Covered Entity Details

DSH260061 NEVADA CITY HOSPITAL (Active) - information as of 5/1/2025 11:46:45 PM

Main Details

Name

NEVADA CITY HOSPITAL

Subdivision Name

DBA NEVADA REGIONAL MEDICAL CENTER

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH260061

Medicare Provider Number

260061

Additional Details

Current Program Status

Active

Registration Date

6/4/2009

Participating Start Date

7/1/2009

Participating Approval Date

6/8/2009

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

Nevada City Hospital
Jason Anglin, CEO
(417) 448-3626

Primary Contact

Nevada City Hospital
JODEE Elizabeth MASHEK, PHARMACY DIRECTOR
(417) 448-3649

Addresses

Street Address

800 SOUTH ASH STREET
NEVADA, MO 64772

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
KS	100099780A,100099780H	1942283866
MO	010419000	1942283866

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	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	01/11/2023	01/23/2023	12/31/2024	01/07/2025
Contract Detail	ACARIAHEALTH PHARMACY, INC.	10409 W 84TH TERRACE		LENEXA	KS	66214-1641	01/11/2023	01/23/2023	08/09/2023	10/10/2023
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/17/2023	01/30/2023		01/30/2023
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/17/2023	01/30/2023		01/30/2023
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/17/2023	01/30/2023		01/30/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/17/2023	01/30/2023		01/30/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/17/2023	01/30/2023		01/30/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/17/2023	01/30/2023		01/30/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	01/17/2023	01/30/2023		01/30/2023
Contract Detail	AUBURN PHARMACY, INC.	AUBURN PHARMACY #250	301 N 14TH ST PO BOX 70	RICH HILL	MO	64779	01/15/2018	04/01/2018		01/15/2018
Contract Detail	AUBURN PHARMACY, INC.	AUBURN PHARMACY #245	105 S OAK ST.	NEVADA	MO	64772-3436	01/11/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/08/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/08/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/08/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/08/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/08/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/08/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/08/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/08/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/08/2022	10/01/2022		10/01/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/08/2022	10/01/2022		10/01/2022
Contract Detail	COMMUNITY PHARMACY	SUMMERS PHARMACY OF NEVADA, LLC	900 S ADAMS ST	NEVADA	MO	64772	07/05/2016	10/01/2016		02/15/2017
Contract Detail	COMMUNITY PHARMACY INC		COMMUNITY PHARMACY 900 S ADAMS	NEVADA	MO	64772	03/21/2011	03/21/2011	04/01/2016	02/15/2017
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/15/2021	07/01/2021		07/01/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/15/2021	07/01/2021		07/01/2021
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/08/2022	10/01/2022		10/01/2022
Contract Detail	DILLONS PHARMACY #108	2600 NORTH BROADWAY		PITTSBURG	KS	66762	04/13/2022	06/13/2022	12/06/2024	01/07/2025
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	01/17/2023	01/30/2023		01/30/2023
Contract Detail	EVANS DRUGS	KB EVANS DRUGS	209 E US HIGHWAY 54	EL DORADO SPRINGS	MO	64744-1925	01/15/2018	04/01/2018		01/15/2018
Contract Detail	EVANS DRUGS NEVADA LLC	1407 W AUSTIN BLVD		NEVADA	MO	64772-2805	10/22/2021	10/22/2021		10/25/2021
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	01/17/2023	01/30/2023		01/30/2023
