Covered Entity Details

CAH181309-02 CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL (Active) - information as of 4/27/2025 11:34:33 PM

Main Details

Name

CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL

Subdivision Name

CASEY COUNTY FAMILY PRACTICE

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH181309-02

Medicare Provider Number

181309

Outpatient Facility Provider Number

183469

Additional Details

Current Program Status

Active

Registration Date

6/17/2011

Participating Start Date

7/1/2011

Participating Approval Date

6/17/2011

Last Recertification Date

8/30/2024

Contacts

Authorizing Official

CAH
Richard John Hendershot, CFO
(606) 787-6275 Ext: 605

Primary Contact

Casey County Hospital
Christopher Dudgeon, Assistant Chief Financial Officer
(606) 787-6275 Ext: 604

Addresses

Street Address

199 Adams Street
LIBERTY, KY 42539

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?
No

Shipping Addresses

Same as Street Address

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
CAH181309-01	Child	CAH	CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL	CASEY COUNTY PRIMARY CARE	187 WOLFORD AVENUE	LIBERTY	KY	Active
CAH181309-02	Child	CAH	CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL	CASEY COUNTY FAMILY PRACTICE	199 Adams Street	LIBERTY	KY	Active
CAH181309-03	Child	CAH	CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL	Casey County Intensive Outpatient Psych - Psych	174 Sanders Street	Liberty	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/16/2023 11:15:53 AM	8/30/2024 11:19:51 AM	8/30/2024 11:19 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 4:15:39 PM	8/16/2023 11:15:53 AM	8/16/2023 11:15 AM
Addresses	Main Address	Update	Change Request	112 LIBERTY SQUARE SHOPPING CENTER LIBERTY, KY 42539	199 Adams Street LIBERTY, KY 42539	12/29/2022 7:44 AM
Details	Last Recertification Date	Update	Recertification	9/8/2021 11:01:17 AM	8/29/2022 4:15:39 PM	8/29/2022 4:15 PM
Details	Last Recertification Date	Update	Recertification	8/20/2020 12:05:22 PM	9/8/2021 11:01:17 AM	9/8/2021 11:01 AM
Contacts	Primary Contact	Update	Recertification	Lampl, Deborah L Asst. CFO Casey County Hospital 6067876275-604	Dudgeon, Christopher Assistant Chief Financial Officer Casey County Hospital 6067876275-604	8/20/2020 12:05 PM
Details	Last Recertification Date	Update	Recertification	8/22/2019 3:30:50 PM	8/20/2020 12:05:22 PM	8/20/2020 12:05 PM
Details	Last Recertification Date	Update	Recertification	8/23/2018 3:55:54 PM	8/22/2019 3:30:50 PM	8/22/2019 3:30 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 4:25:21 PM	8/23/2018 3:55:54 PM	8/23/2018 3:55 PM
Contacts	Authorizing Official	Update	Change Request	TUNGATE, REX A. CEO Casey County Hospital District 6067876275-601	Hendershot, Richard John CFO CAH 6067876275-605	8/7/2018 4:04 PM
Contacts	Primary Contact	Update	Recertification	TUNGATE, REX A. CEO 6067876275-601	Lampl, Deborah L Asst. CFO Casey County Hospital 6067876275-604	11/29/2017 4:25 PM
Details	Last Recertification Date	Update	Recertification	8/24/2016 12:00:00 AM	11/29/2017 4:25:21 PM	11/29/2017 4:25 PM
Contacts	Authorizing Official	Update		TUNGATE, REX A. CEO 6067876275-601	TUNGATE, REX A. CEO Casey County Hospital District 6067876275-601	11/29/2017 3:48 PM
Addresses	Main Address	Insert			112 LIBERTY SQUARE SHOPPING CENTER LIBERTY, KY 42539	6/22/2017 3:43 PM
Contacts	Authorizing Official	Update		Tungate, Rex A. CEO 2709324211-220	TUNGATE, REX A. CEO 6067876275-601	6/22/2017 3:43 PM
Contacts	Primary Contact	Insert			TUNGATE, REX A. CEO 6067876275-601	6/22/2017 3:43 PM
Details	Last Recertification Date	Update		8/27/2015 12:00:00 AM	8/24/2016 12:00:00 AM	8/24/2016 6:06 PM
Details	Last Recertification Date	Update		8/21/2014 12:00:00 AM	8/27/2015 12:00:00 AM	8/27/2015 7:42 AM
Contacts	Authorizing Official	Insert			Tungate, Rex A. CEO 2709324211-220	1/14/2015 6:02 PM
Details	Last Recertification Date	Update		9/5/2013 12:00:00 AM	8/21/2014 12:00:00 AM	8/21/2014 11:50 AM
Details	Last Recertification Date	Update			9/5/2013 12:00:00 AM	9/5/2013 5:14 AM
Details	Last Recertification Date	Insert				6/17/2011 5:11 PM
Details	Grant Number	Insert				6/17/2011 5:11 PM
Details	340B ID	Insert			CAH181309-02	6/17/2011 5:11 PM
Details	Is Authorizing Official EHB Data	Insert				6/17/2011 5:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/17/2011 5:11 PM
Details	Medicare Provider Number	Insert			181309	6/17/2011 5:11 PM
Details	Entity Name	Insert			CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL	6/17/2011 5:11 PM
Details	Program Code	Insert			CAH	6/17/2011 5:11 PM
Details	Entity Subname	Insert			CASEY COUNTY FAMILY PRACTICE	6/17/2011 5:11 PM
Dates	Participating Approval Date	Insert			6/17/2011 12:00:00 AM	6/17/2011 5:11 PM
Details	State	Insert			Active	6/17/2011 5:11 PM
Dates	Registration Date	Insert			6/17/2011 12:00:00 AM	6/17/2011 5:11 PM
Dates	Signed By Date	Insert			6/14/2011 12:00:00 AM	6/17/2011 5:11 PM
Dates	Start Date	Insert			7/1/2011 12:00:00 AM	6/17/2011 5:11 PM
Terminations	Termination Comments	Insert				6/17/2011 5:11 PM
Terminations	Termination Date	Insert				6/17/2011 5:11 PM
Terminations	Termination Effective Date	Insert				6/17/2011 5:11 PM
Terminations	Termination Reason	Insert				6/17/2011 5:11 PM