Covered Entity Details

DSH180029A HAZARD ARH REGIONAL MEDICAL CENTER (Terminated) - information as of 4/27/2025 12:53:30 AM

Main Details

Name

HAZARD ARH REGIONAL MEDICAL CENTER

Subdivision Name

ARH MEDICAL MALL

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH180029A

Medicare Provider Number

180029

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

6/10/2009

Participating Start Date

7/1/2009

Participating Approval Date

6/14/2009

Last Recertification Date

8/16/2016

Termination Date
Termination Reason

10/1/2017
Site closure

Contacts

Authorizing Official

Appalachian Regional Healthcare
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450

Primary Contact

Appalachian Regional Healthcare
Jeffrey Akers, CEO of Pharmaceutical Services
(606) 616-2296

Addresses

Street Address

210 BLACK GOLD BLVD
HAZARD, KY 41701

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
12/27/11 remove medicaid #, add NPI, change AO from Grossman to Hayne and PC from Short to Akers JH	12/27/2011

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	01014844
		1609869916

Shipping Addresses

Shipping Address 1

ARH COMMUNITY PHARMACY
210 BLACK GOLD BLVD, SUITE 104
HAZARD, KY 41701

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
DSH180029A	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH MEDICAL MALL	210 BLACK GOLD BLVD	HAZARD	KY	Terminated
DSH180029AA	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Gastroenterology	200 Medical Center Drive	Hazard	KY	Active
DSH180029AB	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	JACKSON ARH SPECIALTY CLINIC - CARDIOLOGY	424 Jet Drive	Jackson	KY	Terminated
DSH180029AC	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	JACKSON ARH SPECIALTY CLINIC - Surgery	424 Jet Drive	Jackson	KY	Terminated
DSH180029AD	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	JACKSON ARH SPECIALTY CLINIC - UROLOGY	424 Jet Drive	Jackson	KY	Terminated
DSH180029AE	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH HAZARD CLINIC - PEDIATRICS	181 Roy Campbell Dr	Hazard	KY	Active
DSH180029AF	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Pain Management and Headache Medicine - RECOVERY CLINIC	101 Medical Center Drive	Hazard	KY	Active
DSH180029AG	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH HAZARD CLINIC - Family Practice	181 Roy Campbell Dr	Hazard	KY	Active
DSH180029AH	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Behavioral Health	200 Medical Center Drive	Hazard	KY	Active
DSH180029AJ	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH WOUND TREATMENT CENTER - WOUND CARE	200 Medical Center Drive	Hazard	KY	Active
DSH180029AK	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical Mall Family Specialty Clinic - Orthopedics	210 Black Gold Blvd	Hazard	KY	Active
DSH180029AL	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Hazard - Cardiology	200 Medical Center Drive	Hazard	KY	Active
DSH180029B	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Hazard Family Health Services - ONCOLOGY	110 Medical Center Drive	Hazard	KY	Active
DSH180029C	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH PSYCHIATRIC CENTER - HAZARD	102 MEDICAL CENTER DRIVE	HAZARD	KY	Active
DSH180029D	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical Mall Family Specialty Clinic - Physical Medicine and Rehabilitation	210 BLACK GOLD BLVD	HAZARD	KY	Active
DSH180029E	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH SPECIALTY ASSOCIATES HAZARD-MEDICAL	200 MEDICAL CENTER DRIVE	HAZARD	KY	Terminated
DSH180029F	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Surgical	200 MEDICAL CENTER DRIVE	HAZARD	KY	Active
DSH180029G	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	HAZARD FAMILY HEALTH CENTER / FAMILY HEALTH SERVICES	200 MEDICAL CENTER DRIVE	HAZARD	KY	Terminated
DSH180029H	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	HAZARD FAMILY HEALTH CENTER	110 MEDICAL CENTER DRIVE	HAZARD	KY	Terminated
DSH180029J	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical Mall Family Specialty Clinic - Dermatology	210 BLACK GOLD BLVD	HAZARD	KY	Active
DSH180029K	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical Mall Family Specialty Clinic - Bariatrics	210 BLACK GOLD BLVD	HAZARD	KY	Active
DSH180029L	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical Mall Family Specialty Clinic - Cardiology	210 BLACK GOLD BLVD	HAZARD	KY	Active
DSH180029M	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	JACKSON ARH SPECIALTY CLINIC - ONCOLOGY	424 Jet Drive	JACKSON	KY	Terminated
DSH180029N	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Pain Management and Headache Medicine	200 Medical Center Drive	Hazard	KY	Active
DSH180029P	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Specialty Associates - Hazard - Neurology	200 Medical Center Drive	Hazard	KY	Active
DSH180029Q	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Hazard - Infectious Disease	200 Medical Center Drive	Hazard	KY	Active
DSH180029R	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Hazard Clinic - Internal Medicine	181 Roy Campbell Dr	Hazard	KY	Active
