Covered Entity Details

DSH180005E HIGHLANDS REGIONAL MEDICAL CENTER (Terminated) - information as of 5/13/2025 10:58:27 PM

Main Details

Name

HIGHLANDS REGIONAL MEDICAL CENTER

Subdivision Name

SALYERSVILLE AFTER HOURS

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH180005E

Medicare Provider Number

180005

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/14/2013

Participating Start Date

1/1/2014

Participating Approval Date

12/9/2013

Last Recertification Date

9/10/2018

Termination Date
Termination Reason

10/1/2019
Business decision by the Covered Entity

Contacts

Authorizing Official

Appalachian Regional Healthcare
Joseph Grossman, PRESIDENT and CEO
(859) 226-2450

Primary Contact

Appalachian Regional Healthcare
Jeffrey Akers, CEO of Pharmaceutical Services
(606) 616-2296

Addresses

Street Address

100 Brianna Blvd.
Suite 100
Salyersville, KY 41465

Billing Address

Highlands Regional Medical Center
5000 KY Rt. 321
Prestonsburg, KY 41653

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	7100390940,7100264770,700255340
		1447683958,1396304044

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
DSH180005A	Child	DSH	HIGHLANDS ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Harold	24 Left Penhook Rd	Harold	KY	Terminated
DSH180005B	Child	DSH	HIGHLANDS REGIONAL MEDICAL CENTER	Highlands Orthopaedic	5000 Ky Route 321	Prestonsburg	KY	Terminated
DSH180005C	Child	DSH	HIGHLANDS ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Highlands Urology	5000 Ky Route 321	Prestonsburg	KY	Active
DSH180005D	Child	DSH	HIGHLANDS ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Salyersville	100 Brianna Blvd.	Salyersville	KY	Terminated
DSH180005E	Child	DSH	HIGHLANDS REGIONAL MEDICAL CENTER	SALYERSVILLE AFTER HOURS	100 Brianna Blvd.	Salyersville	KY	Terminated
DSH180005F	Child	DSH	HIGHLANDS REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Paintsville	713 Broadway	Paintsville	KY	Terminated
DSH180005G	Child	DSH	HIGHLANDS ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Highlands - ORTHOPEDICS	5000 KY Rt. 321	PRESTONSBURG	KY	Active
DSH180005J	Child	DSH	HIGHLANDS ARH REGIONAL MEDICAL CENTER	ARH Medical and Surgical Associates - Highlands Oncology	5000 KY Route 321	Prestonsburg	KY	Active
DSH180005K	Child	DSH	HIGHLANDS ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Highlands - Internal Medicine	5000 KY Route 321	Prestonsburg	KY	Active
DSH180005L	Child	DSH	HIGHLANDS ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates Highlands - CARDIOLOGY	5000 KY Route 321	Prestonsburg	KY	Active
DSH180005M	Child	DSH	HIGHLANDS ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Highlands - Nephrology	5000 KY Route 321	Prestonsburg	KY	Active
DSH180005N	Child	DSH	HIGHLANDS ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Highlands - Surgery	5000 KY Route 321	Prestonsburg	KY	Active
DSH180005P	Child	DSH	HIGHLANDS ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Highlands - Pulmonology	5000 KY Route 321	Prestonsburg	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6066162296	Akers, Jeffrey CEO of Pharmaceutical Services Appalachian Regional Healthcare 6066162296	2/8/2022 7:53 PM
Contacts	Primary Contact	Update	Profile Change Request	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6064396988	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6066162296	1/8/2020 11:00 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/31/2019 12:00:00 AM	8/8/2019 6:22 AM
Details	State	Update	Termination Request	Active	To Be Terminated	8/8/2019 6:22 AM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	8/8/2019 6:22 AM
Terminations	Termination Effective Date	Update	Termination Request		7/31/2019 12:00:00 AM	8/8/2019 6:22 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	8/8/2019 6:22 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1396304044	8/5/2019 3:58 PM
Contacts	Primary Contact	Update	Change Request	Howard, Vylinda Director of Pharmacy Services Highlands Regional Medical Center 6068867617	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6064396988	8/5/2019 3:58 PM
