Covered Entity Details

SCH140015-52 BLESSING HOSPITAL (Terminated) - information as of 4/25/2025 8:34:48 PM

Main Details

Name

BLESSING HOSPITAL

Subdivision Name

BLESSING HEALTH OUTPATIENT SPECIALTISTS - Hannibal Diagnostic - Non-Invasive Cardiology

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH140015-52

Medicare Provider Number

140015

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/3/2024

Participating Start Date

7/1/2024

Participating Approval Date

4/25/2024

Last Recertification Date

8/12/2024

Termination Date
Termination Reason

4/1/2025
Change of covered entity type

Contacts

Authorizing Official

Blessing Hospital
Pat Gerveler, Executive Vice President/Chief Financial Officer
(217) 223-8400 Ext: 6814

Primary Contact

Blessing Health
Robert Ritchey, Administrative Director BHS Pharmacy & Supply Chain
(217) 223-8400 Ext: 6411

Addresses

Street Address

100 Medical Drive
Ste 1E
HANNIBAL, MO 63401

Billing Address

Blessing Hospital
1005 BROADWAY ST.
Quincy, IL 62301

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?
Yes

State	Medicaid Number	NPI Number
IL	370661183001	1760571699
MO	10673101	1760571699
IA	0699108	1760571699

Shipping Addresses

Shipping Address 1

Blessing Hospital
1005 BROADWAY ST.
Quincy, IL 62301

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
SCH140015-01	Child	SCH	BLESSING HOSPITAL	Blessing Surgery Center - Ambulatory Surgery Center	1118 Hampshire St.	Quincy	IL	Terminated
SCH140015-02	Child	SCH	BLESSING HOSPITAL	Blessing Sleep Center - Sleep Clinic	1132 Broadway St.	Quincy	IL	Terminated
SCH140015-03	Child	SCH	BLESSING HOSPITAL	Blessing Wound Center - Woundcare	927 Broadway St.	Quincy	IL	Terminated
SCH140015-04	Child	SCH	BLESSING HOSPITAL	East Adams Clinic - Rural Health Clinic	102 Prairie Mills Road	Golden	IL	Terminated
SCH140015-05	Child	SCH	BLESSING HOSPITAL	Blessing Breast Center - Mammography	927 Broadway St.	Quincy	IL	Terminated
SCH140015-06	Child	SCH	BLESSING HOSPITAL	Blessing Cardiac Rehabilitation - Cardiology	927 Broadway St.	Quincy	IL	Terminated
SCH140015-07	Child	SCH	BLESSING HOSPITAL	Blessing Pulmonary Rehabilitation - Pulmonology	927 Broadway St.	Quincy	IL	Terminated
SCH140015-08	Child	SCH	BLESSING HOSPITAL	Blessing Diabetic Center - Endocrinology	927 Broadway St.	Quincy	IL	Terminated
SCH140015-09	Child	SCH	BLESSING HOSPITAL	Blessing Hospital Cardiology Clinic - Cardiology Clinic	927 Broadway St	Quincy	IL	Terminated
SCH140015-10	Child	SCH	BLESSING HOSPITAL	Blessing Hospital Urology Clinic - Urology	927 Broadway	Quincy	IL	Terminated
SCH140015-11	Child	SCH	BLESSING HOSPITAL	Blessing Hospital Nephrology Clinic - Nephrology	927 Broadway	Quincy	IL	Terminated
SCH140015-12	Child	SCH	BLESSING HOSPITAL	Blessing Hospital GI Clinic - GI	927 Broadway	Quincy	IL	Terminated
SCH140015-13	Child	SCH	BLESSING HOSPITAL	Blessing Hospital Infectious Disease Clinic - Infectious Disease	927 Broadway	Quincy	IL	Terminated
SCH140015-14	Child	SCH	BLESSING HOSPITAL	Blessing Hospital Pulmonology Clinic - Pulmonology	927 Broadway	Quincy	IL	Terminated
SCH140015-15	Child	SCH	BLESSING HOSPITAL	Blessing Hospital Surgery Clinic - Surgery	927 Broadway	Quincy	IL	Terminated
SCH140015-16	Child	SCH	BLESSING HOSPITAL	Main RHC - Pediatrics	927 Broadway	Quincy	IL	Terminated
SCH140015-17	Child	SCH	BLESSING HOSPITAL	Main RHC - OB/GYN	927 Broadway	Quincy	IL	Terminated
SCH140015-18	Child	SCH	BLESSING HOSPITAL	Mt Sterling RHC - Family Medicine	521 East Main Street	Mt Sterling	IL	Terminated
SCH140015-19	Child	SCH	BLESSING HOSPITAL	Main RHC - Family Medicine	927 Broadway	Quincy	IL	Terminated
SCH140015-20	Child	SCH	BLESSING HOSPITAL	Main RHC - Outpatient Behavioral Health	927 Broadway	Quincy	IL	Terminated
SCH140015-21	Child	SCH	BLESSING HOSPITAL	48th RHC - Family Medicine	4800 Maine	Quincy	IL	Terminated
SCH140015-22	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Walk In Clinic	100 Medical Drive	Hannibal	MO	Terminated
SCH140015-23	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Rheumatology	4800 Maine Street	Quincy	IL	Terminated
SCH140015-24	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Podiatry	4800 Maine Street	Quincy	IL	Terminated
