Covered Entity Details

CAH041313-00 OZARK HEALTH INC (Active) - information as of 5/5/2025 11:47:34 PM

Main Details

Name

OZARK HEALTH INC

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH041313-00

Medicare Provider Number

041313

Additional Details

Current Program Status

Active

Registration Date

4/5/2022

Participating Start Date

7/1/2022

Participating Approval Date

6/1/2022

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Ozark Health Medical Center
Robin Corley, CFO
(501) 745-9302

Primary Contact

Ozark Health Medical Center
Annice Craig, PHARMACIST
(501) 745-9587

Addresses

Street Address

2500 HIGHWAY 65 S
CLINTON, AR 72031

Billing Address

OZARK HEALTH MEDICAL CENTER
PO BOX 206
CLINTON, AR 72031

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participated starting 9/20/2010; Terminated 10/1/2018; Reinstated 7/1/2022.	06/01/2022

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
AR	106200105	1992760342

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	AMERICAN HOME PHARMACY LLC	454 INGRAM ST		CLINTON	AR	72031	04/04/2025	07/01/2025	04/04/2025
Contract Detail	BENNETT HEALTH SERVICES INC	DBA FAIRFIELD BAY PHARMACY	367 DAVE CREEK PKWY	FAIRFIELD BAY	AR	72088	04/15/2025	07/01/2025	04/15/2025
Contract Detail	CLINTON BUTLER LLC DBA CLINTON DRUG	2526 HIGHWAY 65 S STE 101		CLINTON	AR	72031	04/04/2025	07/01/2025	04/04/2025
Contract Detail	SEARCY COUNTY PHARMACY LLC DBA MARSHALL	243 HIGHWAY 65 N		MARSHALL	AR	72650	04/04/2025	07/01/2025	04/04/2025
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/15/2025	07/01/2025	04/15/2025
Contract Detail	WAL-MART PHARMACY 10-0788	1966 HWY 65 SOUTH		CLINTON	AR	72031	04/15/2025	07/01/2025	04/15/2025
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/15/2025	07/01/2025	04/15/2025
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/15/2025	07/01/2025	04/15/2025
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/15/2025	07/01/2025	04/15/2025
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/15/2025	07/01/2025	04/15/2025