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	01/17/2023	01/30/2023		01/30/2023
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	01/17/2023	01/30/2023		01/30/2023
Contract Detail	FOUNDATION CARE LLC	111 CHESTERFIELD INDUSTRIAL BLVD STE 115		CHESTERFIELD	MO	63005	01/11/2023	01/23/2023	12/27/2024	02/06/2025
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	04/13/2022	06/13/2022		06/13/2022
Contract Detail	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/13/2022	06/13/2022		06/13/2022
Contract Detail	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	04/13/2022	06/13/2022		06/13/2022
Contract Detail	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	07/15/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	07/15/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/13/2022	06/13/2022		06/13/2022
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/13/2022	06/13/2022		06/13/2022
Contract Detail	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	04/13/2022	06/13/2022		06/13/2022
Contract Detail	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	07/15/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	07/15/2024	10/01/2024		10/01/2024
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/13/2022	06/13/2022		06/13/2022
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/13/2022	06/13/2022		06/13/2022
Contract Detail	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	04/13/2022	07/01/2022	05/27/2022	05/27/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/08/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/08/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/08/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/08/2022	10/01/2022		10/01/2022
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/07/2020	01/01/2021		01/01/2021
Contract Detail	WAL-MART PHARMACY 10-0034	2250 LINCOLN AVE		NEVADA	MO	64772	07/14/2015	10/01/2015		02/15/2017
Contract Detail	WAL-MART PHARMACY 10-0039	2500 SOUTH MAIN		FORT SCOTT	KS	66701	04/13/2022	06/13/2022		06/13/2022
Contract Detail	WAL-MART PHARMACY 10-0338	29 SOUTHWEST FIRST LN		LAMAR	MO	64759	04/13/2022	06/13/2022		06/13/2022
Contract Detail	WAL-MART PHARMACY 10-0888	400 SOUTH FRAN		BUTLER	MO	64730	04/13/2022	06/13/2022		06/13/2022
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/12/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO	DBA: WALGREENS #11086	2229 S MAIN ST	FORT SCOTT	KS	66701-3023	04/13/2022	06/13/2022	01/23/2025	01/23/2025
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16534	1500 E SUNSHINE ST STE 148	SPRINGFIELD	MO	65804	04/13/2022	06/13/2022	01/23/2025	01/23/2025
Contract Detail	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	04/16/2023	07/01/2023	01/23/2025	01/23/2025
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/16/2023	07/01/2023		07/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/08/2024	07/01/2024		07/01/2024
Contract Detail	WILKINSON PHAR OF RICH HILL	PO BOX 70	301 N 14TH STREET	RICH HILL	MO	64779	01/15/2015	04/01/2015	10/03/2017	01/15/2018
Contract Detail	WILKINSON PHARMACY	105 S OAK		NEVADA	MO	64772	01/15/2015	04/01/2015	12/31/2018	01/03/2019
Contract Detail	WILKINSON PHARMACY #5	WILKINSON PHARMACY INC	200 EAST HIGHWAY 54	EL DORADO SPRINGS	MO	64744	01/15/2015	04/01/2015	12/31/2017	01/15/2018
Contract Detail	WILKINSON PHARMACY OF LAMAR	605 A W 12TH	P.O. BOX 626	LAMAR	MO	64759	01/15/2015	04/01/2015	03/01/2018	04/10/2018
Contract Detail	WOODS PHARMACY 2472	WOODS PHARMACY 2472	1407 W AUSTIN BLVD	NEVADA	MO	64772-2805	04/13/2018	07/01/2018	10/21/2021	10/26/2021

