Covered Entity Details

DSH140015AL BLESSING HOSPITAL (Approved) - information as of 4/30/2025 10:56:09 PM

Main Details

Name

BLESSING HOSPITAL

Subdivision Name

BLESSING HEALTH OUTPATIENT SPECIALTISTS - Kahoka RHC

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH140015AL

Medicare Provider Number

140015

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/1/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/2/2025

Last Recertification Date

Contacts

Authorizing Official

Blessing Hospital
Pat Gerveler, Executive Vice President/Chief Financial Officer
(217) 223-8400 Ext: 6814

Primary Contact

Blessing Health
Robert Ritchey, Administrative Director BHS Pharmacy & Supply Chain
(217) 223-8400 Ext: 6411

Addresses

Street Address

400 N Main St
Monroe City, MO 63456

Billing Address

Blessing Hospital
1005 Broadway
Quincy, IL 62301

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
MO		1104512805
IL		1104512805
IA		1104512805

Shipping Addresses

Shipping Address 1

Blessing Hospital
1005 Broadway
Quincy, IL 62301

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
DSH140015A	Child	DSH	BLESSING HOSPITAL	BLESSING HOSPITAL SLEEP CENTER - Sleep Clinic	1132 BROADWAY ST	QUINCY	IL	Active
DSH140015AA	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Family Med	100 Medical Drive	Hannibal	MO	Active
DSH140015AB	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Internal Med	100 Medical Drive	Hannibal	MO	Active
DSH140015AC	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - OB/GYN	100 Medical Drive	Hannibal	MO	Active
DSH140015AD	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Oncology Infusion Center	100 Medical Dr	Hannibal	MO	Active
DSH140015AE	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Peds	100 Medical Drive	Hannibal	MO	Active
DSH140015AF	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Walk In Clinic	100 Medical Drive	Hannibal	MO	Active
DSH140015AG	Child	DSH	BLESSING HOSPITAL	BLESSING HOSPITAL - BLESSING HEALTH OUTPATIENT SPECIALTISTS - Express Clinic	420 N 34TH ST	QUINCY	IL	Active
DSH140015AH	Child	DSH	BLESSING HOSPITAL	BLESSING HOSPITAL PODIATRY - Podiatry	4800 MAINE ST	QUINCY	IL	Active
DSH140015AJ	Child	DSH	BLESSING HOSPITAL	BLESSING HOSPITAL RHEUMATOLOGY - Rheumatology	4800 MAINE ST	QUINCY	IL	Active
DSH140015AK	Child	DSH	BLESSING HOSPITAL	48th RHC - Family Medicine	4800 Maine	Quincy	IL	Active
DSH140015AL	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Kahoka RHC	400 N Main St	Monroe City	MO	Approved
DSH140015AM	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Hamilton Warsaw RHC	1102 N Co Rd 700	Warsaw	IL	Approved
DSH140015B	Child	DSH	BLESSING HOSPITAL	BLESSING HOSPITAL EAST ADAMS - Rural Health Clinic	102 PRAIRIE MILLS RD	GOLDEN	IL	Active
DSH140015C	Child	DSH	BLESSING HOSPITAL	Mt Sterling RHC - Family Medicine	521 East Main Street	Mt Sterling	IL	Active
DSH140015D	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Podiatry	100 MEDICAL DR	HANNIBAL	MO	Active
DSH140015E	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Neurology	100 MEDICAL DR	HANNIBAL	MO	Active
DSH140015F	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Nephrology	100 MEDICAL DR	Hannibal	MO	Active
DSH140015G	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - General Surgery	100 MEDICAL DR	Hannibal	MO	Active
DSH140015H	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Gastroenterology	100 MEDICAL DR	Hannibal	MO	Active
DSH140015J	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - ENT/Audiology	100 MEDICAL DR	Hannibal	MO	Active
DSH140015K	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Endocrinology	100 MEDICAL DR	Hannibal	MO	Active
DSH140015L	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Cardiology	100 MEDICAL DR	Hannibal	MO	Active
DSH140015M	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Bariatric/Weight Loss	100 MEDICAL DR	Hannibal	MO	Active
DSH140015N	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Allergy	100 MEDICAL DR	Hannibal	MO	Active
DSH140015P	Child	DSH	BLESSING HOSPITAL	BLESSING HOSPITAL - Palmyra Clinic	6996 COUNTY ROAD 326	PALMYRA	MO	Active
DSH140015Q	Child	DSH	BLESSING HOSPITAL	BLESSING BARIATRIC INSTITUTE - Bariatric/Weight Loss	1107 COLLEGE AVE	QUINCY	IL	Active
DSH140015R	Child	DSH	BLESSING HOSPITAL	BLESSING HOSPITAL PAIN MANAGEMENT - Pain	910 BROADWAY ST	QUINCY	IL	Active
