Covered Entity Details

DSH170074C STORMONT VAIL HEALTH, FLINT HILLS LLC (Active) - information as of 4/27/2025 12:53:20 AM

Main Details

Name

STORMONT VAIL HEALTH, FLINT HILLS LLC

Subdivision Name

STORMONT VAIL HILLS LLC - RHC OB/GYN

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH170074C

Medicare Provider Number

170074

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/8/2025

Participating Start Date

4/1/2025

Participating Approval Date

2/3/2025

Last Recertification Date

Contacts

Authorizing Official

Stormont Vail Health, Flint Hills LLC
Preston Trecek, Director Finance
(785) 210-3333

Primary Contact

Stormont-Vail Health
Robert Alan Brewer, Pharmacy Manager - Finance and Medication Acquisition
(785) 354-5498

Addresses

Street Address

1110 ST. MARY'S RD
SVH FLINT HILLS RURAL HEALTH CLINIC
JUNCTION CITY, KS 66441-4176

Billing Address

STORMONT VAIL HEALTHCARE INC.
1500 SW 10TH AVE
TOPEKA, KS 66604

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
KS	30003940820004	1952018608

Shipping Addresses

Shipping Address 1

STORMONT VAIL HEALTH, FLINT HILLS LLC
1102 ST. MARYS ROAD
JUNCTION CITY, KS 66441

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
DSH170074A	Child	DSH	STORMONT VAIL HEALTH, FLINT HILLS LLC	STORMONT VAIL HILLS LLC - RURAL HEALTH CLINIC	1110 ST. MARY'S RD	JUNCTION CITY	KS	Active
DSH170074B	Child	DSH	STORMONT VAIL HEALTH, FLINT HILLS LLC	STORMONT VAIL HILLS LLC - RHC WALK-IN CLINIC	1110 ST. MARY'S RD	JUNCTION CITY	KS	Active
DSH170074C	Child	DSH	STORMONT VAIL HEALTH, FLINT HILLS LLC	STORMONT VAIL HILLS LLC - RHC OB/GYN	1110 ST. MARY'S RD	JUNCTION CITY	KS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Addresses	Billing Address	Insert	New Registration		STORMONT VAIL HEALTHCARE INC. 1500 SW 10TH AVE TOPEKA, KS 66604	2/3/2025 2:29 PM
Contacts	Signed By	Insert	New Registration		Trecek, Preston Director Finance Stormont Vail Health, Flint Hills LLC 7852103333	2/3/2025 2:29 PM
Details	340B ID	Update	New Registration		DSH170074C	2/3/2025 2:29 PM
Details	Entity Subname	Update	New Registration	STORMONT VAIL HILLS LLC	STORMONT VAIL HILLS LLC - RHC OB/GYN	2/3/2025 2:29 PM
Dates	Participating Approval Date	Update	New Registration		2/3/2025 2:29:14 PM	2/3/2025 2:29 PM
Details	State	Update	New Registration	Pending	Approved	2/3/2025 2:29 PM
Dates	Signed By Date	Update	New Registration		1/8/2025 10:43:23 AM	2/3/2025 2:29 PM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	2/3/2025 2:29 PM
Addresses	Billing Address	Insert	New Registration		STORMONT VAIL HEALTHCARE INC. 1500 SW 10TH AVE TOPEKA, KS 66604	1/8/2025 10:43 AM
Addresses	Main Address	Insert	New Registration		1110 ST. MARY'S RD SVH FLINT HILLS RURAL HEALTH CLINIC JUNCTION CITY, KS 66441-4176	1/8/2025 10:34 AM
Addresses	Billing Address	Insert	New Registration		STORMONT VAIL HEALTHCARE INC. 1500 SW 10TH AVE TOPEKA, KS 66604	1/8/2025 10:34 AM
Addresses	Shipping Address	Insert	New Registration		STORMONT VAIL HEALTH, FLINT HILLS LLC 1102 ST. MARYS ROAD JUNCTION CITY, KS 66441	1/8/2025 10:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/8/2025 10:34 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		30003940820004	1/8/2025 10:34 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KS	1/8/2025 10:34 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1952018608	1/8/2025 10:34 AM
Medicaid Billing	NPI: State	Insert	New Registration		KS	1/8/2025 10:34 AM
Contacts	Primary Contact	Insert	New Registration		Brewer, Robert Alan Pharmacy Manager - Finance and Medication Acquisition Stormont-Vail Health 7853545498	1/8/2025 10:34 AM
Contacts	Authorizing Official	Insert	New Registration		Trecek, Preston Director Finance Stormont Vail Health, Flint Hills LLC 7852103333	1/8/2025 10:34 AM
Details	Assistance Received From Date	Insert	New Registration			1/8/2025 10:34 AM
Details	Assistance Received To Date	Insert	New Registration			1/8/2025 10:34 AM
Details	Last Recertification Date	Insert	New Registration			1/8/2025 10:34 AM
Details	Grant Number	Insert	New Registration			1/8/2025 10:34 AM
Details	340B ID	Insert	New Registration			1/8/2025 10:34 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/8/2025 10:34 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/8/2025 10:34 AM
Details	Medicare Provider Number	Insert	New Registration		170074	1/8/2025 10:34 AM
Details	Entity Name	Insert	New Registration		STORMONT VAIL HEALTH, FLINT HILLS LLC	1/8/2025 10:34 AM
Details	NOFO Number	Insert	New Registration			1/8/2025 10:34 AM
Details	Program Code	Insert	New Registration		DSH	1/8/2025 10:34 AM
Details	Entity Subname	Insert	New Registration		STORMONT VAIL HILLS LLC	1/8/2025 10:34 AM
Dates	Participating Approval Date	Insert	New Registration			1/8/2025 10:34 AM
Details	State	Insert	New Registration		Pending	1/8/2025 10:34 AM
Dates	Registration Date	Insert	New Registration		1/8/2025 10:34:54 AM	1/8/2025 10:34 AM
Dates	Signed By Date	Insert	New Registration			1/8/2025 10:34 AM
Dates	Start Date	Insert	New Registration			1/8/2025 10:34 AM
Terminations	Termination Comments	Insert	New Registration			1/8/2025 10:34 AM
Terminations	Termination Date	Insert	New Registration			1/8/2025 10:34 AM
Terminations	Termination Effective Date	Insert	New Registration			1/8/2025 10:34 AM
Terminations	Termination Reason	Insert	New Registration			1/8/2025 10:34 AM