SCH140015-25	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Peds	100 Medical Drive	Hannibal	MO	Terminated
SCH140015-26	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Oncology Infusion Center	100 Medical Dr	Hannibal	MO	Terminated
SCH140015-27	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - OB/GYN	100 Medical Drive	Hannibal	MO	Terminated
SCH140015-28	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Internal Med	100 Medical Drive	Hannibal	MO	Terminated
SCH140015-29	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Family Med	100 Medical Drive	Hannibal	MO	Terminated
SCH140015-30	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Express Clinic	420 N. 34th Street	Quincy	IL	Terminated
SCH140015-31	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Bowling Green	710 Business 61 South	Bowling Green	MO	Terminated
SCH140015-32	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Behavioral Health	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-33	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Urology	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-34	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Rheumatology	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-35	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Pulmonary	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-36	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Podiatry	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-37	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Neurology	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-38	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Nephrology	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-39	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - General Surgery	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-40	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Gastroenterology	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-41	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - ENT/Audiology	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-42	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Endocrinology	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-43	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Cardiology	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-44	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Bariatric/Weight Loss	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-45	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Allergy	100 MEDICAL DR	HANNIBAL	MO	Terminated
SCH140015-46	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Palmyra Clinic	6996 County Road 326	Palmyra	MO	Terminated
SCH140015-47	Child	SCH	BLESSING HOSPITAL	BLESSING BARIATRIC INSTITUTE - Bariatric/Weight Loss	1107 COLLEGE AVE	QUINCY	IL	Terminated
SCH140015-48	Child	SCH	BLESSING HOSPITAL	BLESSING HOSPITAL PAIN MANAGEMENT - Pain	910 BROADWAY ST	QUINCY	IL	Terminated
SCH140015-49	Child	SCH	BLESSING HOSPITAL	BLESSING HOSPITAL NEUROSURGERY - Neurosurgery	4800 MAINE ST	QUINCY	IL	Terminated
SCH140015-50	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Hannibal Diagnostic - Ultrasound	100 Medical Drive	HANNIBAL	MO	Terminated
SCH140015-51	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Hannibal Diagnostic - PFT/Respiratory Therapy	100 Medical Drive	HANNIBAL	MO	Terminated
SCH140015-52	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Hannibal Diagnostic - Non-Invasive Cardiology	100 Medical Drive	HANNIBAL	MO	Terminated
SCH140015-53	Child	SCH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Hannibal Diagnostic - Nuclear Medicine/Stress	100 Medical Drive	Hannibal	MO	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	1/27/2025 8:25 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	1/27/2025 8:25 AM
Terminations	Termination Date	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	1/27/2025 8:25 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	1/27/2025 8:25 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	1/27/2025 8:25 AM
