Covered Entity Details

DSH180093A Baptist Health Deaconess Madisonville (Active) - information as of 5/17/2025 10:58:51 PM

Main Details

Name

Baptist Health Deaconess Madisonville

Subdivision Name

MAHR CANCER CLINIC

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH180093A

Medicare Provider Number

180093

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

9/6/2007

Participating Start Date

1/1/2005

Participating Approval Date

9/6/2007

Last Recertification Date

8/30/2024

Contacts

Authorizing Official

Baptist Health Deaconess Madisonville
Valarie Lynn Howard, CFO
(270) 326-6133

Primary Contact

Baptist Health Deaconess Madisonville
Margo Nicks Ashby, Director Pharmacy
(270) 825-5248

Addresses

Street Address

900 HOSPITAL DRIVE
MADISONVILLE, KY 42431

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
KY		1447231956
IN		1447231956
IL		1447231956
TN		1447231956

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	AVELLA OF COLUMBUS	4830 KNIGHTSBRIDGE BLVD STE C		COLUMBUS	OH	43214-2300	01/06/2016	04/01/2016	04/11/2018	04/11/2018
Contract Detail	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	01/06/2016	04/01/2016	12/17/2020	03/12/2021
Contract Detail	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	10/04/2016	01/01/2017	12/17/2020	03/12/2021
Contract Detail	COMMCARE PHARMACY-FTL, LLC	855 SW 78TH AVE STE C100		PLANTATION	FL	33324-3223	01/11/2016	04/01/2016	07/19/2019	07/19/2019
Contract Detail	WELLPARTNER, INC	20800 SW 115TH AVE	SUITE 100	TUALATIN	OR	97062	01/07/2016	04/01/2016	04/28/2017	03/22/2017

