:26 PM
Dates	Signed By Date	Insert	New Registration			1/12/2024 3:26 PM
Dates	Start Date	Insert	New Registration			1/12/2024 3:26 PM
Terminations	Termination Comments	Insert	New Registration			1/12/2024 3:26 PM
Terminations	Termination Date	Insert	New Registration			1/12/2024 3:26 PM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2024 3:26 PM
Terminations	Termination Reason	Insert	New Registration			1/12/2024 3:26 PM