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH260061A	Child	DSH	NEVADA CITY HOSPITAL	RICH HILL FAMILY MEDICAL CLINIC	320 N 14 STREET	RICH HILL	MO	Active
DSH260061B	Child	DSH	NEVADA CITY HOSPITAL DBA NEVADA REGIONAL MEDICAL CENTER	SHELDON FAMILY MEDICAL CLINIC	810 W MAIN	SHELDON	MO	Terminated
DSH260061D	Child	DSH	NEVADA CITY HOSPITAL	WOUND CLINIC	800 SOUTH ASH	NEVADA	MO	Active
DSH260061E	Child	DSH	NEVADA CITY HOSPITAL	SPECIALTY CLINIC	800 SOUTH ASH	NEVADA	MO	Active
DSH260061F	Child	DSH	NEVADA CITY HOSPITAL	NOWCARE CLINIC	345 SOUTH BARRETT STREET	NEVADA	MO	Active
DSH260061G	Child	DSH	NEVADA CITY HOSPITAL	PROFESSIONAL PRACTICE CLINIC	800 SOUTH ASH STREET	NEVADA	MO	Active
DSH260061H	Child	DSH	NEVADA CITY HOSPITAL	NEVADA CITY HOSPITAL / Primary Care Clinic / Rural Health Clinic	627 S ASH ST STE. B	NEVADA	MO	Active
DSH260061J	Child	DSH	NEVADA CITY HOSPITAL	Nevada Medical Clinic - Rural Health Clinic	900 S Adams St	Nevada	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/16/2023 2:22:50 PM	9/4/2024 12:07:39 PM	9/4/2024 12:07 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 1:03:11 PM	8/16/2023 2:22:50 PM	8/16/2023 2:22 PM
Contacts	Authorizing Official	Update	Change Request	White, Dana Chief Financial Officer Nevada City Hospital 4174483711	Anglin, Jason CEO Nevada City Hospital 4174483626	12/8/2022 7:06 AM
Details	Last Recertification Date	Update	Recertification	9/14/2021 8:11:28 AM	9/7/2022 1:03:11 PM	9/7/2022 1:03 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 12:44:41 PM	9/14/2021 8:11:28 AM	9/14/2021 8:11 AM
Contacts	Authorizing Official	Update	AO Change Request	Branstetter, Steve Lee CEO Nevada Regional Medical Center 4174483626	White, Dana Chief Financial Officer Nevada City Hospital 4174483711	8/24/2021 7:45 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1942283866	9/22/2020 8:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		KS	9/22/2020 8:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 12:44 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100099780H	9/9/2020 12:44 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		KS	9/9/2020 12:44 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1942283866	9/9/2020 12:44 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/9/2020 12:44 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1942283866 ( )		9/9/2020 12:44 PM
Details	Last Recertification Date	Update	Recertification	9/5/2019 11:52:37 AM	9/9/2020 12:44:41 PM	9/9/2020 12:44 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/5/2019 11:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100099780A	9/5/2019 11:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		KS	9/5/2019 11:52 AM
Details	Last Recertification Date	Update	Recertification	8/27/2018 1:26:16 PM	9/5/2019 11:52:37 AM	9/5/2019 11:52 AM
Contacts	Authorizing Official	Update	Change Request	Braman, Wes CEO Nevada City Hospital 4174483626	Branstetter, Steve Lee CEO Nevada Regional Medical Center 4174483626	4/17/2019 11:20 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 7:38:17 PM	8/27/2018 1:26:16 PM	8/27/2018 1:26 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/29/2017 7:38:17 PM	11/29/2017 7:38 PM
Contacts	Authorizing Official	Update	AO Change Request	Feuquay, Judith CEO 4174483626	Braman, Wes CEO Nevada City Hospital 4174483626	11/15/2017 7:18 AM
Contacts	Primary Contact	Update		MASHEK, JODEE PHARMACY DIRECTOR 4174483649	MASHEK, JODEE Elizabeth PHARMACY DIRECTOR Nevada City Hospital 4174483649	10/4/2017 10:46 AM
Contacts	Primary Contact	Insert			MASHEK, JODEE PHARMACY DIRECTOR 4174483649	2/15/2017 4:16 PM
Addresses	Main Address	Insert			800 SOUTH ASH STREET NEVADA, MO 64772	2/15/2017 4:16 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/10/2016 2:23 PM
Details	Last Recertification Date	Update		8/26/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 2:23 PM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/26/2015 12:00:00 AM	8/26/2015 9:55 AM
Details	Last Recertification Date	Update		9/12/2013 12:00:00 AM	8/7/2014 12:00:00 AM	8/7/2014 2:05 PM
Contacts	Authorizing Official	Update		FEUQUAY, JUDY CEO 4174483710	Feuquay, Judith CEO 4174483626	11/20/2013 2:21 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/12/2013 12:00:00 AM	9/12/2013 5:17 PM
Medicaid Billing	NPI: Number	Insert			1942283866	5/14/2012 9:07 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/14/2012 9:07 AM
Contacts	Authorizing Official	Insert			FEUQUAY, JUDY CEO 4174483710	6/8/2009 11:04 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	6/4/2009 5:27 PM
Medicaid Billing	Medicaid: Number	Insert			010419000	6/4/2009 5:27 PM
Medicaid Billing	Medicaid: State	Insert			MO	6/4/2009 5:27 PM
Details	Last Recertification Date	Insert				6/4/2009 5:27 PM
Details	Grant Number	Insert				6/4/2009 5:27 PM
Details	340B ID	Insert			DSH260061	6/4/2009 5:27 PM
Details	Is Authorizing Official EHB Data	Insert				6/4/2009 5:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/4/2009 5:27 PM
Details	Medicare Provider Number	Insert			260061	6/4/2009 5:27 PM
Details	Entity Name	Insert			NEVADA CITY HOSPITAL	6/4/2009 5:27 PM
Details	Program Code	Insert			DSH	6/4/2009 5:27 PM
Details	Entity Subname	Insert			DBA NEVADA REGIONAL MEDICAL CENTER	6/4/2009 5:27 PM
Dates	Participating Approval Date	Insert			6/8/2009 12:00:00 AM	6/4/2009 5:27 PM
Details	State	Insert			Active	6/4/2009 5:27 PM
Dates	Registration Date	Insert			6/4/2009 12:00:00 AM	6/4/2009 5:27 PM
Dates	Signed By Date	Insert			5/28/2009 12:00:00 AM	6/4/2009 5:27 PM
Dates	Start Date	Insert			7/1/2009 12:00:00 AM	6/4/2009 5:27 PM
Terminations	Termination Comments	Insert				6/4/2009 5:27 PM
Terminations	Termination Date	Insert				6/4/2009 5:27 PM
Terminations	Termination Effective Date	Insert				6/4/2009 5:27 PM
Terminations	Termination Reason	Insert				6/4/2009 5:27 PM