340B Drug Pricing Program Database


CAH141343-02 CRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITAL (Active) - information as of 6/19/2025 11:51:21 PM

Main Details
CRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITAL
OBLONG RURAL HEALTH CLINIC
Critical Access Hospital
Yes
CAH141343-02
141343
143488


Additional Details
Active
11/30/2010
1/1/2011
12/1/2010
8/19/2024

Contacts

Crawford Memorial Hospital
MITZI MARTIN, BOARD VICE CHAIR
(618) 544-3131 Ext: 5123

Crawford Memorial Hospital
Blake Potts, Director of Pharmacy
(618) 544-3131 Ext: 5380

Addresses

1366 E 1050th Ave.
OBLONG, IL 62449

CRAWFORD MEMORIAL HOSPITAL
1002 N. ALLEN STREET
SUITE B
ROBINSON, IL 62454


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
IL3707937620081790769073,1225028202,1609878420,1316345598,1467086892,1063947067,1639443245,1376170977
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
CAH141343-01ChildCAHCRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITALROBINSON RURAL HEALTH CLINIC1101 N. ALLEN STREETROBINSONILActive
CAH141343-02ChildCAHCRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITALOBLONG RURAL HEALTH CLINIC1366 E 1050th Ave.OBLONGILActive
CAH141343-03ChildCAHCRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITALPALESTINE RURAL HEALTH CLINIC209 E. GRAND PRAIRIE STREETPALESTINEILActive
CAH141343-04ChildCAHCRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITALCRAWFORD HOSPITAL DISTRICT - Med Center Rural Health Clinic IV1000 N ALLEN STROBINSONILActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/16/2023 10:47:36 AM8/19/2024 5:03:57 PM8/19/2024 5:03 PM
Medicaid BillingNPI: NumberInsertChange Request 137617097710/5/2023 9:29 PM
Medicaid BillingNPI: StateInsertChange Request IL10/5/2023 9:29 PM
DetailsLast Recertification DateUpdateRecertification8/29/2022 2:13:01 PM8/16/2023 10:47:36 AM8/16/2023 10:47 AM
DetailsLast Recertification DateUpdateRecertification8/30/2021 12:06:34 PM8/29/2022 2:13:01 PM8/29/2022 2:13 PM
Medicaid BillingNPI: NumberDeleteChange Request1588697890 (IL) 6/15/2022 3:43 PM
Medicaid BillingNPI: NumberInsertChange Request 16098784206/15/2022 3:43 PM
Medicaid BillingNPI: StateInsertChange Request IL6/15/2022 3:43 PM
Medicaid BillingNPI: NumberInsertChange Request 13163455986/15/2022 3:43 PM
Medicaid BillingNPI: StateInsertChange Request IL6/15/2022 3:43 PM
Medicaid BillingNPI: NumberInsertChange Request 14670868926/15/2022 3:43 PM
Medicaid BillingNPI: StateInsertChange Request IL6/15/2022 3:43 PM
Medicaid BillingNPI: NumberInsertChange Request 10639470676/15/2022 3:43 PM
Medicaid BillingNPI: StateInsertChange Request IL6/15/2022 3:43 PM
Medicaid BillingNPI: NumberInsertChange Request 16394432456/15/2022 3:43 PM
Medicaid BillingNPI: StateInsertChange Request IL6/15/2022 3:43 PM
DetailsLast Recertification DateUpdateRecertification8/19/2020 3:07:36 PM8/30/2021 12:06:34 PM8/30/2021 12:06 PM
Medicaid BillingNPI: StateUpdateRecertification IL8/19/2020 3:07 PM
Medicaid BillingNPI: StateUpdateRecertification IL8/19/2020 3:07 PM
Medicaid BillingNPI: StateUpdateRecertification IL8/19/2020 3:07 PM
DetailsLast Recertification DateUpdateRecertification9/9/2019 2:59:12 PM8/19/2020 3:07:36 PM8/19/2020 3:07 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False7/6/2020 2:01 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3707937620087/6/2020 2:01 PM
Medicaid BillingMedicaid: StateInsertChange Request IL7/6/2020 2:01 PM
ContactsPrimary ContactUpdateChange RequestMEEKS, KELLY Staff Pharmacist CAH141343 6185462532Potts, Blake Director of Pharmacy Crawford Memorial Hospital 6185443131-53806/19/2020 2:05 PM