Contacts	Authorizing Official	Update	AO Change Request	Warman Jr., Harold C. CEO Highlands Regional Medical Center 6068867602	Grossman, Joseph PRESIDENT and CEO Appalachian Regional Healthcare 8592262450	8/1/2019 1:41 PM
Contacts	Primary Contact	Update	Recertification	HOWARD, VYLINDA DIRECTOR OF PHARMACY HIGHLANDS REGIONAL MEDICAL CENTER 6068867617	Howard, Vylinda Director of Pharmacy Services Highlands Regional Medical Center 6068867617	9/10/2018 10:06 AM
Details	Last Recertification Date	Update	Recertification	11/9/2017 8:27:45 AM	9/10/2018 10:06:03 AM	9/10/2018 10:06 AM
Addresses	Billing Address	Update	Recertification	Highlands Regional Medical Center 500 KY Rt. 321 Prestonsburg, KY 41653	Highlands Regional Medical Center 5000 KY Rt. 321 Prestonsburg, KY 41653	11/9/2017 8:27 AM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/9/2017 8:27:45 AM	11/9/2017 8:27 AM
Contacts	Primary Contact	Update	Recertification	HOWARD, VYLINDA DIRECTOR OF PHARMACY 6068867617	HOWARD, VYLINDA DIRECTOR OF PHARMACY HIGHLANDS REGIONAL MEDICAL CENTER 6068867617	11/9/2017 8:26 AM
Contacts	Authorizing Official	Update		Warman Jr., Harold C. CEO 6068867602	Warman Jr., Harold C. CEO Highlands Regional Medical Center 6068867602	10/16/2017 3:31 PM
Contacts	Signed By	Insert			BLACKWELL, JACK CFO 6068868511	6/15/2017 2:22 PM
Contacts	Primary Contact	Insert			HOWARD, VYLINDA DIRECTOR OF PHARMACY 6068867617	6/15/2017 2:22 PM
Contacts	Authorizing Official	Insert			Warman Jr., Harold C. CEO 6068867602	6/15/2017 2:22 PM
Addresses	Main Address	Insert			100 Brianna Blvd. Suite 100 Salyersville, KY 41465	6/15/2017 2:22 PM
Addresses	Billing Address	Insert			Highlands Regional Medical Center 500 KY Rt. 321 Prestonsburg, KY 41653	6/15/2017 2:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/1/2016 8:18 AM
Medicaid Billing	Medicaid: Number	Insert			7100390940	9/1/2016 8:18 AM
Medicaid Billing	Medicaid: State	Insert			KY	9/1/2016 8:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/1/2016 8:18 AM
Medicaid Billing	Medicaid: Number	Insert			7100264770	9/1/2016 8:18 AM
Medicaid Billing	Medicaid: State	Insert			KY	9/1/2016 8:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/1/2016 8:18 AM
Medicaid Billing	Medicaid: Number	Insert			700255340	9/1/2016 8:18 AM
Medicaid Billing	Medicaid: State	Insert			KY	9/1/2016 8:18 AM
Medicaid Billing	NPI: Number	Insert			1447683958	9/1/2016 8:18 AM
Details	Last Recertification Date	Update		9/1/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 8:18 AM
Details	Last Recertification Date	Update		8/21/2014 12:00:00 AM	9/1/2015 12:00:00 AM	9/1/2015 4:36 PM
Details	Last Recertification Date	Update			8/21/2014 12:00:00 AM	8/21/2014 1:01 PM
Dates	Participating Approval Date	Update			12/9/2013 12:00:00 AM	12/9/2013 3:26 PM
Details	State	Update		Pending	Active	12/9/2013 3:26 PM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	12/9/2013 3:26 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH180005E	11/14/2013 4:09 PM
Details	Last Recertification Date	Insert				10/14/2013 9:19 AM
Details	Grant Number	Insert				10/14/2013 9:19 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/14/2013 9:19 AM
Details	Is Authorizing Official EHB Data	Insert				10/14/2013 9:19 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/14/2013 9:19 AM
Details	Medicare Provider Number	Insert			180005	10/14/2013 9:19 AM
Details	Entity Name	Insert			HIGHLANDS REGIONAL MEDICAL CENTER	10/14/2013 9:19 AM
Details	Program Code	Insert			DSH	10/14/2013 9:19 AM
Details	Entity Subname	Insert			SALYERSVILLE AFTER HOURS	10/14/2013 9:19 AM
Dates	Participating Approval Date	Insert				10/14/2013 9:19 AM
Details	State	Insert			Pending	10/14/2013 9:19 AM
Dates	Registration Date	Insert			10/14/2013 12:00:00 AM	10/14/2013 9:19 AM
Dates	Signed By Date	Insert			10/14/2013 12:00:00 AM	10/14/2013 9:19 AM
Dates	Start Date	Insert				10/14/2013 9:19 AM
Terminations	Termination Comments	Insert				10/14/2013 9:19 AM
Terminations	Termination Date	Insert				10/14/2013 9:19 AM
Terminations	Termination Effective Date	Insert				10/14/2013 9:19 AM
Terminations	Termination Reason	Insert				10/14/2013 9:19 AM