Covered Entity Details

CAH181324-02 THE MEDICAL CENTER AT SCOTTSVILLE (Active) - information as of 6/27/2025 6:05:08 AM

Main Details

Name

THE MEDICAL CENTER AT SCOTTSVILLE

Subdivision Name

Fountain Run Rural Health Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH181324-02

Medicare Provider Number

181324

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/8/2013

Participating Start Date

1/1/2014

Participating Approval Date

11/25/2013

Last Recertification Date

9/5/2024

Contacts

Authorizing Official

Med Center Health
Wade R. Stone, Executive Vice President
(270) 745-1504

Primary Contact

Commonwealth Health Corporation
Caleb Benningfield, Pharmacist
(270) 745-1640

Addresses

Street Address

47 Akersville Rd
Fountain Run, KY 42133

Billing Address

Commonwealth Health Corporation
PO Box 3560
Bowling Green, KY 42102

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
KY	7100154270	1013234863

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
CAH181324-01	Child	CAH	THE MEDICAL CENTER AT SCOTTSVILLE	Scottsville Rural Health Clinic	466 Burnley Rd	Scottsville	KY	Active
CAH181324-02	Child	CAH	THE MEDICAL CENTER AT SCOTTSVILLE	Fountain Run Rural Health Clinic	47 Akersville Rd	Fountain Run	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/6/2023 11:26:14 AM	9/5/2024 11:39:12 AM	9/5/2024 11:39 AM
Details	Last Recertification Date	Update	Recertification	9/12/2022 4:01:48 PM	9/6/2023 11:26:14 AM	9/6/2023 11:26 AM
Details	Last Recertification Date	Update	Recertification	9/9/2021 12:22:56 PM	9/12/2022 4:01:48 PM	9/12/2022 4:01 PM
Details	Last Recertification Date	Update	Recertification	9/8/2020 2:24:07 PM	9/9/2021 12:22:56 PM	9/9/2021 12:22 PM
Contacts	Authorizing Official	Update	AO Change Request	Joyce, Melinda C Vice-President, Corporate Support Services Med Center Health 2707451599	Stone, Wade R. Executive Vice President Med Center Health 2707451504	8/27/2021 4:42 PM
Medicaid Billing	NPI: State	Update	Recertification		KY	9/8/2020 2:24 PM
Details	Last Recertification Date	Update	Recertification	9/10/2019 3:10:33 PM	9/8/2020 2:24:07 PM	9/8/2020 2:24 PM
Contacts	Primary Contact	Update	Recertification	Polston, Aric Corporate Director of Pharmacy The Medical Center - Bowling Green 2707451640	Benningfield, Caleb Pharmacist Commonwealth Health Corporation 2707451640	9/10/2019 3:10 PM
Details	Last Recertification Date	Update	Recertification	9/6/2018 11:22:24 AM	9/10/2019 3:10:33 PM	9/10/2019 3:10 PM
Details	Last Recertification Date	Update	Recertification	11/20/2017 2:12:13 PM	9/6/2018 11:22:24 AM	9/6/2018 11:22 AM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/20/2017 2:12:13 PM	11/20/2017 2:12 PM
Contacts	Authorizing Official	Insert	AO Change Request		Joyce, Melinda C Vice-President, Corporate Support Services Med Center Health 2707451599	10/23/2017 9:00 AM
Contacts	Primary Contact	Update		Polston, Aric Corporate Director of Pharmacy 2707451640	Polston, Aric Corporate Director of Pharmacy The Medical Center - Bowling Green 2707451640	10/12/2017 4:45 PM
Contacts	Primary Contact	Update		McClelland, Robert Corporate Director of Pharmacy 2707451640	Polston, Aric Corporate Director of Pharmacy 2707451640	8/24/2016 7:12 AM
Contacts	Signed By	Insert			HAGAN, ERIC VICE PRESIDENT/ADMINISTRATOR 2706222800-2821	8/16/2016 4:59 PM
Details	Last Recertification Date	Update		8/6/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 4:59 PM
Addresses	Main Address	Insert			47 Akersville Rd Fountain Run, KY 42133	8/16/2016 4:59 PM
Addresses	Billing Address	Insert			Commonwealth Health Corporation PO Box 3560 Bowling Green, KY 42102	5/2/2016 9:05 PM
Contacts	Primary Contact	Insert			McClelland, Robert Corporate Director of Pharmacy 2707451640	9/16/2015 7:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/16/2015 7:56 AM
Medicaid Billing	Medicaid: Number	Insert			7100154270	9/16/2015 7:56 AM
Medicaid Billing	Medicaid: State	Insert			KY	9/16/2015 7:56 AM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/6/2015 12:00:00 AM	8/6/2015 8:56 AM
Details	Last Recertification Date	Update			8/7/2014 12:00:00 AM	8/7/2014 8:50 AM
Dates	Participating Approval Date	Update			11/25/2013 12:00:00 AM	11/25/2013 4:17 PM
Details	State	Update		Pending	Active	11/25/2013 4:17 PM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	11/25/2013 4:17 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	CAH181324-02	11/22/2013 1:22 PM
Medicaid Billing	NPI: Number	Insert			1013234863	10/8/2013 11:20 AM
Details	Last Recertification Date	Insert				10/8/2013 11:20 AM
Details	Grant Number	Insert				10/8/2013 11:20 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/8/2013 11:20 AM
Details	Is Authorizing Official EHB Data	Insert				10/8/2013 11:20 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/8/2013 11:20 AM
Details	Medicare Provider Number	Insert			181324	10/8/2013 11:20 AM
Details	Entity Name	Insert			THE MEDICAL CENTER AT SCOTTSVILLE	10/8/2013 11:20 AM
Details	Program Code	Insert			CAH	10/8/2013 11:20 AM
Details	Entity Subname	Insert			Fountain Run Rural Health Clinic	10/8/2013 11:20 AM
Dates	Participating Approval Date	Insert				10/8/2013 11:20 AM
Details	State	Insert			Pending	10/8/2013 11:20 AM
Dates	Registration Date	Insert			10/8/2013 12:00:00 AM	10/8/2013 11:20 AM
Dates	Signed By Date	Insert			10/8/2013 12:00:00 AM	10/8/2013 11:20 AM
Dates	Start Date	Insert				10/8/2013 11:20 AM
Terminations	Termination Comments	Insert				10/8/2013 11:20 AM
Terminations	Termination Date	Insert				10/8/2013 11:20 AM
Terminations	Termination Effective Date	Insert				10/8/2013 11:20 AM
Terminations	Termination Reason	Insert				10/8/2013 11:20 AM