Covered Entity Details

CAH141308-01 Washington County Hospital (Active) - information as of 4/25/2025 6:32:38 PM

Main Details

Name

Washington County Hospital

Subdivision Name

WASHINGTON COUNTY HOSPITAL WALK IN - Rural Health Clinic Mill St

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH141308-01

Medicare Provider Number

141308

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/15/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/16/2024

Last Recertification Date

Contacts

Authorizing Official

Washington County Hospital
Brian K Monsma, President
(618) 327-8326

Primary Contact

Washington County Hospital
James Lynch, Pharmacist
(618) 327-2316

Addresses

Street Address

1245 S MILL ST
NASHVILLE, IL 62263-2004

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
CAH141308-01	Child	CAH	Washington County Hospital	WASHINGTON COUNTY HOSPITAL WALK IN - Rural Health Clinic Mill St	1245 S MILL ST	NASHVILLE	IL	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		Monsma, Brian K President Washington County Hospital 6183278326	10/16/2024 12:57 PM
Details	340B ID	Update	New Registration		CAH141308-01	10/16/2024 12:57 PM
Details	Entity Name	Update	New Registration	WASHINGTON COUNTY HOSPITAL	Washington County Hospital	10/16/2024 12:57 PM
Details	Entity Subname	Update	New Registration	WASHINGTON COUNTY HOSPITAL WALK IN	WASHINGTON COUNTY HOSPITAL WALK IN - Rural Health Clinic Mill St	10/16/2024 12:57 PM
Dates	Participating Approval Date	Update	New Registration		10/16/2024 12:57:45 PM	10/16/2024 12:57 PM
Details	State	Update	New Registration	Pending	Approved	10/16/2024 12:57 PM
Dates	Signed By Date	Update	New Registration		10/15/2024 2:38:01 PM	10/16/2024 12:57 PM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/16/2024 12:57 PM
Addresses	Main Address	Insert	New Registration		1245 S MILL ST NASHVILLE, IL 62263-2004	10/15/2024 2:37 PM
Contacts	Primary Contact	Insert	New Registration		Lynch, James Pharmacist Washington County Hospital 6183272316	10/15/2024 2:37 PM
Contacts	Authorizing Official	Insert	New Registration		Monsma, Brian K President Washington County Hospital 6183278326	10/15/2024 2:37 PM
Details	Assistance Received From Date	Insert	New Registration			10/15/2024 2:37 PM
Details	Assistance Received To Date	Insert	New Registration			10/15/2024 2:37 PM
Details	Last Recertification Date	Insert	New Registration			10/15/2024 2:37 PM
Details	Grant Number	Insert	New Registration			10/15/2024 2:37 PM
Details	340B ID	Insert	New Registration			10/15/2024 2:37 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/15/2024 2:37 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/15/2024 2:37 PM
Details	Medicare Provider Number	Insert	New Registration		141308	10/15/2024 2:37 PM
Details	Entity Name	Insert	New Registration		WASHINGTON COUNTY HOSPITAL	10/15/2024 2:37 PM
Details	NOFO Number	Insert	New Registration			10/15/2024 2:37 PM
Details	Program Code	Insert	New Registration		CAH	10/15/2024 2:37 PM
Details	Entity Subname	Insert	New Registration		WASHINGTON COUNTY HOSPITAL WALK IN	10/15/2024 2:37 PM
Dates	Participating Approval Date	Insert	New Registration			10/15/2024 2:37 PM
Details	State	Insert	New Registration		Pending	10/15/2024 2:37 PM
Dates	Registration Date	Insert	New Registration		10/15/2024 2:37:57 PM	10/15/2024 2:37 PM
Dates	Signed By Date	Insert	New Registration			10/15/2024 2:37 PM
Dates	Start Date	Insert	New Registration			10/15/2024 2:37 PM
Terminations	Termination Comments	Insert	New Registration			10/15/2024 2:37 PM
Terminations	Termination Date	Insert	New Registration			10/15/2024 2:37 PM
Terminations	Termination Effective Date	Insert	New Registration			10/15/2024 2:37 PM
Terminations	Termination Reason	Insert	New Registration			10/15/2024 2:37 PM