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH041313-01	Child	CAH	OZARK HEALTH INC	OZARK HEALTH, INC - OZARK MEDICAL CLINIC CLINTON	175 VOLUNTEER PKWY	CLINTON	AR	Approved
CAH041313-02	Child	CAH	OZARK HEALTH INC	OZARK MEDICAL CLINIC FAIRFIELD BAY - OZARK MEDICAL CLINIC FAIRFIELD BAY	383 DAVE CREEK PKWY	FAIRFIELD BAY	AR	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 11:25:54 AM	8/19/2024 10:17:36 AM	8/19/2024 10:17 AM
Details	Last Recertification Date	Update	Recertification	8/25/2022 11:10:07 AM	8/17/2023 11:25:54 AM	8/17/2023 11:25 AM
Details	Last Recertification Date	Update	Recertification		8/25/2022 11:10:07 AM	8/25/2022 11:10 AM
Details	State	Update		Approved	Active	7/1/2022 12:01 AM
Addresses	Main Address	Update	Change Request	HIGHWAY 65 CLINTON, AR 72031	2500 HIGHWAY 65 S CLINTON, AR 72031	6/16/2022 12:51 PM
Addresses	Billing Address	Insert	Reinstatement		OZARK HEALTH MEDICAL CENTER PO BOX 206 CLINTON, AR 72031	6/1/2022 12:06 PM
Addresses	Main Address	Update	Reinstatement	2500 HWY 65 S CLINTON, AR 72031	HIGHWAY 65 CLINTON, AR 72031	6/1/2022 12:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	6/1/2022 12:06 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		106200105	6/1/2022 12:06 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		AR	6/1/2022 12:06 PM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1992760342	6/1/2022 12:06 PM
Medicaid Billing	NPI: State	Insert	Reinstatement		AR	6/1/2022 12:06 PM
Contacts	Authorizing Official	Update	Reinstatement	Deaton, David CEO Ozark Health 5017459502	Corley, Robin CFO Ozark Health Medical Center 5017459302	6/1/2022 12:06 PM
Contacts	Signed By	Insert	Reinstatement		Corley, Robin CFO Ozark Health Medical Center 5017459302	6/1/2022 12:06 PM
Contacts	Primary Contact	Update	Reinstatement	JOHNSON, MICHELLE PHARMACY MANAGER Ozark Health Medical Center 5017459587	Craig, Annice PHARMACIST Ozark Health Medical Center 5017459587	6/1/2022 12:06 PM
Details	Last Recertification Date	Update	Reinstatement	12/4/2017 6:25:20 AM		6/1/2022 12:06 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	9/30/2018 12:00:00 AM		6/1/2022 12:06 PM
Details	Entity Name	Update	Reinstatement	OZARK HEALTH MEDICAL CENTER	OZARK HEALTH INC	6/1/2022 12:06 PM
Dates	Participating Approval Date	Update	Reinstatement	9/20/2010 12:00:00 AM	6/1/2022 12:06:39 PM	6/1/2022 12:06 PM
Details	State	Update	Reinstatement	Terminated	Approved	6/1/2022 12:06 PM
Dates	Registration Date	Update	Reinstatement	8/17/2010 12:00:00 AM	4/5/2022 2:30:20 PM	6/1/2022 12:06 PM
Dates	Signed By Date	Update	Reinstatement	9/17/2010 12:00:00 AM	4/19/2022 9:42:59 AM	6/1/2022 12:06 PM
Dates	Start Date	Update	Reinstatement	9/20/2010 12:00:00 AM	7/1/2022 12:00:00 AM	6/1/2022 12:06 PM
Terminations	Termination Date	Update	Reinstatement	10/1/2018 12:00:00 AM		6/1/2022 12:06 PM
Terminations	Termination Effective Date	Update	Reinstatement	10/1/2018 12:00:00 AM		6/1/2022 12:06 PM
Terminations	Termination Reason	Update	Reinstatement	Failure to recertify		6/1/2022 12:06 PM
Details	Comments Public	Insert	Reinstatement		Participated starting 9/20/2010; Terminated 10/1/2018; Reinstated 7/1/2022.	6/1/2022 11:47 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2018 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/30/2018 12:00:00 AM	9/17/2018 3:44 PM
Details	State	Update	Recertification	Active	To Be Terminated	9/17/2018 3:44 PM
Terminations	Termination Date	Update	Recertification		10/1/2018 12:00:00 AM	9/17/2018 3:44 PM
Terminations	Termination Effective Date	Update	Recertification		10/1/2018 12:00:00 AM	9/17/2018 3:44 PM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	9/17/2018 3:44 PM
Details	Last Recertification Date	Update	Recertification	8/26/2016 12:00:00 AM	12/4/2017 6:25:20 AM	12/4/2017 6:25 AM
Contacts	Primary Contact	Update	Recertification	JOHNSON, MICHELLE PHARMACY MANAGER 5017459587	JOHNSON, MICHELLE PHARMACY MANAGER Ozark Health Medical Center 5017459587	12/1/2017 5:32 PM
Contacts	Authorizing Official	Update		Deaton, David CEO 5017459502	Deaton, David CEO Ozark Health 5017459502	10/14/2017 2:51 PM
Addresses	Main Address	Insert			2500 HWY 65 S CLINTON, AR 72031	8/26/2016 10:57 AM
Contacts	Primary Contact	Insert			JOHNSON, MICHELLE PHARMACY MANAGER 5017459587	8/26/2016 10:57 AM
Contacts	Authorizing Official	Update		Shipp, Rhonda CFO 5017459522	Deaton, David CEO 5017459502	8/26/2016 10:57 AM
Details	Last Recertification Date	Update		9/3/2015 12:00:00 AM	8/26/2016 12:00:00 AM	8/26/2016 10:57 AM
Details	Last Recertification Date	Update		9/9/2014 12:00:00 AM	9/3/2015 12:00:00 AM	9/3/2015 3:04 PM
Details	Last Recertification Date	Update		8/21/2013 6:13:29 PM	9/9/2014 12:00:00 AM	9/9/2014 4:42 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/21/2013 6:13:29 PM	8/21/2013 6:13 PM
Addresses	Billing Address	Insert			OZARK HEALTH MEDICAL CENTER PO BOX 206 CLINTON, AR 72031	8/7/2013 1:46 PM
Contacts	Authorizing Official	Update		REAMEY, KIRK CEO 5017459531	Shipp, Rhonda CFO 5017459522	12/20/2012 4:12 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/31/2012 8:05 AM
Contacts	Authorizing Official	Insert			REAMEY, KIRK CEO 5017459531	9/20/2010 6:41 PM
Details	Last Recertification Date	Insert				9/20/2010 6:41 PM
Details	Grant Number	Insert				9/20/2010 6:41 PM
Details	340B ID	Insert			CAH041313-00	9/20/2010 6:41 PM
Details	Is Authorizing Official EHB Data	Insert				9/20/2010 6:41 PM
Dates	Last Date That 340B Drugs Purchased	Insert				9/20/2010 6:41 PM
Details	Medicare Provider Number	Insert			041313	9/20/2010 6:41 PM
Details	Entity Name	Insert			OZARK HEALTH MEDICAL CENTER	9/20/2010 6:41 PM
Details	Program Code	Insert			CAH	9/20/2010 6:41 PM
Details	Entity Subname	Insert				9/20/2010 6:41 PM
Dates	Participating Approval Date	Insert			9/20/2010 12:00:00 AM	9/20/2010 6:41 PM
Details	State	Insert			Active	9/20/2010 6:41 PM
Dates	Registration Date	Insert			8/17/2010 12:00:00 AM	9/20/2010 6:41 PM
Dates	Signed By Date	Insert			9/17/2010 12:00:00 AM	9/20/2010 6:41 PM
Dates	Start Date	Insert			9/20/2010 12:00:00 AM	9/20/2010 6:41 PM
Terminations	Termination Comments	Insert				9/20/2010 6:41 PM
Terminations	Termination Date	Insert				9/20/2010 6:41 PM
Terminations	Termination Effective Date	Insert				9/20/2010 6:41 PM
Terminations	Termination Reason	Insert				9/20/2010 6:41 PM