Covered Entity Details

CAH261323-02 CEDAR COUNTY MEMORIAL HOSPITAL (Active) - information as of 5/25/2025 1:21:01 AM

Main Details

Name

CEDAR COUNTY MEMORIAL HOSPITAL

Subdivision Name

Cedar County Family Clinic - Family Practice Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH261323-02

Medicare Provider Number

261323

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/10/2024

Participating Start Date

10/1/2024

Participating Approval Date

7/15/2024

Last Recertification Date

Contacts

Authorizing Official

Cedar County Memorial Hospital
Terry Wayne Nichols, Chief Executive Officer
(573) 366-4892

Primary Contact

Cedar County Memorial Hospital
Carla Gilbert, CFO
(417) 876-3097

Addresses

Street Address

807 Owen Mill Road
Stockton, MO 65785

Billing Address

Cedar County Memorial Hospital
Dept 5169, PO Box 55296
Little Rock, AR 72215-5296

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
CAH261323-01	Child	CAH	CEDAR COUNTY MEMORIAL HOSPITAL	CCMH Medical Mall RHC	1317 S. Hwy 32	El Dorado Springs	MO	Active
CAH261323-02	Child	CAH	CEDAR COUNTY MEMORIAL HOSPITAL	Cedar County Family Clinic - Family Practice Clinic	807 Owen Mill Road	Stockton	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Nichols, Terry Wayne Chief Executive Officer Cedar County Memorial Hospital 5733664892	7/15/2024 11:06 AM
Details	340B ID	Update	New Registration		CAH261323-02	7/15/2024 11:06 AM
Details	Entity Subname	Update	New Registration	Cedar County Family Clinic	Cedar County Family Clinic - Family Practice Clinic	7/15/2024 11:06 AM
Dates	Participating Approval Date	Update	New Registration		7/15/2024 11:06:11 AM	7/15/2024 11:06 AM
Details	State	Update	New Registration	Pending	Approved	7/15/2024 11:06 AM
Dates	Signed By Date	Update	New Registration		7/15/2024 9:20:32 AM	7/15/2024 11:06 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	7/15/2024 11:06 AM
Addresses	Main Address	Insert	New Registration		807 Owen Mill Road Stockton, MO 65785	7/10/2024 9:45 AM
Addresses	Billing Address	Insert	New Registration		Cedar County Memorial Hospital Dept 5169, PO Box 55296 Little Rock, AR 72215-5296	7/10/2024 9:45 AM
Contacts	Authorizing Official	Insert	New Registration		Nichols, Terry Wayne Chief Executive Officer Cedar County Memorial Hospital 5733664892	7/10/2024 9:45 AM
Contacts	Primary Contact	Insert	New Registration		Gilbert, Carla CFO Cedar County Memorial Hospital 4178763097	7/10/2024 9:45 AM
Details	Assistance Received From Date	Insert	New Registration			7/10/2024 9:45 AM
Details	Assistance Received To Date	Insert	New Registration			7/10/2024 9:45 AM
Details	Last Recertification Date	Insert	New Registration			7/10/2024 9:45 AM
Details	Grant Number	Insert	New Registration			7/10/2024 9:45 AM
Details	340B ID	Insert	New Registration			7/10/2024 9:45 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/10/2024 9:45 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/10/2024 9:45 AM
Details	Medicare Provider Number	Insert	New Registration		261323	7/10/2024 9:45 AM
Details	Entity Name	Insert	New Registration		CEDAR COUNTY MEMORIAL HOSPITAL	7/10/2024 9:45 AM
Details	NOFO Number	Insert	New Registration			7/10/2024 9:45 AM
Details	Program Code	Insert	New Registration		CAH	7/10/2024 9:45 AM
Details	Entity Subname	Insert	New Registration		Cedar County Family Clinic	7/10/2024 9:45 AM
Dates	Participating Approval Date	Insert	New Registration			7/10/2024 9:45 AM
Details	State	Insert	New Registration		Pending	7/10/2024 9:45 AM
Dates	Registration Date	Insert	New Registration		7/10/2024 9:45:52 AM	7/10/2024 9:45 AM
Dates	Signed By Date	Insert	New Registration			7/10/2024 9:45 AM
Dates	Start Date	Insert	New Registration			7/10/2024 9:45 AM
Terminations	Termination Comments	Insert	New Registration			7/10/2024 9:45 AM
Terminations	Termination Date	Insert	New Registration			7/10/2024 9:45 AM
Terminations	Termination Effective Date	Insert	New Registration			7/10/2024 9:45 AM
Terminations	Termination Reason	Insert	New Registration			7/10/2024 9:45 AM