No
| CAH261312-01 | Child | CAH | HARRISON COUNTY COMMUNITY HOSPITAL | HCCH MEDICAL CLINIC | 3202 MILLER ST | BETHANY | MO | Active |
| CAH261312-02 | Child | CAH | HARRISON COUNTY COMMUNITY HOSPITAL | HARRISON COUNTY FAMILY HEALTH CENTER | 2703 MILLER ST | BETHANY | MO | Terminated |
| CAH261312-03 | Child | CAH | HARRISON COUNTY COMMUNITY HOSPITAL | NORTH HARRISON MEDICAL CLINIC | 16027 LOCUST ST | EAGLEVILLE | MO | Active |
| Details | Last Recertification Date | Update | Recertification | 8/22/2023 2:36:53 PM | 8/27/2024 5:25:13 PM | 8/27/2024 5:25 PM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2022 9:07:03 AM | 8/22/2023 2:36:53 PM | 8/22/2023 2:36 PM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2021 8:12:32 AM | 9/2/2022 9:07:03 AM | 9/2/2022 9:07 AM |
| Details | Entity Subname | Update | Change Request | BETHANY MEDICAL CLINIC | HCCH MEDICAL CLINIC | 12/13/2021 8:36 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2020 8:19:54 AM | 9/1/2021 8:12:32 AM | 9/1/2021 8:12 AM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 598581601 (MO) | | 6/21/2021 8:13 AM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1154645745 (MO) | | 6/21/2021 8:13 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 8/26/2020 8:43 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 598581601 | 8/26/2020 8:43 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | MO | 8/26/2020 8:43 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1154645745 | 8/26/2020 8:43 AM |
| Medicaid Billing | NPI: State | Insert | Change Request | | MO | 8/26/2020 8:43 AM |
| Contacts | Primary Contact | Update | Recertification | Miles, Lee Ann
CFO
Harrison County Community Hospital
6604250307 | Brandt, Doug
CFO
Harrison County Community Hospital
6604250307 | 8/24/2020 8:19 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2019 8:36:17 AM | 8/24/2020 8:19:54 AM | 8/24/2020 8:19 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Gillespie, Christina
CEO
Harrison County Community Hospital
6604252211 | Gillespie, Christina
CEO
Harrison County Community Hospital
6604252211-2250 | 8/21/2019 8:37 AM |
| Details | Last Recertification Date | Update | Recertification | 8/20/2018 9:07:22 AM | 8/21/2019 8:36:17 AM | 8/21/2019 8:36 AM |
| Details | Last Recertification Date | Update | Recertification | 11/4/2017 2:01:24 PM | 8/20/2018 9:07:22 AM | 8/20/2018 9:07 AM |
| Details | Last Recertification Date | Update | Recertification | 10/24/2017 4:11:30 PM | 11/4/2017 2:01:24 PM | 11/4/2017 2:01 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2016 12:00:00 AM | 10/24/2017 4:11:30 PM | 10/24/2017 4:11 PM |
| Contacts | Authorizing Official | Update | | Gillespie, Christina
CEO
6604252211 | Gillespie, Christina
CEO
Harrison County Community Hospital
6604252211 | 10/23/2017 9:04 AM |
| Contacts | Primary Contact | Update | | Miles, Lee Ann
CFO
6604250307 | Miles, Lee Ann
CFO
Harrison County Community Hospital
6604250307 | 9/28/2017 2:32 PM |
| Contacts | Primary Contact | Insert | | | Miles, Lee Ann
CFO
6604250307 | 8/7/2017 3:06 PM |
| Contacts | Authorizing Official | Insert | | | Gillespie, Christina
CEO
6604252211 | 8/7/2017 3:06 PM |
| Addresses | Main Address | Insert | | |
3202 MILLER ST
BETHANY, MO 64424 | 8/7/2017 3:05 PM |
| Addresses | Billing Address | Insert | | | HARRISON COUNTY COMMUNITY HOSPITAL
2600 MILLER STREET
BETHANY, MO 64424-2701 | 8/7/2017 3:05 PM |
| Contacts | Signed By | Insert | | | HAMILTON, RICHARD C.
ADMINISTRATOR
6604250250 | 8/7/2017 3:05 PM |
| Details | Last Recertification Date | Update | | 8/31/2015 12:00:00 AM | 8/23/2016 12:00:00 AM | 8/23/2016 5:49 PM |
| Details | Last Recertification Date | Update | | 8/12/2014 12:00:00 AM | 8/31/2015 12:00:00 AM | 8/31/2015 3:14 PM |
| Details | Last Recertification Date | Update | | 8/19/2013 12:00:00 AM | 8/12/2014 12:00:00 AM | 8/12/2014 11:21 AM |
| Details | Last Recertification Date | Update | | | 8/19/2013 12:00:00 AM | 8/19/2013 11:09 AM |
| Details | 340B ID | Update | | ISDMCAH261312-01 | CAH261312-01 | 10/3/2012 3:45 PM |
| Dates | Participating Approval Date | Update | | | 10/3/2012 12:00:00 AM | 10/3/2012 3:45 PM |
| Details | State | Update | | Pending | Active | 10/3/2012 3:45 PM |
| Dates | Start Date | Update | | | 1/1/2013 12:00:00 AM | 10/3/2012 3:45 PM |
| Details | 340B ID | Update | | DM092612D | ISDMCAH261312-01 | 10/3/2012 2:48 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | DM092612D | 9/26/2012 10:09 PM |
| Details | Last Recertification Date | Insert | | | | 9/13/2012 12:38 PM |
| Details | Grant Number | Insert | | | | 9/13/2012 12:38 PM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 9/13/2012 12:38 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 9/13/2012 12:38 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 9/13/2012 12:38 PM |
| Details | Medicare Provider Number | Insert | | | 261312 | 9/13/2012 12:38 PM |
| Details | Entity Name | Insert | | | HARRISON COUNTY COMMUNITY HOSPITAL | 9/13/2012 12:38 PM |
| Details | Program Code | Insert | | | CAH | 9/13/2012 12:38 PM |
| Details | Entity Subname | Insert | | | BETHANY MEDICAL CLINIC | 9/13/2012 12:38 PM |
| Dates | Participating Approval Date | Insert | | | | 9/13/2012 12:38 PM |
| Details | State | Insert | | | Pending | 9/13/2012 12:38 PM |
| Dates | Registration Date | Insert | | | 9/13/2012 12:00:00 AM | 9/13/2012 12:38 PM |
| Dates | Signed By Date | Insert | | | 9/13/2012 12:00:00 AM | 9/13/2012 12:38 PM |
| Dates | Start Date | Insert | | | | 9/13/2012 12:38 PM |
| Terminations | Termination Comments | Insert | | | | 9/13/2012 12:38 PM |
| Terminations | Termination Date | Insert | | | | 9/13/2012 12:38 PM |
| Terminations | Termination Effective Date | Insert | | | | 9/13/2012 12:38 PM |
| Terminations | Termination Reason | Insert | | | | 9/13/2012 12:38 PM |