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH180093A	Child	DSH	Baptist Health Deaconess Madisonville	MAHR CANCER CLINIC	900 HOSPITAL DRIVE	MADISONVILLE	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Ashby, Kimberly Denise Vice President Finance Baptist Health Deaconess Madisonville 2705843255	Howard, Valarie Lynn CFO Baptist Health Deaconess Madisonville 2703266133	2/18/2025 9:07 AM
Details	Last Recertification Date	Update	Recertification	9/7/2023 2:06:22 PM	8/30/2024 1:15:02 PM	8/30/2024 1:15 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	01022219 (KY)		10/10/2023 2:53 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	Q037820 (TN)		10/10/2023 2:53 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	7100772650 (KY)		10/10/2023 2:53 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	610654587002 (IL)		10/10/2023 2:53 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	300029692 (IN)		10/10/2023 2:53 PM
Contacts	Primary Contact	Update	Change Request	Ashby, Margo N. Director Pharmacy Baptist Health Madisonville 2708255248	Ashby, Margo Nicks Director Pharmacy Baptist Health Deaconess Madisonville 2708255248	10/6/2023 7:51 AM
Contacts	Authorizing Official	Update	Change Request	Ashby, Kim Vice President of Finance Baptist Health Madisonville, Inc. 2708255781	Ashby, Kimberly Denise Vice President Finance Baptist Health Deaconess Madisonville 2705843255	10/6/2023 7:49 AM
Details	Last Recertification Date	Update	Recertification	9/9/2022 10:20:42 AM	9/7/2023 2:06:22 PM	9/7/2023 2:06 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	094690700 (FL)		5/1/2023 12:37 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1447231956 (MO)		5/1/2023 12:37 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1447231956 (FL)		5/1/2023 12:37 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1447231956 (MO)		5/1/2023 12:37 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 9:00:05 AM	9/9/2022 10:20:42 AM	9/9/2022 10:20 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/24/2022 7:19 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7100772650	5/24/2022 7:19 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	5/24/2022 7:19 PM
Details	Entity Name	Update	Recertification	BAPTIST HEALTH MADISONVILLE, INC.	Baptist Health Deaconess Madisonville	9/10/2021 8:25 AM
Details	Last Recertification Date	Update	Recertification	8/27/2020 1:21:15 PM	9/7/2021 9:00:05 AM	9/7/2021 9:00 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1447231956	8/27/2020 1:21 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	8/27/2020 1:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1447231956	8/27/2020 1:21 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	8/27/2020 1:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1447231956	8/27/2020 1:21 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	8/27/2020 1:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1447231956	8/27/2020 1:21 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	8/27/2020 1:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1447231956	8/27/2020 1:21 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	8/27/2020 1:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1447231956	8/27/2020 1:21 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	8/27/2020 1:21 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1447231956 ( )		8/27/2020 1:21 PM
Details	Last Recertification Date	Update	Recertification	8/29/2019 12:46:20 PM	8/27/2020 1:21:15 PM	8/27/2020 1:21 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	100041460A	300029692	10/11/2019 1:52 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0180093 (TN)		10/11/2019 1:52 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1447231956 (WV)		10/11/2019 1:52 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	000167472X (GA)		10/11/2019 1:52 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	82918KYIP (KY)		10/11/2019 1:52 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	10027803 (KY)		10/11/2019 1:52 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	02693256 (KY)		10/11/2019 1:52 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	261971 (KY)		10/11/2019 1:52 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1447231956 (KY)		10/11/2019 1:52 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	199045 (KY)		10/11/2019 1:52 PM
Details	Last Recertification Date	Update	Recertification	8/23/2018 1:32:53 PM	8/29/2019 12:46:20 PM	8/29/2019 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/16/2019 9:59 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q037820	7/16/2019 9:59 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	7/16/2019 9:59 AM
Details	Last Recertification Date	Update	Recertification	11/21/2017 5:30:40 PM	8/23/2018 1:32:53 PM	8/23/2018 1:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		82918KYIP	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10027803	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02693256	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		261971	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1447231956	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		199045	12/18/2017 2:17 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	12/18/2017 2:17 PM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/21/2017 5:30:40 PM	11/21/2017 5:30 PM
Contacts	Primary Contact	Update	Recertification	Ashby, Margo Director Pharmacy Baptist Health Madisonville 2708255248	Ashby, Margo N. Director Pharmacy Baptist Health Madisonville 2708255248	11/21/2017 5:24 PM
Contacts	Authorizing Official	Update		Ashby, Kim Vice President of Finance 2708255781	Ashby, Kim Vice President of Finance Baptist Health Madisonville, Inc. 2708255781	11/17/2017 5:10 PM
Contacts	Primary Contact	Update		Ashby, Margo Director Pharmacy 2708255248	Ashby, Margo Director Pharmacy Baptist Health Madisonville 2708255248	10/10/2017 12:05 PM
Contacts	Authorizing Official	Update		Ashby, Kim Vice President of Finance 2708255781	Ashby, Kim Vice President of Finance 2708255781	3/22/2017 10:50 AM
Addresses	Main Address	Insert			900 HOSPITAL DRIVE MADISONVILLE, KY 42431	8/16/2016 5:46 PM
Contacts	Primary Contact	Insert			Ashby, Margo Director Pharmacy 2708255248	8/16/2016 5:46 PM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 5:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Number	Insert			610654587002	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: State	Insert			IL	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Number	Insert			100041460A	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: State	Insert			IN	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Number	Insert			0180093	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: State	Insert			TN	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Number	Insert			094690700	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: State	Insert			FL	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Number	Insert			1447231956	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: State	Insert			WV	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Number	Insert			000167472X	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: State	Insert			GA	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: Number	Insert			1447231956	10/3/2015 4:51 PM
Medicaid Billing	Medicaid: State	Insert			MO	10/3/2015 4:51 PM
Details	Last Recertification Date	Update		8/12/2014 12:00:00 AM	8/17/2015 12:00:00 AM	8/17/2015 11:30 AM
Details	Last Recertification Date	Update		9/10/2013 12:00:00 AM	8/12/2014 12:00:00 AM	8/12/2014 12:42 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/10/2013 12:00:00 AM	9/10/2013 8:28 PM
Contacts	Authorizing Official	Insert			Ashby, Kim Vice President of Finance 2708255781	1/31/2013 11:57 AM
Dates	Participating Approval Date	Update		9/6/2007 1:14:14 PM	9/6/2007 12:00:00 AM	1/31/2013 11:57 AM
Details	Entity Name	Update		THE TROVER CLINIC FOUNDATION, INC.DBA REGIONAL MEDICAL CENTER	BAPTIST HEALTH MADISONVILLE, INC.	11/27/2012 2:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/26/2012 1:22 PM
Medicaid Billing	Medicaid: Number	Insert			01022219	5/26/2012 1:22 PM
Medicaid Billing	Medicaid: State	Insert			KY	5/26/2012 1:22 PM
Medicaid Billing	NPI: Number	Update		0102221900	1447231956	5/26/2012 1:22 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/26/2012 1:22 PM
Medicaid Billing	NPI: Number	Insert			0102221900	9/6/2007 1:12 PM
Details	Last Recertification Date	Insert				9/6/2007 1:12 PM
Details	Grant Number	Insert				9/6/2007 1:12 PM
Details	340B ID	Insert			DSH180093A	9/6/2007 1:12 PM
Details	Is Authorizing Official EHB Data	Insert				9/6/2007 1:12 PM
Dates	Last Date That 340B Drugs Purchased	Insert				9/6/2007 1:12 PM
Details	Medicare Provider Number	Insert			180093	9/6/2007 1:12 PM
Details	Entity Name	Insert			THE TROVER CLINIC FOUNDATION, INC.DBA REGIONAL MEDICAL CENTER	9/6/2007 1:12 PM
Details	Program Code	Insert			DSH	9/6/2007 1:12 PM
Details	Entity Subname	Insert			MAHR CANCER CLINIC	9/6/2007 1:12 PM
Dates	Participating Approval Date	Insert			9/6/2007 1:14:14 PM	9/6/2007 1:12 PM
Details	State	Insert			Active	9/6/2007 1:12 PM
Dates	Registration Date	Insert			9/6/2007 12:00:00 AM	9/6/2007 1:12 PM
Dates	Signed By Date	Insert				9/6/2007 1:12 PM
Dates	Start Date	Insert			1/1/2005 12:00:00 AM	9/6/2007 1:12 PM
Terminations	Termination Comments	Insert				9/6/2007 1:12 PM
Terminations	Termination Date	Insert				9/6/2007 1:12 PM
Terminations	Termination Effective Date	Insert				9/6/2007 1:12 PM
Terminations	Termination Reason	Insert				9/6/2007 1:12 PM