Covered Entity Details

CAH521352-02 Upland Hills Health Inc. (Active) - information as of 5/17/2025 10:48:18 PM

Main Details

Name

Upland Hills Health Inc.

Subdivision Name

Upland Hills Health Highland Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH521352-02

Medicare Provider Number

521352

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

9/21/2011

Participating Start Date

10/1/2011

Participating Approval Date

9/23/2011

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Upland Hills Health, Inc.
Arthur K. Pustina, CFO
(608) 930-8000 Ext: 4102

Primary Contact

Upland Hills Health
Jeff Robertson, Director of Pharmacy
(608) 930-8000 Ext: 3250

Addresses

Street Address

551 N. Main
Highland, WI 53543

Billing Address

Upland Hills Health Inc
800 Compassion Way
Dodgeville, WI 53533

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
CAH521352-01	Child	CAH	Upland Hills Health Inc.	Upland Hills Health Montfort Clinic	202 W Hwy 18	Monfort	WI	Active
CAH521352-02	Child	CAH	Upland Hills Health Inc.	Upland Hills Health Highland Clinic	551 N. Main	Highland	WI	Active
CAH521352-03	Child	CAH	Upland Hills Health Inc.	Upland Hills Health Dialysis Center	800 Compassion Way	Dodgeville	WI	Terminated
CAH521352-04	Child	CAH	Upland Hills Health Inc.	Upland Hills Health Center	800 Compassion Way	Dodgeville	WI	Active
CAH521352-05	Child	CAH	Upland Hills Health Inc.	UPLAND HILLS HEALTH INC - Upland Hills Health Spring Green Clinic	156W JEFFERSON ST	SPRING GREEN	WI	Active
CAH521352-06	Child	CAH	Upland Hills Health Inc.	UPLAND HILLS HEALTH INC - Rural Health Clinic Barneveld	103 QUAIL RIDGE DR	BARNEVELD	WI	Active
CAH521352-07	Child	CAH	Upland Hills Health Inc.	UPLAND HILLS HEALTH INC - Rural Health Clinic Dodgeville	1204 JOSEPH ST	DODGEVILLE	WI	Active
CAH521352-08	Child	CAH	Upland Hills Health Inc.	UPLAND HILLS HEALTH INC - Rural Health Clinic Mineral Point	1050 Branger Drive	MINERAL POINT	WI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/16/2023 12:29:40 PM	8/12/2024 5:21:09 PM	8/12/2024 5:21 PM
Details	Last Recertification Date	Update	Recertification	8/24/2022 8:26:09 PM	8/16/2023 12:29:40 PM	8/16/2023 12:29 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 2:50:29 PM	8/24/2022 8:26:09 PM	8/24/2022 8:26 PM
Contacts	Primary Contact	Update	Profile Change Request	Robertson, Jeff Pharmacy Supervisor Upland Hills Health 6089308000-3220	Robertson, Jeff Director of Pharmacy Upland Hills Health 6089308000-3250	11/1/2021 5:39 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 8:41:46 AM	8/16/2021 2:50:29 PM	8/16/2021 2:50 PM
Contacts	Primary Contact	Update	Change Request	Peterson, Michael R Director of Pharmacy Upland Hills Health 6089308000-3250	Robertson, Jeff Pharmacy Supervisor Upland Hills Health 6089308000-3220	7/30/2021 7:49 AM
Details	Last Recertification Date	Update	Recertification	8/20/2019 7:14:28 PM	8/18/2020 8:41:46 AM	8/18/2020 8:41 AM
Details	Last Recertification Date	Update	Recertification	8/17/2018 9:00:28 AM	8/20/2019 7:14:28 PM	8/20/2019 7:14 PM
Details	Last Recertification Date	Update	Recertification	11/8/2017 9:38:40 AM	8/17/2018 9:00:28 AM	8/17/2018 9:00 AM