DSH140015S	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Hannibal Diagnostic - Ultrasound	100 Medical Drive	Hannibal	MO	Active
DSH140015T	Child	DSH	BLESSING HOSPITAL	BLESSING HOSPITAL NEUROSURGERY - Neurosurgery	4800 MAINE ST	QUINCY	IL	Active
DSH140015U	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Hannibal Diagnostic - Nuclear Medicine/Stress	100 Medical Drive	Hannibal	MO	Active
DSH140015V	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Pulmonary	100 MEDICAL DR	HANNIBAL	MO	Active
DSH140015W	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Rheumatology	100 MEDICAL DR	Hannibal	MO	Active
DSH140015X	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Urology	100 MEDICAL DR	HANNIBAL	MO	Active
DSH140015Y	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Behavioral Health	100 MEDICAL DR	Hannibal	MO	Active
DSH140015Z	Child	DSH	BLESSING HOSPITAL	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Bowling Green Rural Health Clinic	710 Business 61 South	Bowling Green	MO	ToBeTerminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Gerveler, Pat Executive Vice President/Chief Financial Officer Blessing Hospital 2172238400-6814	4/2/2025 10:12 AM
Details	340B ID	Update	New Registration		DSH140015AL	4/2/2025 10:12 AM
Details	Entity Subname	Update	New Registration	BLESSING HEALTH OUTPATIENT SPECIALTISTS	BLESSING HEALTH OUTPATIENT SPECIALTISTS - Kahoka RHC	4/2/2025 10:12 AM
Dates	Participating Approval Date	Update	New Registration		4/2/2025 10:12:29 AM	4/2/2025 10:12 AM
Details	State	Update	New Registration	Pending	Approved	4/2/2025 10:12 AM
Dates	Signed By Date	Update	New Registration		4/2/2025 9:37:10 AM	4/2/2025 10:12 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/2/2025 10:12 AM
Addresses	Main Address	Insert	New Registration		400 N Main St Monroe City, MO 63456	4/1/2025 1:00 PM
Addresses	Billing Address	Insert	New Registration		Blessing Hospital 1005 Broadway Quincy, IL 62301	4/1/2025 1:00 PM
Addresses	Shipping Address	Insert	New Registration		Blessing Hospital 1005 Broadway Quincy, IL 62301	4/1/2025 1:00 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104512805	4/1/2025 1:00 PM
Medicaid Billing	NPI: State	Insert	New Registration		MO	4/1/2025 1:00 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104512805	4/1/2025 1:00 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/1/2025 1:00 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104512805	4/1/2025 1:00 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/1/2025 1:00 PM
Contacts	Authorizing Official	Insert	New Registration		Gerveler, Pat Executive Vice President/Chief Financial Officer Blessing Hospital 2172238400-6814	4/1/2025 1:00 PM
Contacts	Primary Contact	Insert	New Registration		Ritchey, Robert Administrative Director BHS Pharmacy & Supply Chain Blessing Health 2172238400-6411	4/1/2025 1:00 PM
Details	Assistance Received From Date	Insert	New Registration			4/1/2025 1:00 PM
Details	Assistance Received To Date	Insert	New Registration			4/1/2025 1:00 PM
Details	Last Recertification Date	Insert	New Registration			4/1/2025 1:00 PM
Details	Grant Number	Insert	New Registration			4/1/2025 1:00 PM
Details	340B ID	Insert	New Registration			4/1/2025 1:00 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/1/2025 1:00 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/1/2025 1:00 PM
Details	Medicare Provider Number	Insert	New Registration		140015	4/1/2025 1:00 PM
Details	Entity Name	Insert	New Registration		BLESSING HOSPITAL	4/1/2025 1:00 PM
Details	NOFO Number	Insert	New Registration			4/1/2025 1:00 PM
Details	Program Code	Insert	New Registration		DSH	4/1/2025 1:00 PM
Details	Entity Subname	Insert	New Registration		BLESSING HEALTH OUTPATIENT SPECIALTISTS	4/1/2025 1:00 PM
Dates	Participating Approval Date	Insert	New Registration			4/1/2025 1:00 PM
Details	State	Insert	New Registration		Pending	4/1/2025 1:00 PM
Dates	Registration Date	Insert	New Registration		4/1/2025 1:00:07 PM	4/1/2025 1:00 PM
Dates	Signed By Date	Insert	New Registration			4/1/2025 1:00 PM
Dates	Start Date	Insert	New Registration			4/1/2025 1:00 PM
Terminations	Termination Comments	Insert	New Registration			4/1/2025 1:00 PM
Terminations	Termination Date	Insert	New Registration			4/1/2025 1:00 PM
Terminations	Termination Effective Date	Insert	New Registration			4/1/2025 1:00 PM
Terminations	Termination Reason	Insert	New Registration			4/1/2025 1:00 PM