Covered Entity Details

CAH261321-01 Saint Luke's Hospital of Chillicothe DBA Hedrick Medical Center (Active) - information as of 5/6/2025 12:00:00 AM

Main Details

Name

Saint Luke's Hospital of Chillicothe DBA Hedrick Medical Center

Subdivision Name

Hedrick Family Care

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH261321-01

Medicare Provider Number

261321

Outpatient Facility Provider Number

268539

Additional Details

Current Program Status

Active

Registration Date

4/12/2013

Participating Start Date

7/1/2013

Participating Approval Date

4/26/2013

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Saint Luke's Hospital of Chillicothe
Catherine Denise Hamilton, Administrator
(660) 214-8105

Primary Contact

Saint Luke's Hospital of Chillicothe
Cassie Jo Mitchell, Manger Pharmacy Operations
(660) 214-8265

Addresses

Street Address

2791 N Washington St
Chillicothe, MO 64601

Billing Address

Saint Luke's Health System Central Accounts Payable (CAP)
PO Box 5870
Kansas City, MO 64171-0870

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?
Yes

State	Medicaid Number	NPI Number
MO	010570208,595818402	1912948308,1437191095

Shipping Addresses

Shipping Address 1

Hedrick Family Care
2791 N Washington St
Chillicothe, MO 64601

Shipping Address 2

Hedrick Medical Center Pharmacy Department
2799 N Washington St
Chillicothe, MO 64601