Contacts	Primary Contact	Update	Contract Pharmacy Registration	Peterson, Michael Director of Pharmacy Upland Hills Health 6089308000-3250	Peterson, Michael R Director of Pharmacy Upland Hills Health 6089308000-3250	1/2/2018 3:46 PM
Details	Last Recertification Date	Update	Recertification	8/12/2016 12:00:00 AM	11/8/2017 9:38:40 AM	11/8/2017 9:38 AM
Details	Entity Subname	Update	Change Request	Blackhawk Area Health Care clinic (Highland)	Upland Hills Health Highland Clinic	10/18/2017 12:40 PM
Contacts	Authorizing Official	Update		Pustina, Arthur K. CFO 6089308000-4102	Pustina, Arthur K. CFO Upland Hills Health, Inc. 6089308000-4102	10/11/2017 8:56 AM
Contacts	Signed By	Update		Pustina, Arthur K. CFO 6089308000-4102	Pustina, Arthur K. CFO Upland Hills Health, Inc. 6089308000-4102	10/11/2017 8:56 AM
Contacts	Primary Contact	Update		Peterson, Michael Director of Pharmacy 6089308000-3250	Peterson, Michael Director of Pharmacy Upland Hills Health 6089308000-3250	10/10/2017 9:17 AM
Addresses	Main Address	Insert			551 N. Main Highland, WI 53543	8/12/2016 10:31 AM
Contacts	Primary Contact	Insert			Peterson, Michael Director of Pharmacy 6089308000-3250	8/12/2016 10:31 AM
Contacts	Authorizing Official	Insert			Pustina, Arthur K. CFO 6089308000-4102	8/12/2016 10:31 AM
Contacts	Signed By	Insert			Pustina, Arthur K. CFO 6089308000-4102	8/12/2016 10:31 AM
Details	Last Recertification Date	Update		8/12/2015 12:00:00 AM	8/12/2016 12:00:00 AM	8/12/2016 10:30 AM
Details	Last Recertification Date	Update		8/13/2014 12:00:00 AM	8/12/2015 12:00:00 AM	8/12/2015 12:41 PM
Details	Last Recertification Date	Update		9/4/2013 10:00:38 AM	8/13/2014 12:00:00 AM	8/13/2014 9:51 AM
Details	Last Recertification Date	Update			9/4/2013 10:00:38 AM	9/4/2013 10:00 AM
Addresses	Billing Address	Insert			Upland Hills Health Inc 800 Compassion Way Dodgeville, WI 53533	12/19/2011 5:13 PM
Dates	Participating Approval Date	Update			9/23/2011 12:00:00 AM	9/23/2011 7:46 PM
Details	State	Update		Pending	Active	9/23/2011 7:46 PM
Dates	Start Date	Update			10/1/2011 12:00:00 AM	9/23/2011 7:46 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	CAH521352-02	9/23/2011 6:45 PM
Details	Last Recertification Date	Insert				9/21/2011 4:34 PM
Details	Grant Number	Insert				9/21/2011 4:34 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	9/21/2011 4:34 PM
Details	Is Authorizing Official EHB Data	Insert				9/21/2011 4:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert				9/21/2011 4:34 PM
Details	Medicare Provider Number	Insert			521352	9/21/2011 4:34 PM
Details	Entity Name	Insert			Upland Hills Health Inc.	9/21/2011 4:34 PM
Details	Program Code	Insert			CAH	9/21/2011 4:34 PM
Details	Entity Subname	Insert			Blackhawk Area Health Care clinic (Highland)	9/21/2011 4:34 PM
Dates	Participating Approval Date	Insert				9/21/2011 4:34 PM
Details	State	Insert			Pending	9/21/2011 4:34 PM
Dates	Registration Date	Insert			9/21/2011 12:00:00 AM	9/21/2011 4:34 PM
Dates	Signed By Date	Insert			9/21/2011 12:00:00 AM	9/21/2011 4:34 PM
Dates	Start Date	Insert				9/21/2011 4:34 PM
Terminations	Termination Comments	Insert				9/21/2011 4:34 PM
Terminations	Termination Date	Insert				9/21/2011 4:34 PM
Terminations	Termination Effective Date	Insert				9/21/2011 4:34 PM
Terminations	Termination Reason	Insert				9/21/2011 4:34 PM