Covered Entity Details

SCH330211-06 Claxton Hepburn Medical Center (Terminated) - information as of 6/12/2025 6:01:38 AM

Main Details

Name

Claxton Hepburn Medical Center

Subdivision Name

MADRID HEALTH CENTER

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH330211-06

Medicare Provider Number

330211

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/10/2013

Participating Start Date

1/1/2014

Participating Approval Date

11/8/2013

Last Recertification Date

8/17/2021

Termination Date
Termination Reason

4/1/2022
Change of covered entity type

Contacts

Authorizing Official

Claxton-Hepburn Medical Center
Richard Duvall, CEO
(315) 713-5237

Primary Contact

City of Ogdensburg
Sarah Purdy, city manager
(315) 393-6100

Addresses

Street Address

2263 SH 310
MADRID, NY 13660

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?
Yes

State	Medicaid Number	NPI Number
NY	02997831	1891753034

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
SCH330211-01	Child	SCH	Claxton Hepburn Medical Center	Hepburn Health Clinic	100 HORWOOD PLACE	OGDENSBURG	NY	Terminated
SCH330211-02	Child	SCH	Claxton Hepburn Medical Center	HAMMOND HEALTH CENTER	225 ST LAWRENCE AVENUE	HAMMOND	NY	Terminated
SCH330211-03	Child	SCH	Claxton Hepburn Medical Center	HEUVELTON HEALTH CENTER	103 RENSSELAER STREET	HEUVELTON	NY	Terminated
SCH330211-04	Child	SCH	Claxton Hepburn Medical Center	CANTON HEALTH CENTER	39 WEST MAIN STREET	CANTON	NY	Terminated
SCH330211-05	Child	SCH	Claxton Hepburn Medical Center	CHMC-RAVINDER AGARWAL RENAL CENTER	124 FORD AVENUE	OGDENSBURG	NY	Terminated
SCH330211-06	Child	SCH	Claxton Hepburn Medical Center	MADRID HEALTH CENTER	2263 SH 310	MADRID	NY	Terminated
SCH330211-07	Child	SCH	Claxton Hepburn Medical Center	Waddington Health Center	4 MONTGOMERY HEIGHTS	WADDINGTON	NY	Terminated
SCH330211-08	Child	SCH	Claxton Hepburn Medical Center	CLAXTON HEPBURN MEDICAL CENTER / oncology	5 LYONS PLACE	OGDENSBURG	NY	Terminated
SCH330211-09	Child	SCH	Claxton Hepburn Medical Center	Lisbon Health Center	Lisbon Health Center	Lisbon	NY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		4/1/2022 12:00:00 AM	1/31/2022 6:53 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	1/31/2022 6:53 AM
Terminations	Termination Date	Update	Hospital Type Change Request		4/1/2022 12:00:00 AM	1/31/2022 6:53 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		4/1/2022 12:00:00 AM	1/31/2022 6:53 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	1/31/2022 6:53 AM
Details	Last Recertification Date	Update	Recertification	9/8/2020 3:32:10 PM	8/17/2021 10:35:31 AM	8/17/2021 10:35 AM
Contacts	Authorizing Official	Update	Change Request	Schnackel, Donald H Chief Financial Officer Claxton-Hepburn Medical Center 3157135355	Duvall, Richard CEO Claxton-Hepburn Medical Center 3157135237	7/12/2021 10:44 AM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/8/2020 3:32 PM
Details	Last Recertification Date	Update	Recertification	8/28/2019 11:50:22 AM	9/8/2020 3:32:10 PM	9/8/2020 3:32 PM
Contacts	Authorizing Official	Update	Change Request	Tiernan, Kelley M. CFO Claxton-Hepburn Medical Center 3157135350	Schnackel, Donald H Chief Financial Officer Claxton-Hepburn Medical Center 3157135355	8/12/2020 10:53 AM
Details	Last Recertification Date	Update	Recertification	9/5/2018 1:51:46 PM	8/28/2019 11:50:22 AM	8/28/2019 11:50 AM
