Covered Entity Details

CAH171350-00 Russell Regional Hospital (Active) - information as of 5/29/2025 2:00:21 AM

Main Details

Name

Russell Regional Hospital

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH171350-00

Medicare Provider Number

171350

Additional Details

Current Program Status

Active

Registration Date

4/8/2014

Participating Start Date

7/1/2014

Participating Approval Date

4/15/2014

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Russell Regional Hospital
David Paul Caudill, CEO
(785) 483-0708

Primary Contact

Russell Regional Hospital
Nick Moyers, Pharmacist
(785) 483-3131

Addresses

Street Address

200 S. Main Street
Russell, KS 67665

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
KS	100306710A	1417939729

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/12/2023	01/01/2024		01/01/2024
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/12/2023	01/01/2024		01/01/2024
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/12/2023	01/01/2024		01/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/12/2023	01/01/2024		01/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/12/2023	01/01/2024		01/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/12/2023	01/01/2024		01/01/2024
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/11/2021	04/01/2021		04/01/2021
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/12/2023	01/01/2024		01/01/2024
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/12/2023	01/01/2024		01/01/2024
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/12/2023	01/01/2024		01/01/2024
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/12/2023	01/01/2024		01/01/2024
Contract Detail	GENOA HEALTHCARE LLC	208 E 7TH ST		HAYS	KS	67601	10/09/2023	01/01/2024		01/01/2024
Contract Detail	GREGWIRE DRUG STORE	HILGER ENTERPRISES	714 N MAIN ST	RUSSELL	KS	67665-1931	04/15/2014	07/01/2014	06/07/2024	07/08/2024
Contract Detail	MIDWEST FAMILY HEALTH	300 STATE ST		PHILLIPSBURG	KS	67661-1930	04/15/2014	07/01/2014		08/27/2014
Contract Detail	MIDWEST FAMILY HEALTH OF PLAINVILLE, LLC	210 W MILL ST		PLAINVILLE	KS	67663-2227	04/15/2014	07/01/2014		08/27/2014
Contract Detail	MIDWEST FAMILY HEALTH OF RUSSELL, LLC	208 S FOSSIL ST		RUSSELL	KS	67665-3021	04/15/2014	07/01/2014		08/27/2014
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/09/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	10/09/2023	01/01/2024		01/01/2024
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/09/2023	01/01/2024		01/01/2024
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/11/2021	04/01/2021		04/01/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/05/2016	04/01/2016		01/05/2016
Contract Detail	WAL-MART PHARMACY 10-0558	2900 SOUTH 9TH STREET		SALINA	KS	67401	10/09/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-0664	4301 VINE STREET		HAYS	KS	67601	01/05/2016	04/01/2016		01/05/2016
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/05/2016	04/01/2016		01/05/2016
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/11/2021	04/01/2021		04/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/11/2021	04/01/2021		04/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/11/2021	04/01/2021		04/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/11/2021	04/01/2021		04/01/2021
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/09/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH171350-01	Child	CAH	Russell Regional Hospital	Russell Regional Hospital Physicians Clinic	200 S. Main	Russell	KS	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 8:26:06 AM	8/12/2024 10:31:30 AM	8/12/2024 10:31 AM
Details	Last Recertification Date	Update	Recertification	9/15/2022 8:10:42 AM	8/15/2023 8:26:06 AM	8/15/2023 8:26 AM