Medicaid BillingNPI: NumberInsertChange Request 15886978901/24/2020 1:28 PM
Medicaid BillingNPI: NumberDeleteChange Request1417095456 ( ) 11/20/2019 8:02 AM
DetailsLast Recertification DateUpdateRecertification9/11/2018 2:01:43 PM9/9/2019 2:59:12 PM9/9/2019 2:59 PM
DetailsLast Recertification DateUpdateRecertification11/30/2017 1:45:48 PM9/11/2018 2:01:43 PM9/11/2018 2:01 PM
ContactsPrimary ContactUpdateProfile Change RequestMEEKS, KELLY DIRECTOR, PHARMACY CAH141343 6185462532MEEKS, KELLY Staff Pharmacist CAH141343 61854625326/30/2018 10:15 PM
AddressesBilling AddressUpdateRecertificationCRAWFORD MEMORIAL HOSPITAL 1002 N. ALLEN STREET ROBINSON, IL 62454CRAWFORD MEMORIAL HOSPITAL 1002 N. ALLEN STREET SUITE B ROBINSON, IL 6245411/30/2017 1:45 PM
DetailsLast Recertification DateUpdateRecertification8/19/2016 12:00:00 AM11/30/2017 1:45:48 PM11/30/2017 1:45 PM
ContactsAuthorizing OfficialUpdate MARTIN, MITZI BOARD VICE CHAIR 6185443131-5123MARTIN, MITZI BOARD VICE CHAIR Crawford Memorial Hospital 6185443131-512310/23/2017 1:59 PM
ContactsPrimary ContactUpdate MEEKS, KELLY DIRECTOR, PHARMACY 6185462532MEEKS, KELLY DIRECTOR, PHARMACY CAH141343 61854625329/21/2017 1:27 PM
ContactsAuthorizing OfficialUpdate CARLSON, RICHARD CHIEF FINANCIAL OFFICER 6185462592MARTIN, MITZI BOARD VICE CHAIR 6185443131-51239/11/2017 3:29 PM
ContactsPrimary ContactInsert  MEEKS, KELLY DIRECTOR, PHARMACY 61854625328/10/2017 11:15 AM
ContactsAuthorizing OfficialInsert  CARLSON, RICHARD CHIEF FINANCIAL OFFICER 61854625928/19/2016 11:59 AM
DetailsLast Recertification DateUpdate 8/17/2015 12:00:00 AM8/19/2016 12:00:00 AM8/19/2016 11:59 AM
AddressesMain AddressInsert   1366 E 1050th Ave. OBLONG, IL 624498/19/2016 11:59 AM
AddressesBilling AddressInsert  CRAWFORD MEMORIAL HOSPITAL 1002 N. ALLEN STREET ROBINSON, IL 624548/8/2016 1:35 PM
DetailsLast Recertification DateUpdate 8/20/2014 12:00:00 AM8/17/2015 12:00:00 AM8/17/2015 11:29 AM
Medicaid BillingNPI: NumberInsert  17907690738/22/2014 12:55 PM
Medicaid BillingNPI: NumberInsert  14170954568/22/2014 12:55 PM
Medicaid BillingNPI: NumberInsert  12250282028/22/2014 12:55 PM
DetailsLast Recertification DateUpdate 8/23/2013 3:53:31 PM8/20/2014 12:00:00 AM8/20/2014 5:37 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/23/2013 3:53:31 PM8/23/2013 3:53 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/31/2012 8:10 AM
DetailsLast Recertification DateInsert   12/1/2010 8:34 AM
DetailsGrant NumberInsert   12/1/2010 8:34 AM
Details340B IDInsert  CAH141343-0212/1/2010 8:34 AM
DetailsIs Authorizing Official EHB DataInsert   12/1/2010 8:34 AM
DatesLast Date That 340B Drugs PurchasedInsert   12/1/2010 8:34 AM
DetailsMedicare Provider NumberInsert  14134312/1/2010 8:34 AM
DetailsEntity NameInsert  CRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITAL12/1/2010 8:34 AM
DetailsProgram CodeInsert  CAH12/1/2010 8:34 AM
DetailsEntity SubnameInsert  OBLONG RURAL HEALTH CLINIC12/1/2010 8:34 AM
DatesParticipating Approval DateInsert  12/1/2010 12:00:00 AM12/1/2010 8:34 AM
DetailsStateInsert  Active12/1/2010 8:34 AM
DatesRegistration DateInsert  11/30/2010 12:00:00 AM12/1/2010 8:34 AM
DatesSigned By DateInsert  11/23/2010 12:00:00 AM12/1/2010 8:34 AM
DatesStart DateInsert  1/1/2011 12:00:00 AM12/1/2010 8:34 AM
TerminationsTermination CommentsInsert   12/1/2010 8:34 AM
TerminationsTermination DateInsert   12/1/2010 8:34 AM
TerminationsTermination Effective DateInsert   12/1/2010 8:34 AM
TerminationsTermination ReasonInsert   12/1/2010 8:34 AM