Covered Entity Details

CAH371311-18 JEFFERSON COUNTY HOSPITAL (Active) - information as of 6/27/2025 6:05:42 AM

Main Details

Name

JEFFERSON COUNTY HOSPITAL

Subdivision Name

PAVILION CLINC FAMILY CARE - Family Practice

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH371311-18

Medicare Provider Number

371311

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/14/2025

Participating Start Date

4/1/2025

Participating Approval Date

1/21/2025

Last Recertification Date

Contacts

Authorizing Official

DRH Health
Roger Neal, VP-COO
(580) 606-9169

Primary Contact

Duncan Regional Hospital
Dana Strawn Berryhill, Director of Pharmacy
(580) 251-8784

Addresses

Street Address

2515 N WHISENANT DR
STE 301
DUNCAN, OK 73533-2684

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
CAH371311-01	Child	CAH	JEFFERSON COUNTY HOSPITAL	JEFFERSON COUNTY HEALTHCARE / RINGLING FAMILY CARE	108 S. 5TH ST	RINGLING	OK	Active
CAH371311-02	Child	CAH	JEFFERSON COUNTY HOSPITAL	JEFFERSON COUNTY HEALTHCARE - RYAN FAMILY CARE	1104 6TH ST	RYAN	OK	Active
CAH371311-03	Child	CAH	JEFFERSON COUNTY HOSPITAL	WAURIKA FAMILY CARE - FAMILY PRACTICE	9172 US HWY 70	WAURIKA	OK	Active
CAH371311-04	Child	CAH	JEFFERSON COUNTY HOSPITAL	SANFORD CHILDREN'S CLINIC - PEDIATRICS	2560 W. ELK AVENUE	DUNCAN	OK	Active
CAH371311-05	Child	CAH	JEFFERSON COUNTY HOSPITAL	VELMA FAMILY CARE - FAMILY PRACTICE	404 MAIN ST.	VELMA	OK	Active
CAH371311-06	Child	CAH	JEFFERSON COUNTY HOSPITAL	Park Clinic - Family Care (formerly DFC)	2434 HARVILLE RD.	DUNCAN	OK	Active
CAH371311-07	Child	CAH	JEFFERSON COUNTY HOSPITAL	COMANCHE FAMILY CARE - PRIMARY CARE	303 N. Highway 81	COMANCHE	OK	Active
CAH371311-08	Child	CAH	JEFFERSON COUNTY HOSPITAL	MARLOW FAMILY CARE - FAMILY PRACTICE	501 N 4th St	MARLOW	OK	Active
CAH371311-09	Child	CAH	JEFFERSON COUNTY HOSPITAL	DUNCAN MEDICAL ASSOCIATES - FAMILY PRACTICE	2635 W. ELK AVENUE	DUNCAN	OK	Active
CAH371311-10	Child	CAH	JEFFERSON COUNTY HOSPITAL	PAVILION CLINIC (DOBG)	2515 WHISENANT DRIVE	DUNCAN	OK	Active
CAH371311-11	Child	CAH	JEFFERSON COUNTY HOSPITAL	Plaza Clinic - Family Care (formerly DFM)	2340 W ELK AVE.	DUNCAN	OK	Active
CAH371311-12	Child	CAH	JEFFERSON COUNTY HOSPITAL	WALTERS FAMILY CARE - FAMILY MEDICINE	402 N BROADWAY	WALTERS	OK	Active
CAH371311-13	Child	CAH	JEFFERSON COUNTY HOSPITAL	Elgin Family Care - Family Care	8148 State Hwy 17	Elgin	OK	Active
CAH371311-14	Child	CAH	JEFFERSON COUNTY HOSPITAL	Pavilion Clinic - Pulmonary	2515 WHISENANT DRIVE	Duncan	OK	Active
CAH371311-15	Child	CAH	JEFFERSON COUNTY HOSPITAL	Pavilion Clinic - Urology	2515 WHISENANT DRIVE	Duncan	OK	Active
CAH371311-16	Child	CAH	JEFFERSON COUNTY HOSPITAL	PAVILION CLINIC - CARDIOLOGY - CARDIOLOGY	2515 WHISENANT DRIVE	DUNCAN	OK	Active
CAH371311-17	Child	CAH	JEFFERSON COUNTY HOSPITAL	Plaza Clinic - Addiction & Behavioral Health (formerly DBH)	2340 W Elk	Duncan	OK	Active
CAH371311-18	Child	CAH	JEFFERSON COUNTY HOSPITAL	PAVILION CLINC FAMILY CARE - Family Practice	2515 N WHISENANT DR	DUNCAN	OK	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		Neal, Roger VP-COO DRH Health 5806069169	1/21/2025 5:52 AM
Details	340B ID	Update	New Registration		CAH371311-18	1/21/2025 5:52 AM
Details	Entity Subname	Update	New Registration	PAVILION CLINC FAMILY CARE	PAVILION CLINC FAMILY CARE - Family Practice	1/21/2025 5:52 AM
Dates	Participating Approval Date	Update	New Registration		1/21/2025 5:52:39 AM	1/21/2025 5:52 AM
Details	State	Update	New Registration	Pending	Approved	1/21/2025 5:52 AM
Dates	Signed By Date	Update	New Registration		1/16/2025 5:44:12 PM	1/21/2025 5:52 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	1/21/2025 5:52 AM
Addresses	Main Address	Insert	New Registration		2515 N WHISENANT DR STE 301 DUNCAN, OK 73533-2684	1/14/2025 12:46 PM
Contacts	Primary Contact	Insert	New Registration		Berryhill, Dana Strawn Director of Pharmacy Duncan Regional Hospital 5802518784	1/14/2025 12:46 PM
Contacts	Authorizing Official	Insert	New Registration		Neal, Roger VP-COO DRH Health 5806069169	1/14/2025 12:46 PM
Details	Assistance Received From Date	Insert	New Registration			1/14/2025 12:46 PM
Details	Assistance Received To Date	Insert	New Registration			1/14/2025 12:46 PM
Details	Last Recertification Date	Insert	New Registration			1/14/2025 12:46 PM
Details	Grant Number	Insert	New Registration			1/14/2025 12:46 PM
Details	340B ID	Insert	New Registration			1/14/2025 12:46 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/14/2025 12:46 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/14/2025 12:46 PM
Details	Medicare Provider Number	Insert	New Registration		371311	1/14/2025 12:46 PM
Details	Entity Name	Insert	New Registration		JEFFERSON COUNTY HOSPITAL	1/14/2025 12:46 PM
Details	NOFO Number	Insert	New Registration			1/14/2025 12:46 PM
Details	Program Code	Insert	New Registration		CAH	1/14/2025 12:46 PM
Details	Entity Subname	Insert	New Registration		PAVILION CLINC FAMILY CARE	1/14/2025 12:46 PM
Dates	Participating Approval Date	Insert	New Registration			1/14/2025 12:46 PM
Details	State	Insert	New Registration		Pending	1/14/2025 12:46 PM
Dates	Registration Date	Insert	New Registration		1/14/2025 12:46:23 PM	1/14/2025 12:46 PM
Dates	Signed By Date	Insert	New Registration			1/14/2025 12:46 PM
Dates	Start Date	Insert	New Registration			1/14/2025 12:46 PM
Terminations	Termination Comments	Insert	New Registration			1/14/2025 12:46 PM
Terminations	Termination Date	Insert	New Registration			1/14/2025 12:46 PM
Terminations	Termination Effective Date	Insert	New Registration			1/14/2025 12:46 PM
Terminations	Termination Reason	Insert	New Registration			1/14/2025 12:46 PM