Covered Entity Details

CAH141320-08 HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital) (Approved) - information as of 5/1/2025 11:50:54 PM

Main Details

Name

HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)

Subdivision Name

HOSPITAL & MEDICAL FOUND INC - Sycamore Wellness

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH141320-08

Medicare Provider Number

141320

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/2/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/14/2025

Last Recertification Date

Contacts

Authorizing Official

Hospital & Medical Foundation of Paris, Inc.
Martin Donald Adams, Chief Financial Officer
(217) 466-4246

Primary Contact

Hospital & Medical Foundation of Paris, Inc.
Ryan Christopher Bonomo, Pharmacy Manager
(217) 466-4221

Addresses

Street Address

1378 S STATE ROAD 46
HORIZON HEALTH
TERRE HAUTE, IN 47803-9787

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?
Yes

State	Medicaid Number	NPI Number
IN	300089603	1730880477

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
CAH141320-01	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	PARIS CLINIC	727 EAST COURT STREET	PARIS	IL	Active
CAH141320-02	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC.	FAMILY MEDICAL CENTER-KANSAS	104 EAST BUENA VISTA	KANSAS	IL	Terminated
CAH141320-03	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	CHRISMAN CLINIC	112 W. MADISON	CHRISMAN	IL	Active
CAH141320-04	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	Paris EZ Care Clinic - EZ Care RHC	1 Phipps Ln	Paris	IL	Active
CAH141320-05	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	Marshall EZ Care Clinic - EZ Care- Marshall RHC	1602 N IL-1	Marshall	IL	Active
CAH141320-06	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	Oakland Clinic - Oakland RHC	5 S Walnut St	Oakland	IL	Active
CAH141320-07	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	Pain Management Clinic - Pain Management Clinic	15317 US Highway 150	Paris	IL	Approved
CAH141320-08	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	HOSPITAL & MEDICAL FOUND INC - Sycamore Wellness	1378 S STATE ROAD 46	TERRE HAUTE	IN	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Adams, Martin Donald Chief Financial Officer Hospital & Medical Foundation of Paris, Inc. 2174664246	4/14/2025 7:03 AM
Details	340B ID	Update	New Registration		CAH141320-08	4/14/2025 7:03 AM
Details	Entity Name	Update	New Registration	PARIS COMMUNITY HOSPITAL	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	4/14/2025 7:03 AM
Details	Entity Subname	Update	New Registration	HOSPITAL & MEDICAL FOUND INC	HOSPITAL & MEDICAL FOUND INC - Sycamore Wellness	4/14/2025 7:03 AM
Dates	Participating Approval Date	Update	New Registration		4/14/2025 7:03:15 AM	4/14/2025 7:03 AM
Details	State	Update	New Registration	Pending	Approved	4/14/2025 7:03 AM
Dates	Signed By Date	Update	New Registration		4/7/2025 4:04:27 PM	4/14/2025 7:03 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/14/2025 7:03 AM
Addresses	Main Address	Insert	New Registration		1378 S STATE ROAD 46 HORIZON HEALTH TERRE HAUTE, IN 47803-9787	4/2/2025 1:24 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2025 1:24 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		300089603	4/2/2025 1:24 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IN	4/2/2025 1:24 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1730880477	4/2/2025 1:24 PM
Medicaid Billing	NPI: State	Insert	New Registration		IN	4/2/2025 1:24 PM
Contacts	Primary Contact	Insert	New Registration		Bonomo, Ryan Christopher Pharmacy Manager Hospital & Medical Foundation of Paris, Inc. 2174664221	4/2/2025 1:24 PM
Contacts	Authorizing Official	Insert	New Registration		Adams, Martin Donald Chief Financial Officer Hospital & Medical Foundation of Paris, Inc. 2174664246	4/2/2025 1:24 PM
Details	Assistance Received From Date	Insert	New Registration			4/2/2025 1:24 PM
Details	Assistance Received To Date	Insert	New Registration			4/2/2025 1:24 PM
Details	Last Recertification Date	Insert	New Registration			4/2/2025 1:24 PM
Details	Grant Number	Insert	New Registration			4/2/2025 1:24 PM
Details	340B ID	Insert	New Registration			4/2/2025 1:24 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2025 1:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2025 1:24 PM
Details	Medicare Provider Number	Insert	New Registration		141320	4/2/2025 1:24 PM
Details	Entity Name	Insert	New Registration		PARIS COMMUNITY HOSPITAL	4/2/2025 1:24 PM
Details	NOFO Number	Insert	New Registration			4/2/2025 1:24 PM
Details	Program Code	Insert	New Registration		CAH	4/2/2025 1:24 PM
Details	Entity Subname	Insert	New Registration		HOSPITAL & MEDICAL FOUND INC	4/2/2025 1:24 PM
Dates	Participating Approval Date	Insert	New Registration			4/2/2025 1:24 PM
Details	State	Insert	New Registration		Pending	4/2/2025 1:24 PM
Dates	Registration Date	Insert	New Registration		4/2/2025 1:24:33 PM	4/2/2025 1:24 PM
Dates	Signed By Date	Insert	New Registration			4/2/2025 1:24 PM
Dates	Start Date	Insert	New Registration			4/2/2025 1:24 PM
Terminations	Termination Comments	Insert	New Registration			4/2/2025 1:24 PM
Terminations	Termination Date	Insert	New Registration			4/2/2025 1:24 PM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2025 1:24 PM
Terminations	Termination Reason	Insert	New Registration			4/2/2025 1:24 PM