Covered Entity Details

SCH140001-32 GRAHAM HOSPITAL ASSOCIATION (Active) - information as of 5/14/2025 10:57:44 PM

Main Details

Name

GRAHAM HOSPITAL ASSOCIATION

Subdivision Name

GRAHAM HOSPITAL ASSOCIATION - GRAHAM MEDICAL GROUP - Galesburg-Knoxville

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH140001-32

Medicare Provider Number

140001

Outpatient Facility Provider Number

148659

Additional Details

Current Program Status

Active

Registration Date

2/10/2025

Participating Start Date

4/1/2025

Participating Approval Date

2/12/2025

Last Recertification Date

Contacts

Authorizing Official

Graham Hospital Association
Holly Henline, VP of Ancillary Services & Corporate Compliance Officer
(309) 647-5240 Ext: 2709

Primary Contact

Graham Hospital Association
Corie Christian, Compliance/340B Director
(309) 647-5240 Ext: 2414

Addresses

Street Address

2028 N SEMINARY ST
GALESBURG, IL 61401-4559

Billing Address

Graham Hospital Association
180 S. Main Street
Canton, IL 61520

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

Shipping Address 1

Graham Hospital Association
210 W. Walnut Street
Canton, IL 61520

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
SCH140001-01	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-LEWISTOWN / Obstetrics/Gynecology	408 S. Main Street	Lewistown	IL	Active
SCH140001-02	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-LEWISTOWN / Pediatrics	408 S. Main Street	Lewistown	IL	Active
SCH140001-03	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-LEWISTOWN / Primary Care	408 S. Main Street	Lewistown	IL	Active
SCH140001-04	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-CUBA	114 S. 14th Street	Cuba	IL	Terminated
SCH140001-05	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-FARMINGTON / Radiology	601 E. Fort Street	Farmington	IL	Active
SCH140001-06	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-FARMINGTON / Obstetrics/Gynecology	601 E. Fort Street	Farmington	IL	Active
SCH140001-07	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-FARMINGTON / Orthopedics	601 E. Fort Street	Farmington	IL	Active
SCH140001-08	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-FARMINGTON / Primary Care	601 E. Fort Street	Farmington	IL	Active
SCH140001-09	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-CANTON / Pain Management	180 S. Main Street	Canton	IL	Active
SCH140001-10	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-CANTON / General Surgery	180 S. Main Street	Canton	IL	Active
SCH140001-11	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-CANTON / ENT	180 S. Main Street	Canton	IL	Active
SCH140001-12	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-CANTON / Radiology	180 S. Main Street	Canton	IL	Active
SCH140001-13	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-CANTON / Pediatrics	180 S. Main Street	Canton	IL	Active
SCH140001-14	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-CANTON / Obstetrics/Gynecology	180 S. Main Street	Canton	IL	Active
SCH140001-15	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-CANTON / Orthopedics	180 S. Main Street	Canton	IL	Active
SCH140001-16	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-CANTON / Lab	180 S. Main Street	Canton	IL	Active
SCH140001-17	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP-CANTON / Primary Care	180 S. Main Street	Canton	IL	Active
SCH140001-18	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	Graham Medical Group - Farmington - General Surgery	601 E. Fort Street	Farmington	IL	Active
SCH140001-19	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - ELMWOOD - Podiatry	1024 N. Magnolia Street	Elmwood	IL	Active
SCH140001-20	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - ELMWOOD- Family Practice	1024 N. Magnolia Street	Elmwood	IL	Active
SCH140001-21	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - ELMWOOD - Pain	1024 N. Magnolia Street	Elmwood	IL	Active
SCH140001-22	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - ELMWOOD - General Surgery	1024 N. Magnolia Street	Elmwood	IL	Active
SCH140001-23	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - FARMINGTON - Podiatry	601 E. Fort Street	Farmington	IL	Active
SCH140001-24	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - FARMINGTON - Pain	601 E. Fort Street	Farmington	IL	Active
SCH140001-25	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - Canton - Behavioral Health	180 S. Main Street	Canton	IL	Active
SCH140001-26	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - Canton - Urology	180 S. Main Street	Canton	IL	Active
SCH140001-27	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - Canton - Vascular	180 S. Main Street	Canton	IL	Active
SCH140001-28	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - Canton - Podiatry	180 S. Main Street	Canton	IL	Active
SCH140001-29	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM MEDICAL GROUP - Canton - Diabetic	180 S. Main Street	Canton	IL	Active
SCH140001-30	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM HOSPITAL ASSOCIATION - GRAHAM MEDICAL GROUP - WILLIAMSFIELD - Family Practice	120 E. Gale Street	Williamsfield	IL	Active
SCH140001-31	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM HOSPITAL ASSOCIATION - GRAHAM MEDICAL GROUP - Canton CC	126 N 5TH AVE	CANTON	IL	Active
SCH140001-32	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM HOSPITAL ASSOCIATION - GRAHAM MEDICAL GROUP - Galesburg-Knoxville	2028 N SEMINARY ST	GALESBURG	IL	Active
SCH140001-33	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM HOSPITAL ASSOCIATION - GRAHAM MEDICAL GROUP - Macomb-Bushnell	1630 E JACKSON ST	MACOMB	IL	Active
SCH140001-34	Child	SCH	GRAHAM HOSPITAL ASSOCIATION	GRAHAM HOSPITAL ASSOCIATION - GRAHAM MEDICAL GROUP - Galesburg B	530 N. Seminary Street	Galesburg	IL	Terminated

