Covered Entity Details

CAH041313-02 OZARK HEALTH INC (Approved) - information as of 5/13/2025 11:06:34 PM

Main Details

Name

OZARK HEALTH INC

Subdivision Name

OZARK MEDICAL CLINIC FAIRFIELD BAY - OZARK MEDICAL CLINIC FAIRFIELD BAY

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH041313-02

Medicare Provider Number

041313

Outpatient Facility Provider Number

048544

Additional Details

Current Program Status

Approved

Registration Date

4/4/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/7/2025

Last Recertification Date

Contacts

Authorizing Official

Ozark Health Medical Center
Robin Corley, CFO
(501) 745-9302

Primary Contact

Ozark Health Medical Center
Annice Craig, PHARMACIST
(501) 745-9587

Addresses

Street Address

383 DAVE CREEK PKWY
FAIRFIELD BAY, AR 72088-3631

Billing Address

OZARK MEDICAL CLINIC FAIRFIELD BAY
P.O. BOX 206
CLINTON, AR 72031

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
AR	215189729	1477960581

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
CAH041313-01	Child	CAH	OZARK HEALTH INC	OZARK HEALTH, INC - OZARK MEDICAL CLINIC CLINTON	175 VOLUNTEER PKWY	CLINTON	AR	Approved
CAH041313-02	Child	CAH	OZARK HEALTH INC	OZARK MEDICAL CLINIC FAIRFIELD BAY - OZARK MEDICAL CLINIC FAIRFIELD BAY	383 DAVE CREEK PKWY	FAIRFIELD BAY	AR	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Corley, Robin CFO Ozark Health Medical Center 5017459302	4/7/2025 2:47 PM
Details	340B ID	Update	New Registration		CAH041313-02	4/7/2025 2:47 PM
Details	Entity Subname	Update	New Registration	OZARK MEDICAL CLINIC FAIRFIELD BAY	OZARK MEDICAL CLINIC FAIRFIELD BAY - OZARK MEDICAL CLINIC FAIRFIELD BAY	4/7/2025 2:47 PM
Dates	Participating Approval Date	Update	New Registration		4/7/2025 2:47:58 PM	4/7/2025 2:47 PM
Details	State	Update	New Registration	Pending	Approved	4/7/2025 2:47 PM
Dates	Signed By Date	Update	New Registration		4/4/2025 11:33:25 AM	4/7/2025 2:47 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/7/2025 2:47 PM
Addresses	Main Address	Insert	New Registration		383 DAVE CREEK PKWY FAIRFIELD BAY, AR 72088-3631	4/4/2025 11:33 AM
Addresses	Billing Address	Insert	New Registration		OZARK MEDICAL CLINIC FAIRFIELD BAY P.O. BOX 206 CLINTON, AR 72031	4/4/2025 11:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 11:33 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		215189729	4/4/2025 11:33 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		AR	4/4/2025 11:33 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1477960581	4/4/2025 11:33 AM
Medicaid Billing	NPI: State	Insert	New Registration		AR	4/4/2025 11:33 AM
Contacts	Authorizing Official	Insert	New Registration		Corley, Robin CFO Ozark Health Medical Center 5017459302	4/4/2025 11:33 AM
Contacts	Primary Contact	Insert	New Registration		Craig, Annice PHARMACIST Ozark Health Medical Center 5017459587	4/4/2025 11:33 AM
Details	Assistance Received From Date	Insert	New Registration			4/4/2025 11:33 AM
Details	Assistance Received To Date	Insert	New Registration			4/4/2025 11:33 AM
Details	Last Recertification Date	Insert	New Registration			4/4/2025 11:33 AM
Details	Grant Number	Insert	New Registration			4/4/2025 11:33 AM
Details	340B ID	Insert	New Registration			4/4/2025 11:33 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/4/2025 11:33 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/4/2025 11:33 AM
Details	Medicare Provider Number	Insert	New Registration		041313	4/4/2025 11:33 AM
Details	Entity Name	Insert	New Registration		OZARK HEALTH INC	4/4/2025 11:33 AM
Details	NOFO Number	Insert	New Registration			4/4/2025 11:33 AM
Details	Program Code	Insert	New Registration		CAH	4/4/2025 11:33 AM
Details	Entity Subname	Insert	New Registration		OZARK MEDICAL CLINIC FAIRFIELD BAY	4/4/2025 11:33 AM
Dates	Participating Approval Date	Insert	New Registration			4/4/2025 11:33 AM
Details	State	Insert	New Registration		Pending	4/4/2025 11:33 AM
Dates	Registration Date	Insert	New Registration		4/4/2025 11:33:25 AM	4/4/2025 11:33 AM
Dates	Signed By Date	Insert	New Registration			4/4/2025 11:33 AM
Dates	Start Date	Insert	New Registration			4/4/2025 11:33 AM
Terminations	Termination Comments	Insert	New Registration			4/4/2025 11:33 AM
Terminations	Termination Date	Insert	New Registration			4/4/2025 11:33 AM
Terminations	Termination Effective Date	Insert	New Registration			4/4/2025 11:33 AM
Terminations	Termination Reason	Insert	New Registration			4/4/2025 11:33 AM