Contacts	Primary Contact	Update	Recertification	Beauchamp, Emma Secretary Claxton-Hepburn Medical Center 3157135350	Purdy, Sarah city manager City of Ogdensburg 3153936100	9/5/2018 1:51 PM
Details	Last Recertification Date	Update	Recertification	12/4/2017 9:10:11 AM	9/5/2018 1:51:46 PM	9/5/2018 1:51 PM
Details	Last Recertification Date	Update	Recertification	8/25/2016 12:00:00 AM	12/4/2017 9:10:11 AM	12/4/2017 9:10 AM
Contacts	Primary Contact	Update		Beauchamp, Emma Secretary 3157135350	Beauchamp, Emma Secretary Claxton-Hepburn Medical Center 3157135350	10/10/2017 9:22 AM
Contacts	Authorizing Official	Update		Tiernan, Kelley M. CFO 3157135350	Tiernan, Kelley M. CFO Claxton-Hepburn Medical Center 3157135350	9/19/2017 12:58 PM
Contacts	Signed By	Update		Tiernan, Kelley M. CFO 3157135350	Tiernan, Kelley M. CFO Claxton-Hepburn Medical Center 3157135350	9/19/2017 12:58 PM
Addresses	Main Address	Insert			2263 SH 310 MADRID, NY 13660	7/25/2017 7:35 AM
Contacts	Authorizing Official	Insert			Tiernan, Kelley M. CFO 3157135350	7/25/2017 7:35 AM
Contacts	Signed By	Insert			Tiernan, Kelley M. CFO 3157135350	7/25/2017 7:35 AM
Contacts	Primary Contact	Insert			Beauchamp, Emma Secretary 3157135350	7/25/2017 7:35 AM
Details	Last Recertification Date	Update		9/3/2015 12:00:00 AM	8/25/2016 12:00:00 AM	8/25/2016 11:05 AM
Medicaid Billing	Medicaid: Number	Update		00354072	02997831	6/10/2016 8:38 AM
Medicaid Billing	NPI: Number	Insert			1891753034	6/10/2016 8:38 AM
Details	Last Recertification Date	Update		8/20/2014 12:00:00 AM	9/3/2015 12:00:00 AM	9/3/2015 1:27 PM
Details	Last Recertification Date	Update			8/20/2014 12:00:00 AM	8/20/2014 2:41 PM
Details	340B ID	Update		deleteSCH330211-06	SCH330211-06	11/8/2013 7:24 AM
Dates	Participating Approval Date	Update			11/8/2013 12:00:00 AM	11/8/2013 7:24 AM
Details	State	Update		Rejected	Active	11/8/2013 7:24 AM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	11/8/2013 7:24 AM
Details	340B ID	Update		SCH330211-06	deleteSCH330211-06	11/5/2013 4:10 PM
Details	State	Update		Pending	Rejected	11/5/2013 4:10 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	SCH330211-06	10/31/2013 1:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/10/2013 4:24 PM
Medicaid Billing	Medicaid: Number	Insert			00354072	10/10/2013 4:24 PM
Medicaid Billing	Medicaid: State	Insert			NY	10/10/2013 4:24 PM
Details	Last Recertification Date	Insert				10/10/2013 4:24 PM
Details	Grant Number	Insert				10/10/2013 4:24 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/10/2013 4:24 PM
Details	Is Authorizing Official EHB Data	Insert				10/10/2013 4:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/10/2013 4:24 PM
Details	Medicare Provider Number	Insert			330211	10/10/2013 4:24 PM
Details	Entity Name	Insert			Claxton Hepburn Medical Center	10/10/2013 4:24 PM
Details	Program Code	Insert			SCH	10/10/2013 4:24 PM
Details	Entity Subname	Insert			MADRID HEALTH CENTER	10/10/2013 4:24 PM
Dates	Participating Approval Date	Insert				10/10/2013 4:24 PM
Details	State	Insert			Pending	10/10/2013 4:24 PM
Dates	Registration Date	Insert			10/10/2013 12:00:00 AM	10/10/2013 4:24 PM
Dates	Signed By Date	Insert			10/10/2013 12:00:00 AM	10/10/2013 4:24 PM
Dates	Start Date	Insert				10/10/2013 4:24 PM
Terminations	Termination Comments	Insert				10/10/2013 4:24 PM
Terminations	Termination Date	Insert				10/10/2013 4:24 PM
Terminations	Termination Effective Date	Insert				10/10/2013 4:24 PM
Terminations	Termination Reason	Insert				10/10/2013 4:24 PM