DSH180029S	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Pulmonology	200 Medical Center Drive	Hazard	KY	Active
DSH180029T	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Specialty Associates - Hazard - Oncology	200 Medical Center Drive	Hazard	KY	Terminated
DSH180029U	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Hazard Clinic - Primary Care Clinic	181 Roy Campbell Dr	Hazard	KY	Active
DSH180029V	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Nephrology	200 Medical Center	Hazard	KY	Active
DSH180029W	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Specialty Associates - Hazard - ENT Clinic	200 Medical Center Drive	Hazard	KY	Terminated
DSH180029X	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Orthopedics	200 Medical Center Drive	Hazard	KY	Active
DSH180029Y	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Urology	200 Medical Center Drive	Hazard	KY	Active
DSH180029Z	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	JACKSON ARH SPECIALTY CLINIC - Physical Medicine and Rehabilitation	424 Jet Drive	Jackson	KY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6066162296	Akers, Jeffrey CEO of Pharmaceutical Services Appalachian Regional Healthcare 6066162296	2/8/2022 7:53 PM
Contacts	Primary Contact	Update	Profile Change Request	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6064396988	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6066162296	1/8/2020 11:00 AM
Contacts	Authorizing Official	Update		Grossman, Joseph PRESIDENT and CEO 8592262450	Grossman, Joseph PRESIDENT and CEO Appalachian Regional Healthcare 8592262450	9/22/2017 4:03 PM
Contacts	Primary Contact	Update		Akers, Jeffrey System Director of Pharmacy 6064396988	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6064396988	9/22/2017 3:59 PM
Contacts	Authorizing Official	Update		HAYNES, JERRY PRESIDENT & CEO 8592262450	Grossman, Joseph PRESIDENT and CEO 8592262450	8/1/2017 2:30 PM
Addresses	Main Address	Insert			210 BLACK GOLD BLVD HAZARD, KY 41701	8/1/2017 2:30 PM
Addresses	Shipping Address	Insert			ARH COMMUNITY PHARMACY 210 BLACK GOLD BLVD, SUITE 104 HAZARD, KY 41701	8/1/2017 2:30 PM
Contacts	Primary Contact	Update		SHORT, REBECCA PHARMACIST-IN-CHARGE 6064877380	Akers, Jeffrey System Director of Pharmacy 6064396988	8/1/2017 2:30 PM
Details	State	Update		To Be Terminated	Terminated	8/1/2017 2:30 PM
Dates	Last Date That 340B Drugs Purchased	Update			6/30/2017 12:00:00 AM	8/1/2017 2:30 PM
Details	State	Update		Active	To Be Terminated	8/1/2017 2:30 PM
Terminations	Termination Comments	Update			Site has been closed.	8/1/2017 2:30 PM
Terminations	Termination Date	Update			10/1/2017 12:00:00 AM	8/1/2017 2:30 PM
Terminations	Termination Effective Date	Update			6/30/2017 12:00:00 AM	8/1/2017 2:30 PM
Terminations	Termination Reason	Update			Site closure	8/1/2017 2:30 PM
Contacts	Authorizing Official	Insert			HAYNES, JERRY PRESIDENT & CEO 8592262450	7/21/2017 7:24 PM
Details	Last Recertification Date	Update		8/16/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/16/2015 7:11 PM
Medicaid Billing	Medicaid: Number	Insert			01014844	8/16/2015 7:11 PM
Medicaid Billing	Medicaid: State	Insert			KY	8/16/2015 7:11 PM
Medicaid Billing	NPI: Number	Insert			1609869916	8/16/2015 7:11 PM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/16/2015 12:00:00 AM	8/16/2015 7:11 PM
Details	Last Recertification Date	Update		8/20/2013 12:00:00 AM	8/7/2014 12:00:00 AM	8/7/2014 1:57 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/20/2013 12:00:00 AM	8/20/2013 10:05 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/26/2012 1:31 PM
Details	Comments Public	Insert			12/27/11 remove medicaid #, add NPI, change AO from Grossman to Hayne and PC from Short to Akers JH	12/27/2011 9:09 AM
Contacts	Primary Contact	Insert			SHORT, REBECCA PHARMACIST-IN-CHARGE 6064877380	6/14/2009 11:07 PM
Details	Last Recertification Date	Insert				6/14/2009 11:07 PM
Details	Grant Number	Insert				6/14/2009 11:07 PM
Details	340B ID	Insert			DSH180029A	6/14/2009 11:07 PM
Details	Is Authorizing Official EHB Data	Insert				6/14/2009 11:07 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/14/2009 11:07 PM
Details	Medicare Provider Number	Insert			180029	6/14/2009 11:07 PM
Details	Entity Name	Insert			HAZARD ARH REGIONAL MEDICAL CENTER	6/14/2009 11:07 PM
Details	Program Code	Insert			DSH	6/14/2009 11:07 PM
Details	Entity Subname	Insert			ARH MEDICAL MALL	6/14/2009 11:07 PM
Dates	Participating Approval Date	Insert			6/14/2009 12:00:00 AM	6/14/2009 11:07 PM
Details	State	Insert			Active	6/14/2009 11:07 PM
Dates	Registration Date	Insert			6/10/2009 12:00:00 AM	6/14/2009 11:07 PM
Dates	Signed By Date	Insert			5/29/2009 12:00:00 AM	6/14/2009 11:07 PM
Dates	Start Date	Insert			7/1/2009 12:00:00 AM	6/14/2009 11:07 PM
Terminations	Termination Comments	Insert				6/14/2009 11:07 PM
Terminations	Termination Date	Insert				6/14/2009 11:07 PM
Terminations	Termination Effective Date	Insert				6/14/2009 11:07 PM
Terminations	Termination Reason	Insert				6/14/2009 11:07 PM