Contacts	Primary Contact	Update	Recertification	Moyers, Randy Pharmacist - DOP West Central Kansas Association 7854853131-261	Moyers, Nick Pharmacist Russell Regional Hospital 7854833131	9/15/2022 8:10 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 4:06:02 PM	9/15/2022 8:10:42 AM	9/15/2022 8:10 AM
Contacts	Authorizing Official	Update	AO Change Request	Kreutzer, Kevin J CFO West Central Kansas Association 7854833131	Caudill, David Paul CEO Russell Regional Hospital 7854830708	9/14/2022 3:00 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 9:24:13 AM	8/16/2021 4:06:02 PM	8/16/2021 4:06 PM
Contacts	Authorizing Official	Update	AO Change Request	Collins, Sharon J CEO Russell Regional Hospital 7854830708	Kreutzer, Kevin J CFO West Central Kansas Association 7854833131	6/14/2021 2:55 PM
Details	Last Recertification Date	Update	Recertification	8/19/2019 12:54:28 PM	8/18/2020 9:24:13 AM	8/18/2020 9:24 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2020 5:36 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100306710A	8/3/2020 5:36 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	8/3/2020 5:36 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1417939729	8/3/2020 5:36 PM
Medicaid Billing	NPI: State	Insert	Change Request		KS	8/3/2020 5:36 PM
Details	Last Recertification Date	Update	Recertification	8/15/2018 9:00:34 AM	8/19/2019 12:54:28 PM	8/19/2019 12:54 PM
Contacts	Authorizing Official	Update	AO Change Request	Nahmensen, Robert David CEO Russell Regional Hospital 7854830706	Collins, Sharon J CEO Russell Regional Hospital 7854830708	8/8/2019 6:25 AM
Details	Last Recertification Date	Update	Recertification	11/8/2017 8:24:28 AM	8/15/2018 9:00:34 AM	8/15/2018 9:00 AM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/8/2017 8:24:28 AM	11/8/2017 8:24 AM
Contacts	Primary Contact	Update	Recertification	Moyers, Randy Pharmacist - DOP 7854853131-261	Moyers, Randy Pharmacist - DOP West Central Kansas Association 7854853131-261	11/6/2017 3:52 PM
Contacts	Authorizing Official	Insert	AO Change Request		Nahmensen, Robert David CEO Russell Regional Hospital 7854830706	11/6/2017 2:43 PM
Contacts	Signed By	Insert			Courtois, Reginald Harold Chief Executive Officer 7854830706	8/18/2016 4:57 PM
Contacts	Primary Contact	Insert			Moyers, Randy Pharmacist - DOP 7854853131-261	8/18/2016 4:57 PM
Addresses	Main Address	Insert			200 S. Main Street Russell, KS 67665	8/18/2016 4:57 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 4:57 PM
Details	Last Recertification Date	Update		8/13/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 12:41 PM
Details	Last Recertification Date	Update			8/13/2014 12:00:00 AM	8/13/2014 2:07 PM
Dates	Participating Approval Date	Update			4/15/2014 12:00:00 AM	4/15/2014 8:03 AM
Details	State	Update		Pending	Active	4/15/2014 8:03 AM
Dates	Start Date	Update			7/1/2014 12:00:00 AM	4/15/2014 8:03 AM
Details	340B ID	Update		ONLINE_REG	CAH171350-00	4/9/2014 9:41 AM
Details	Last Recertification Date	Insert				4/8/2014 3:40 PM
Details	Grant Number	Insert				4/8/2014 3:40 PM
Details	340B ID	Insert			ONLINE_REG	4/8/2014 3:40 PM
Details	Is Authorizing Official EHB Data	Insert				4/8/2014 3:40 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/8/2014 3:40 PM
Details	Medicare Provider Number	Insert			171350	4/8/2014 3:40 PM
Details	Entity Name	Insert			Russell Regional Hospital	4/8/2014 3:40 PM
Details	Program Code	Insert			CAH	4/8/2014 3:40 PM
Details	Entity Subname	Insert				4/8/2014 3:40 PM
Dates	Participating Approval Date	Insert				4/8/2014 3:40 PM
Details	State	Insert			Pending	4/8/2014 3:40 PM
Dates	Registration Date	Insert			4/8/2014 12:00:00 AM	4/8/2014 3:40 PM
Dates	Signed By Date	Insert			4/8/2014 12:00:00 AM	4/8/2014 3:40 PM
Dates	Start Date	Insert				4/8/2014 3:40 PM
Terminations	Termination Comments	Insert				4/8/2014 3:40 PM
Terminations	Termination Date	Insert				4/8/2014 3:40 PM
Terminations	Termination Effective Date	Insert				4/8/2014 3:40 PM
Terminations	Termination Reason	Insert				4/8/2014 3:40 PM