Covered Entity Details

DSH150065L SCHNECK MEDICAL CENTER (Approved) - information as of 4/28/2025 1:44:16 AM

Main Details

Name

SCHNECK MEDICAL CENTER

Subdivision Name

JACKSON COUNTY SCHNECK HOSPITAL - Primary Care

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH150065L

Medicare Provider Number

150065

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/14/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/22/2025

Last Recertification Date

Contacts

Authorizing Official

Jackson County Schneck Memorial Hospital
Deborah Ridlen, VP Finance/CFO
(812) 522-0170

Primary Contact

JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL
Kathy Covert, VP Workforce and Support Services
(812) 522-2349

Addresses

Street Address

403 S MAIN ST STE 129
SCHNECK MEDICAL CTR
SALEM, IN 47167-1350

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
DSH150065A	Child	DSH	SCHNECK MEDICAL CENTER	Jackson Medical Building - Case Management	225 S. Pine Street	Seymour	IN	Terminated
DSH150065B	Child	DSH	SCHNECK MEDICAL CENTER	SCHNECK MEDICAL CENTER - Cancer Ctr	200 S PINE ST	SEYMOUR	IN	Active
DSH150065C	Child	DSH	SCHNECK MEDICAL CENTER	SCHNECK MEDICAL CENTER / Physical Therapy	100 N WALNUT ST	SEYMOUR	IN	Terminated
DSH150065D	Child	DSH	SCHNECK MEDICAL CENTER	SCHNECK MEDICAL CENTER / Wound Care	100 N WALNUT ST	SEYMOUR	IN	Terminated
DSH150065E	Child	DSH	SCHNECK MEDICAL CENTER	JACKSON COUNTY SCHNECK MEM HOSPITAL - PRIMARY CARE	806 W COMMERCE ST	BROWNSTOWN	IN	Active
DSH150065F	Child	DSH	SCHNECK MEDICAL CENTER	SCHNECK MEDICAL CENTER - INTERNAL MEDICINE/PEDIATRICS	225 S PINE ST	SEYMOUR	IN	Active
DSH150065G	Child	DSH	SCHNECK MEDICAL CENTER	JACKSON COUNTY SCHNECK MEM HOSPITAL - Urgent Care	1130 MEDICAL PLACE	SEYMOUR	IN	Active
DSH150065H	Child	DSH	SCHNECK MEDICAL CENTER	JACKSON COUNTY SCHNECK MEM HOSP - Primary Care	1124 MEDICAL PLACE	SEYMOUR	IN	Active
DSH150065J	Child	DSH	SCHNECK MEDICAL CENTER	JACKSON COUNTY SCHNECK HOSPITAL - OB Gyn	411 W TIPTON ST	SEYMOUR	IN	Active
DSH150065K	Child	DSH	SCHNECK MEDICAL CENTER	JACKSON COUNTY SCHNECK HOSPITAL - Primary Care	1366 N GARDNER ST	SCOTTSBURG	IN	Approved
DSH150065L	Child	DSH	SCHNECK MEDICAL CENTER	JACKSON COUNTY SCHNECK HOSPITAL - Primary Care	403 S MAIN ST STE 129	SALEM	IN	Approved
DSH150065M	Child	DSH	SCHNECK MEDICAL CENTER	JACKSON COUNTY SCHNECK HOSPITAL - PRIMARY CARE	2145 N STATE HWY 3	NORTH VERNON	IN	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Ridlen, Deborah VP Finance/CFO Jackson County Schneck Memorial Hospital 8125220170	4/22/2025 7:54 AM
Details	340B ID	Update	New Registration		DSH150065L	4/22/2025 7:54 AM
Details	Entity Subname	Update	New Registration	JACKSON COUNTY SCHNECK HOSPITAL	JACKSON COUNTY SCHNECK HOSPITAL - Primary Care	4/22/2025 7:54 AM
Dates	Participating Approval Date	Update	New Registration		4/22/2025 7:54:26 AM	4/22/2025 7:54 AM
Details	State	Update	New Registration	Pending	Approved	4/22/2025 7:54 AM
Dates	Signed By Date	Update	New Registration		4/14/2025 10:46:08 AM	4/22/2025 7:54 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/22/2025 7:54 AM
Addresses	Main Address	Insert	New Registration		403 S MAIN ST STE 129 SCHNECK MEDICAL CTR SALEM, IN 47167-1350	4/14/2025 10:46 AM
Contacts	Primary Contact	Insert	New Registration		Covert, Kathy VP Workforce and Support Services JACKSON COUNTY SCHNECK MEMORIAL HOSPITAL 8125222349	4/14/2025 10:46 AM
Contacts	Authorizing Official	Insert	New Registration		Ridlen, Deborah VP Finance/CFO Jackson County Schneck Memorial Hospital 8125220170	4/14/2025 10:46 AM
Details	Assistance Received From Date	Insert	New Registration			4/14/2025 10:46 AM
Details	Assistance Received To Date	Insert	New Registration			4/14/2025 10:46 AM
Details	Last Recertification Date	Insert	New Registration			4/14/2025 10:46 AM
Details	Grant Number	Insert	New Registration			4/14/2025 10:46 AM
Details	340B ID	Insert	New Registration			4/14/2025 10:46 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2025 10:46 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2025 10:46 AM
Details	Medicare Provider Number	Insert	New Registration		150065	4/14/2025 10:46 AM
Details	Entity Name	Insert	New Registration		SCHNECK MEDICAL CENTER	4/14/2025 10:46 AM
Details	NOFO Number	Insert	New Registration			4/14/2025 10:46 AM
Details	Program Code	Insert	New Registration		DSH	4/14/2025 10:46 AM
Details	Entity Subname	Insert	New Registration		JACKSON COUNTY SCHNECK HOSPITAL	4/14/2025 10:46 AM
Dates	Participating Approval Date	Insert	New Registration			4/14/2025 10:46 AM
Details	State	Insert	New Registration		Pending	4/14/2025 10:46 AM
Dates	Registration Date	Insert	New Registration		4/14/2025 10:46:07 AM	4/14/2025 10:46 AM
Dates	Signed By Date	Insert	New Registration			4/14/2025 10:46 AM
Dates	Start Date	Insert	New Registration			4/14/2025 10:46 AM
Terminations	Termination Comments	Insert	New Registration			4/14/2025 10:46 AM
Terminations	Termination Date	Insert	New Registration			4/14/2025 10:46 AM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2025 10:46 AM
Terminations	Termination Reason	Insert	New Registration			4/14/2025 10:46 AM