Details	Last Recertification Date	Update	Recertification		8/12/2024 12:56:29 PM	8/12/2024 12:56 PM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Gerveler, Pat Executive Vice President/Chief Financial Officer Blessing Hospital 2172238400-6814	4/25/2024 9:40 AM
Details	340B ID	Update	New Registration		SCH140015-52	4/25/2024 9:40 AM
Details	Entity Subname	Update	New Registration	BLESSING HEALTH OUTPATIENT SPECIALTISTS	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Hannibal Diagnostic - Non-Invasive Cardiology	4/25/2024 9:40 AM
Dates	Participating Approval Date	Update	New Registration		4/25/2024 9:40:37 AM	4/25/2024 9:40 AM
Details	State	Update	New Registration	Pending	Approved	4/25/2024 9:40 AM
Dates	Signed By Date	Update	New Registration		4/3/2024 4:47:26 PM	4/25/2024 9:40 AM
Dates	Start Date	Update	New Registration		7/1/2024 12:00:00 AM	4/25/2024 9:40 AM
Addresses	Main Address	Insert	New Registration		100 Medical Drive Ste 1E HANNIBAL, MO 63401	4/3/2024 4:20 PM
Addresses	Billing Address	Insert	New Registration		Blessing Hospital 1005 BROADWAY ST. Quincy, IL 62301	4/3/2024 4:20 PM
Addresses	Shipping Address	Insert	New Registration		Blessing Hospital 1005 BROADWAY ST. Quincy, IL 62301	4/3/2024 4:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 4:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		370661183001	4/3/2024 4:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	4/3/2024 4:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 4:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		10673101	4/3/2024 4:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MO	4/3/2024 4:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 4:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0699108	4/3/2024 4:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	4/3/2024 4:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1760571699	4/3/2024 4:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/3/2024 4:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1760571699	4/3/2024 4:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		MO	4/3/2024 4:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1760571699	4/3/2024 4:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/3/2024 4:20 PM
Contacts	Authorizing Official	Insert	New Registration		Gerveler, Pat Executive Vice President/Chief Financial Officer Blessing Hospital 2172238400-6814	4/3/2024 4:20 PM
Contacts	Primary Contact	Insert	New Registration		Ritchey, Robert Administrative Director BHS Pharmacy & Supply Chain Blessing Health 2172238400-6411	4/3/2024 4:20 PM
Details	Assistance Received From Date	Insert	New Registration			4/3/2024 4:20 PM
Details	Assistance Received To Date	Insert	New Registration			4/3/2024 4:20 PM
Details	Last Recertification Date	Insert	New Registration			4/3/2024 4:20 PM
Details	Grant Number	Insert	New Registration			4/3/2024 4:20 PM
Details	340B ID	Insert	New Registration			4/3/2024 4:20 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/3/2024 4:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/3/2024 4:20 PM
Details	Medicare Provider Number	Insert	New Registration		140015	4/3/2024 4:20 PM
Details	Entity Name	Insert	New Registration		BLESSING HOSPITAL	4/3/2024 4:20 PM
Details	NOFO Number	Insert	New Registration			4/3/2024 4:20 PM
Details	Program Code	Insert	New Registration		SCH	4/3/2024 4:20 PM
Details	Entity Subname	Insert	New Registration		BLESSING HEALTH OUTPATIENT SPECIALTISTS	4/3/2024 4:20 PM
Dates	Participating Approval Date	Insert	New Registration			4/3/2024 4:20 PM
Details	State	Insert	New Registration		Pending	4/3/2024 4:20 PM
Dates	Registration Date	Insert	New Registration		4/3/2024 4:20:55 PM	4/3/2024 4:20 PM
Dates	Signed By Date	Insert	New Registration			4/3/2024 4:20 PM
Dates	Start Date	Insert	New Registration			4/3/2024 4:20 PM
Terminations	Termination Comments	Insert	New Registration			4/3/2024 4:20 PM
Terminations	Termination Date	Insert	New Registration			4/3/2024 4:20 PM
Terminations	Termination Effective Date	Insert	New Registration			4/3/2024 4:20 PM
Terminations	Termination Reason	Insert	New Registration			4/3/2024 4:20 PM