Covered Entity Details

CAH171381-03 Hosp Dist #1 of Dickinson (Approved) - information as of 5/27/2025 2:25:15 PM

Main Details

Name

Hosp Dist #1 of Dickinson

Subdivision Name

HOSPITAL DISTRICT NO KANSAS - Rural Health Clinic (Herington)

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH171381-03

Medicare Provider Number

171381

Outpatient Facility Provider Number

178649

Additional Details

Current Program Status

Approved

Registration Date

4/9/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/14/2025

Last Recertification Date

Contacts

Authorizing Official

Hospital District No. 1 of Dickinson County, KS
Reginald Harold Courtois, CEO
(785) 263-6610

Primary Contact

Hospital District #1 of Dickinson
Lisa Wright, Pharmacist
(785) 263-6682

Addresses

Street Address

18 N BROADWAY
HERINGTON, KS 67449-2402

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
CAH171381-01	Child	CAH	Hosp Dist #1 of Dickinson	Heartland Healthcare Clinic	511 NE 10th	Abilene	KS	Active
CAH171381-02	Child	CAH	Memorial Hospital	Village Manor	705 N. Brady	Abilene	KS	Terminated
CAH171381-03	Child	CAH	Hosp Dist #1 of Dickinson	HOSPITAL DISTRICT NO KANSAS - Rural Health Clinic (Herington)	18 N BROADWAY	HERINGTON	KS	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Courtois, Reginald Harold CEO Hospital District No. 1 of Dickinson County, KS 7852636610	4/14/2025 7:03 AM
Details	340B ID	Update	New Registration		CAH171381-03	4/14/2025 7:03 AM
Details	Entity Subname	Update	New Registration	HOSPITAL DISTRICT NO KANSAS	HOSPITAL DISTRICT NO KANSAS - Rural Health Clinic (Herington)	4/14/2025 7:03 AM
Dates	Participating Approval Date	Update	New Registration		4/14/2025 7:03:40 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		4/10/2025 9:19:10 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		18 N BROADWAY HERINGTON, KS 67449-2402	4/9/2025 1:42 PM
Contacts	Primary Contact	Insert	New Registration		Wright, Lisa Pharmacist Hospital District #1 of Dickinson 7852636682	4/9/2025 1:42 PM
Contacts	Authorizing Official	Insert	New Registration		Courtois, Reginald Harold CEO Hospital District No. 1 of Dickinson County, KS 7852636610	4/9/2025 1:42 PM
Details	Assistance Received From Date	Insert	New Registration			4/9/2025 1:42 PM
Details	Assistance Received To Date	Insert	New Registration			4/9/2025 1:42 PM
Details	Last Recertification Date	Insert	New Registration			4/9/2025 1:42 PM
Details	Grant Number	Insert	New Registration			4/9/2025 1:42 PM
Details	340B ID	Insert	New Registration			4/9/2025 1:42 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/9/2025 1:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/9/2025 1:42 PM
Details	Medicare Provider Number	Insert	New Registration		171381	4/9/2025 1:42 PM
Details	Entity Name	Insert	New Registration		Hosp Dist #1 of Dickinson	4/9/2025 1:42 PM
Details	NOFO Number	Insert	New Registration			4/9/2025 1:42 PM
Details	Program Code	Insert	New Registration		CAH	4/9/2025 1:42 PM
Details	Entity Subname	Insert	New Registration		HOSPITAL DISTRICT NO KANSAS	4/9/2025 1:42 PM
Dates	Participating Approval Date	Insert	New Registration			4/9/2025 1:42 PM
Details	State	Insert	New Registration		Pending	4/9/2025 1:42 PM
Dates	Registration Date	Insert	New Registration		4/9/2025 1:42:19 PM	4/9/2025 1:42 PM
Dates	Signed By Date	Insert	New Registration			4/9/2025 1:42 PM
Dates	Start Date	Insert	New Registration			4/9/2025 1:42 PM
Terminations	Termination Comments	Insert	New Registration			4/9/2025 1:42 PM
Terminations	Termination Date	Insert	New Registration			4/9/2025 1:42 PM
Terminations	Termination Effective Date	Insert	New Registration			4/9/2025 1:42 PM
Terminations	Termination Reason	Insert	New Registration			4/9/2025 1:42 PM