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
CAH261321-01	Child	CAH	Saint Luke's Hospital of Chillicothe DBA Hedrick Medical Center	Hedrick Family Care	2791 N Washington St	Chillicothe	MO	Active
CAH261321-02	Child	CAH	Saint Luke's Hospital of Chillicothe DBA Hedrick Medical Center	Hedrick Associates / OBGYN	2791 N WASHINGTON ST	CHILLICOTHE	MO	Active
CAH261321-03	Child	CAH	Saint Luke's Hospital of Chillicothe DBA Hedrick Medical Center	Hedrick Associates / Surgical	2791 N WASHINGTON ST	CHILLICOTHE	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	Stringer, Stacey 340B Program Coordinator St Lukes Hospital of Kansas City 8169325335	Mitchell, Cassie Jo Manger Pharmacy Operations Saint Luke's Hospital of Chillicothe 6602148265	2/20/2025 7:55 AM
Details	Last Recertification Date	Update	Recertification	8/30/2023 3:29:22 PM	8/21/2024 2:01:20 PM	8/21/2024 2:01 PM
Contacts	Primary Contact	Update	Group Change Request	Olvera, Cassandra Jo Pharmacy Director- HMC and WMH Saint Luke's Health System 6602148265	Stringer, Stacey 340B Program Coordinator St Lukes Hospital of Kansas City 8169325335	7/22/2024 1:08 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 5:20:24 PM	8/30/2023 3:29:22 PM	8/30/2023 3:29 PM
Contacts	Authorizing Official	Update	AO Change Request	Schieber, Steve CEO Critical Access Region Saint Luke's Health System 6602148104	Hamilton, Catherine Denise Administrator Saint Luke's Hospital of Chillicothe 6602148105	8/29/2023 3:20 PM
Contacts	Authorizing Official	Update	Change Request	Schieber, Steve M CEO Critical Access Region Saint Luke's Health System 6602148104	Schieber, Steve CEO Critical Access Region Saint Luke's Health System 6602148104	10/21/2022 7:40 AM
Details	Last Recertification Date	Update	Recertification	8/18/2021 11:20:21 AM	9/7/2022 5:20:24 PM	9/7/2022 5:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/13/2021 5:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010570208	12/13/2021 5:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	12/13/2021 5:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/13/2021 5:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		595818402	12/13/2021 5:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	12/13/2021 5:09 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1912948308	12/13/2021 5:09 PM
Medicaid Billing	NPI: State	Insert	Change Request		MO	12/13/2021 5:09 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1437191095	12/13/2021 5:09 PM
Medicaid Billing	NPI: State	Insert	Change Request		MO	12/13/2021 5:09 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 4:08:42 PM	8/18/2021 11:20:21 AM	8/18/2021 11:20 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	595818402 (MO)		6/11/2021 3:59 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	010570208 (MO)		6/11/2021 3:59 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1912948308 (MO)		6/11/2021 3:59 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1437191095 (MO)		6/11/2021 3:59 PM
Contacts	Primary Contact	Update	Change Request	Peters, Cassandra Pharmacy Operations Manager Saint Luke's Health System 6603585779-48265	Olvera, Cassandra Jo Pharmacy Director- HMC and WMH Saint Luke's Health System 6602148265	5/24/2021 10:08 AM
Contacts	Authorizing Official	Update	Change Request	BUCKMAN, JANET CHIEF FINANCIAL OFFICER Hedrick Medical Center 6602148106	Schieber, Steve M CEO Critical Access Region Saint Luke's Health System 6602148104	5/21/2021 6:33 AM
Medicaid Billing	NPI: State	Update	Recertification		MO	9/4/2020 4:08 PM
Medicaid Billing	NPI: State	Update	Recertification		MO	9/4/2020 4:08 PM
Details	Last Recertification Date	Update	Recertification	8/26/2019 11:01:42 AM	9/4/2020 4:08:42 PM	9/4/2020 4:08 PM
Addresses	Billing Address	Insert	Change Request		Saint Luke's Health System Central Accounts Payable (CAP) PO Box 5870 Kansas City, MO 64171-0870	6/1/2020 6:54 AM
Addresses	Shipping Address	Insert	Change Request		Hedrick Family Care 2791 N Washington St Chillicothe, MO 64601	6/1/2020 6:54 AM
Addresses	Shipping Address	Insert	Change Request		Hedrick Medical Center Pharmacy Department 2799 N Washington St Chillicothe, MO 64601	6/1/2020 6:54 AM
Addresses	Main Address	Update	Change Request	2791 N Washington Chillicothe, MO 64601	2791 N Washington St Chillicothe, MO 64601	6/1/2020 6:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/1/2020 6:54 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010570208	6/1/2020 6:54 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	6/1/2020 6:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1912948308	6/1/2020 6:54 AM
Details	Last Recertification Date	Update	Recertification	8/23/2018 8:01:11 AM	8/26/2019 11:01:42 AM	8/26/2019 11:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/13/2019 9:21 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		595818402	3/13/2019 9:21 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	3/13/2019 9:21 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	010570208 (MO)		3/13/2019 9:21 PM
Details	Last Recertification Date	Update	Recertification	12/6/2017 10:06:26 AM	8/23/2018 8:01:11 AM	8/23/2018 8:01 AM
Details	Entity Name	Update	Recertification	HEDRICK MEDICAL CENTER	Saint Luke's Hospital of Chillicothe DBA Hedrick Medical Center	12/6/2017 10:34 AM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	12/6/2017 10:06:26 AM	12/6/2017 10:06 AM
Contacts	Authorizing Official	Update		BUCKMAN, JANET CHIEF FINANCIAL OFFICER 6602148106	BUCKMAN, JANET CHIEF FINANCIAL OFFICER Hedrick Medical Center 6602148106	10/16/2017 10:25 AM
Contacts	Signed By	Update		BUCKMAN, JANET CHIEF FINANCIAL OFFICER 6602148106	BUCKMAN, JANET CHIEF FINANCIAL OFFICER Hedrick Medical Center 6602148106	10/16/2017 10:25 AM
Contacts	Primary Contact	Update		Peters, Cassandra Pharmacy Operations Manager 6603585779	Peters, Cassandra Pharmacy Operations Manager Saint Luke's Health System 6603585779-48265	9/25/2017 6:23 PM
Contacts	Primary Contact	Insert			Peters, Cassandra Pharmacy Operations Manager 6603585779	8/25/2016 11:04 AM
Addresses	Main Address	Insert			2791 N Washington Chillicothe, MO 64601	8/23/2016 10:35 AM
Contacts	Authorizing Official	Insert			BUCKMAN, JANET CHIEF FINANCIAL OFFICER 6602148106	8/23/2016 10:35 AM
Contacts	Signed By	Insert			BUCKMAN, JANET CHIEF FINANCIAL OFFICER 6602148106	8/23/2016 10:35 AM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/23/2016 12:00:00 AM	8/23/2016 10:35 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/6/2016 4:11 PM
Medicaid Billing	Medicaid: Number	Insert			010570208	1/6/2016 4:11 PM
Medicaid Billing	Medicaid: State	Insert			MO	1/6/2016 4:11 PM
Medicaid Billing	NPI: Number	Insert			1437191095	1/6/2016 4:11 PM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 7:49 AM
Details	Last Recertification Date	Update		8/21/2013 12:00:00 AM	8/6/2014 12:00:00 AM	8/6/2014 2:18 PM
Details	Last Recertification Date	Update		8/21/2013 11:18:16 AM	8/21/2013 12:00:00 AM	2/20/2014 11:04 AM
Details	Last Recertification Date	Update			8/21/2013 11:18:16 AM	8/21/2013 11:18 AM
Details	340B ID	Update		ISDR-CAH261321-01	CAH261321-01	4/26/2013 5:04 PM
Dates	Participating Approval Date	Update			4/26/2013 12:00:00 AM	4/26/2013 5:04 PM
Details	State	Update		Pending	Active	4/26/2013 5:04 PM
Dates	Start Date	Update			7/1/2013 12:00:00 AM	4/26/2013 5:04 PM
Details	340B ID	Update		DR041413B	ISDR-CAH261321-01	4/25/2013 1:28 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DR041413B	4/14/2013 6:38 PM
Details	Last Recertification Date	Insert				4/12/2013 4:47 PM
Details	Grant Number	Insert				4/12/2013 4:47 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	4/12/2013 4:47 PM
Details	Is Authorizing Official EHB Data	Insert				4/12/2013 4:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/12/2013 4:47 PM
Details	Medicare Provider Number	Insert			261321	4/12/2013 4:47 PM
Details	Entity Name	Insert			HEDRICK MEDICAL CENTER	4/12/2013 4:47 PM
Details	Program Code	Insert			CAH	4/12/2013 4:47 PM
Details	Entity Subname	Insert			Hedrick Family Care	4/12/2013 4:47 PM
Dates	Participating Approval Date	Insert				4/12/2013 4:47 PM
Details	State	Insert			Pending	4/12/2013 4:47 PM
Dates	Registration Date	Insert			4/12/2013 12:00:00 AM	4/12/2013 4:47 PM
Dates	Signed By Date	Insert			4/12/2013 12:00:00 AM	4/12/2013 4:47 PM
Dates	Start Date	Insert				4/12/2013 4:47 PM
Terminations	Termination Comments	Insert				4/12/2013 4:47 PM
Terminations	Termination Date	Insert				4/12/2013 4:47 PM
Terminations	Termination Effective Date	Insert				4/12/2013 4:47 PM
Terminations	Termination Reason	Insert				4/12/2013 4:47 PM