Covered Entity Details

CAH161311-00 Hawarden Regional Healthcare (Active) - information as of 5/8/2025 10:23:18 PM

Main Details

Name

Hawarden Regional Healthcare

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH161311-00

Medicare Provider Number

161311

Additional Details

Current Program Status

Active

Registration Date

9/1/2011

Participating Start Date

10/1/2011

Participating Approval Date

9/22/2011

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Hawarden Regional Healthcare
Jayson Pullman, CEO
(712) 551-3103

Primary Contact

Hawarden Regional Healthcare
Naomi Graves, Pharmacist
(712) 551-3173

Addresses

Street Address

1111 11th Street
Hawarden, IA 51023

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
Contract Detail	BOOTH PHARMACY INC	903 CENTRAL AVE	PO BOX 233	HAWARDEN	IA	51023-2233	07/15/2014	10/01/2014			07/15/2014

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH161311-01	Child	CAH	Hawarden Regional Healthcare	Hawarden Regional Healthcare Clinics - Rural Health Clinic	1122 12th street	Hawarden	IA	Active
CAH161311-02	Child	CAH	Hawarden Regional Healthcare	Hawarden Regional Healthcare Akron Clinic - Rural Health Clinic	321 Mill Street	Akron	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/22/2023 3:58:18 PM	8/15/2024 6:49:43 AM	8/15/2024 6:49 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 3:15:16 PM	8/22/2023 3:58:18 PM	8/22/2023 3:58 PM
Details	Last Recertification Date	Update	Recertification	8/17/2021 10:38:50 AM	8/29/2022 3:15:16 PM	8/29/2022 3:15 PM
Details	Last Recertification Date	Update	Recertification	9/3/2020 7:48:56 AM	8/17/2021 10:38:50 AM	8/17/2021 10:38 AM
Details	Entity Name	Update	Change Request	Hawarden Community Hospital	Hawarden Regional Healthcare	4/5/2021 12:18 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 7:50:34 AM	9/3/2020 7:48:56 AM	9/3/2020 7:48 AM
Contacts	Primary Contact	Update	Recertification	Hughes, Jessica Director of Finance Hawarden Regional Healthcare 7125513105	Graves, Naomi Pharmacist Hawarden Regional Healthcare 7125513173	8/20/2019 7:50 AM
Details	Last Recertification Date	Update	Recertification	8/22/2018 3:31:13 PM	8/20/2019 7:50:34 AM	8/20/2019 7:50 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 7:58:08 AM	8/22/2018 3:31:13 PM	8/22/2018 3:31 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/29/2017 7:58:08 AM	11/29/2017 7:58 AM
Contacts	Authorizing Official	Update		Pullman, Jayson CEO 7125513103	Pullman, Jayson CEO Hawarden Regional Healthcare 7125513103	10/10/2017 4:36 PM
Contacts	Primary Contact	Update		Hughes, Jessica Director of Finance 7125513105	Hughes, Jessica Director of Finance Hawarden Regional Healthcare 7125513105	10/10/2017 3:49 PM
Addresses	Main Address	Insert			1111 11th Street Hawarden, IA 51023	8/10/2016 2:48 PM
Contacts	Primary Contact	Insert			Hughes, Jessica Director of Finance 7125513105	8/10/2016 2:48 PM
Contacts	Signed By	Insert			Monsma, Brian K. Interim CEO 7122792925	8/10/2016 2:48 PM
Contacts	Authorizing Official	Insert			Pullman, Jayson CEO 7125513103	8/10/2016 2:48 PM
Details	Last Recertification Date	Update		8/6/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 2:48 PM
Details	Last Recertification Date	Update		8/13/2014 12:00:00 AM	8/6/2015 12:00:00 AM	8/6/2015 10:00 AM
Details	Last Recertification Date	Update		8/20/2013 5:13:34 PM	8/13/2014 12:00:00 AM	8/13/2014 2:45 PM
Details	Last Recertification Date	Update			8/20/2013 5:13:34 PM	8/20/2013 5:13 PM
Dates	Participating Approval Date	Update			9/22/2011 12:00:00 AM	9/22/2011 5:19 PM
Details	State	Update		Pending	Active	9/22/2011 5:19 PM
Details	340B ID	Update		ONLINE_REG	CAH161311-00	9/8/2011 1:16 PM
Dates	Start Date	Update			10/1/2011 12:00:00 AM	9/8/2011 1:16 PM
Details	Last Recertification Date	Insert				9/1/2011 10:37 AM
Details	Grant Number	Insert				9/1/2011 10:37 AM
Details	340B ID	Insert			ONLINE_REG	9/1/2011 10:37 AM
Details	Is Authorizing Official EHB Data	Insert				9/1/2011 10:37 AM
Dates	Last Date That 340B Drugs Purchased	Insert				9/1/2011 10:37 AM
Details	Medicare Provider Number	Insert			161311	9/1/2011 10:37 AM
Details	Entity Name	Insert			Hawarden Community Hospital	9/1/2011 10:37 AM
Details	Program Code	Insert			CAH	9/1/2011 10:37 AM
Details	Entity Subname	Insert				9/1/2011 10:37 AM
Dates	Participating Approval Date	Insert				9/1/2011 10:37 AM
Details	State	Insert			Pending	9/1/2011 10:37 AM
Dates	Registration Date	Insert			9/1/2011 12:00:00 AM	9/1/2011 10:37 AM
Dates	Signed By Date	Insert			9/1/2011 12:00:00 AM	9/1/2011 10:37 AM
Dates	Start Date	Insert				9/1/2011 10:37 AM
Terminations	Termination Comments	Insert				9/1/2011 10:37 AM
Terminations	Termination Date	Insert				9/1/2011 10:37 AM
Terminations	Termination Effective Date	Insert				9/1/2011 10:37 AM
Terminations	Termination Reason	Insert				9/1/2011 10:37 AM