Covered Entity Details

CAH161354-04 Ida County Iowa Community Hospital dba Horn Memorial Hospital (Active) - information as of 4/29/2025 4:37:46 AM

Main Details

Name

Ida County Iowa Community Hospital dba Horn Memorial Hospital

Subdivision Name

Horn Physicians Clinic Holstein - RHC HOLSTEIN

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH161354-04

Medicare Provider Number

161354

Outpatient Facility Provider Number

168665

Additional Details

Current Program Status

Active

Registration Date

10/10/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/17/2024

Last Recertification Date

Contacts

Authorizing Official

Ida County Iowa Community Hospital dba Horn Memorial Hospital
EMILY LANGE, CCO/CNO
(712) 364-7269

Primary Contact

Ida County Iowa Community Hospital dba Horn Memorial Hospital
Alex Weirich, Pharmacy Director
(712) 364-7253

Addresses

Street Address

1400 S KIEL ST.
HOLSTEIN, IA 51025

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
CAH161354-01	Child	CAH	Ida County Iowa Community Hospital dba Horn Memorial Hospital	HPC Rural Health Clinic	700 E 2nd St, Ste 2	Ida Grove	IA	Active
CAH161354-02	Child	CAH	Ida County Iowa Community Hospital dba Horn Memorial Hospital	Horn Physicians Clinic Mapleton	520 Main St	Mapleton	IA	Active
CAH161354-03	Child	CAH	Ida County Iowa Community Hospital dba Horn Memorial Hospital	Horn Physicians Clinic Odebolt	300 S Maple St	Odebolt	IA	Active
CAH161354-04	Child	CAH	Ida County Iowa Community Hospital dba Horn Memorial Hospital	Horn Physicians Clinic Holstein - RHC HOLSTEIN	1400 S KIEL ST.	HOLSTEIN	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		LANGE, EMILY CCO/CNO Ida County Iowa Community Hospital dba Horn Memorial Hospital 7123647269	10/17/2024 8:03 AM
Details	340B ID	Update	New Registration		CAH161354-04	10/17/2024 8:03 AM
Details	Entity Name	Update	New Registration	HORN MEMORIAL HOSPITAL	Ida County Iowa Community Hospital dba Horn Memorial Hospital	10/17/2024 8:03 AM
Details	Entity Subname	Update	New Registration	Horn Physicians Clinic Holstein	Horn Physicians Clinic Holstein - RHC HOLSTEIN	10/17/2024 8:03 AM
Dates	Participating Approval Date	Update	New Registration		10/17/2024 8:03:58 AM	10/17/2024 8:03 AM
Details	State	Update	New Registration	Pending	Approved	10/17/2024 8:03 AM
Dates	Signed By Date	Update	New Registration		10/10/2024 4:32:02 PM	10/17/2024 8:03 AM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/17/2024 8:03 AM
Addresses	Main Address	Insert	New Registration		1400 S KIEL ST. HOLSTEIN, IA 51025	10/10/2024 4:31 PM
Contacts	Primary Contact	Insert	New Registration		Weirich, Alex Pharmacy Director Ida County Iowa Community Hospital dba Horn Memorial Hospital 7123647253	10/10/2024 4:31 PM
Contacts	Authorizing Official	Insert	New Registration		LANGE, EMILY CCO/CNO Ida County Iowa Community Hospital dba Horn Memorial Hospital 7123647269	10/10/2024 4:31 PM
Details	Assistance Received From Date	Insert	New Registration			10/10/2024 4:31 PM
Details	Assistance Received To Date	Insert	New Registration			10/10/2024 4:31 PM
Details	Last Recertification Date	Insert	New Registration			10/10/2024 4:31 PM
Details	Grant Number	Insert	New Registration			10/10/2024 4:31 PM
Details	340B ID	Insert	New Registration			10/10/2024 4:31 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/10/2024 4:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/10/2024 4:31 PM
Details	Medicare Provider Number	Insert	New Registration		161354	10/10/2024 4:31 PM
Details	Entity Name	Insert	New Registration		HORN MEMORIAL HOSPITAL	10/10/2024 4:31 PM
Details	NOFO Number	Insert	New Registration			10/10/2024 4:31 PM
Details	Program Code	Insert	New Registration		CAH	10/10/2024 4:31 PM
Details	Entity Subname	Insert	New Registration		Horn Physicians Clinic Holstein	10/10/2024 4:31 PM
Dates	Participating Approval Date	Insert	New Registration			10/10/2024 4:31 PM
Details	State	Insert	New Registration		Pending	10/10/2024 4:31 PM
Dates	Registration Date	Insert	New Registration		10/10/2024 4:31:59 PM	10/10/2024 4:31 PM
Dates	Signed By Date	Insert	New Registration			10/10/2024 4:31 PM
Dates	Start Date	Insert	New Registration			10/10/2024 4:31 PM
Terminations	Termination Comments	Insert	New Registration			10/10/2024 4:31 PM
Terminations	Termination Date	Insert	New Registration			10/10/2024 4:31 PM
Terminations	Termination Effective Date	Insert	New Registration			10/10/2024 4:31 PM
Terminations	Termination Reason	Insert	New Registration			10/10/2024 4:31 PM