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		Henline, Holly VP of Ancillary Services & Corporate Compliance Officer Graham Hospital Association 3096475240-2709	2/12/2025 7:32 AM
Details	340B ID	Update	New Registration		SCH140001-32	2/12/2025 7:32 AM
Details	Entity Subname	Update	New Registration	GRAHAM HOSPITAL ASSOCIATION	GRAHAM HOSPITAL ASSOCIATION - GRAHAM MEDICAL GROUP - Galesburg-Knoxville	2/12/2025 7:32 AM
Dates	Participating Approval Date	Update	New Registration		2/12/2025 7:32:33 AM	2/12/2025 7:32 AM
Details	State	Update	New Registration	Pending	Approved	2/12/2025 7:32 AM
Dates	Signed By Date	Update	New Registration		2/10/2025 4:30:31 PM	2/12/2025 7:32 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	2/12/2025 7:32 AM
Addresses	Main Address	Insert	New Registration		2028 N SEMINARY ST GALESBURG, IL 61401-4559	2/10/2025 4:30 PM
Addresses	Billing Address	Insert	New Registration		Graham Hospital Association 180 S. Main Street Canton, IL 61520	2/10/2025 4:30 PM
Addresses	Shipping Address	Insert	New Registration		Graham Hospital Association 210 W. Walnut Street Canton, IL 61520	2/10/2025 4:30 PM
Contacts	Authorizing Official	Insert	New Registration		Henline, Holly VP of Ancillary Services & Corporate Compliance Officer Graham Hospital Association 3096475240-2709	2/10/2025 4:30 PM
Contacts	Primary Contact	Insert	New Registration		Christian, Corie Compliance/340B Director Graham Hospital Association 3096475240-2414	2/10/2025 4:30 PM
Details	Assistance Received From Date	Insert	New Registration			2/10/2025 4:30 PM
Details	Assistance Received To Date	Insert	New Registration			2/10/2025 4:30 PM
Details	Last Recertification Date	Insert	New Registration			2/10/2025 4:30 PM
Details	Grant Number	Insert	New Registration			2/10/2025 4:30 PM
Details	340B ID	Insert	New Registration			2/10/2025 4:30 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			2/10/2025 4:30 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			2/10/2025 4:30 PM
Details	Medicare Provider Number	Insert	New Registration		140001	2/10/2025 4:30 PM
Details	Entity Name	Insert	New Registration		GRAHAM HOSPITAL ASSOCIATION	2/10/2025 4:30 PM
Details	NOFO Number	Insert	New Registration			2/10/2025 4:30 PM
Details	Program Code	Insert	New Registration		SCH	2/10/2025 4:30 PM
Details	Entity Subname	Insert	New Registration		GRAHAM HOSPITAL ASSOCIATION	2/10/2025 4:30 PM
Dates	Participating Approval Date	Insert	New Registration			2/10/2025 4:30 PM
Details	State	Insert	New Registration		Pending	2/10/2025 4:30 PM
Dates	Registration Date	Insert	New Registration		2/10/2025 4:30:28 PM	2/10/2025 4:30 PM
Dates	Signed By Date	Insert	New Registration			2/10/2025 4:30 PM
Dates	Start Date	Insert	New Registration			2/10/2025 4:30 PM
Terminations	Termination Comments	Insert	New Registration			2/10/2025 4:30 PM
Terminations	Termination Date	Insert	New Registration			2/10/2025 4:30 PM
Terminations	Termination Effective Date	Insert	New Registration			2/10/2025 4:30 PM
Terminations	Termination Reason	Insert	New Registration			2/10/2025 4:30 PM