Covered Entity Details

CAH251335-05 Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital (Active) - information as of 6/12/2025 6:03:25 AM

Main Details

Name

Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital

Subdivision Name

Marion Family Clinic JCSC DD03 - RUSH MPCC FAMILY MEDICINE

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH251335-05

Medicare Provider Number

251335

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/10/2014

Participating Start Date

7/1/2014

Participating Approval Date

4/15/2014

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Ochsner Rush Health
David Butler, Chief Financial Officer
(601) 703-3082

Primary Contact

Kemper, Inc.- d.b.a. John C. Stennis Memorial Hospital
Willis Kilpatrick, Director of Pharmacy
(769) 486-1055

Addresses

Street Address

5334 Dale Drive
Marion, MS 39342

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
MS	939715	1669812962

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
CAH251335-01	Child	CAH	Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital	ICFC ImmCare Fam Cli JCSC FS03 - RUSH ICFC FAMILY MEDICINE	1710 14th Streeet	Meridian	MS	Terminated
CAH251335-02	Child	CAH	Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital	Dekalb Clinic JCSC PA01 - RUSH DMCC FAMILY MEDICINE	30 Ponderosa Avenue	DeKalb	MS	Active
CAH251335-03	Child	CAH	Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital	RHC Livingston JCSC WS04 - RUSH MGLC FAMILY MEDICINE	1221 North Washington Street	Livingston	AL	Active
CAH251335-04	Child	CAH	Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital	RHC NH Med Clin JCSC HW34 - RUSH NFMC FAMILY MEDICINE	4331 Highway 39 N	Meridian	MS	Active
CAH251335-05	Child	CAH	Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital	Marion Family Clinic JCSC DD03 - RUSH MPCC FAMILY MEDICINE	5334 Dale Drive	Marion	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Kilpatrick, Willis Director of Pharmacy John C. Stennis Memorial Hospital 7694861055	Kilpatrick, Willis Director of Pharmacy Kemper, Inc.- d.b.a. John C. Stennis Memorial Hospital 7694861055	2/25/2025 6:36 AM
Details	Last Recertification Date	Update	Recertification	8/31/2023 3:43:43 PM	9/3/2024 10:38:36 AM	9/3/2024 10:38 AM
Details	Entity Subname	Update	Recertification	Marion Primary Care Center	Marion Family Clinic JCSC DD03 - RUSH MPCC FAMILY MEDICINE	9/3/2024 10:38 AM
Contacts	Authorizing Official	Update	AO Change Request	Mize, Suzanne H 340B Administrator Rush Health Systems 2054599180	Butler, David Chief Financial Officer Ochsner Rush Health 6017033082	5/29/2024 9:25 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 1:28:00 PM	8/31/2023 3:43:43 PM	8/31/2023 3:43 PM
Details	Last Recertification Date	Update	Recertification	8/19/2021 9:36:42 AM	9/7/2022 1:28:00 PM	9/7/2022 1:28 PM
Contacts	Authorizing Official	Update	Change Request	Mize, Suzanne H 340B Administrator Rush Health Systems 2054599180	Mize, Suzanne H 340B Administrator Rush Health Systems 2054599180	8/12/2022 10:11 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/10/2022 4:47 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		939715	6/10/2022 4:47 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	6/10/2022 4:47 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1669812962	6/10/2022 4:47 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	6/10/2022 4:47 PM
Contacts	Primary Contact	Update	Recertification	Kilpatrick, Willis Director of Pharmacy John C. Stennis Memorial Hospital 7694861055	Kilpatrick, Willis Director of Pharmacy John C. Stennis Memorial Hospital 7694861055	8/19/2021 9:36 AM
Details	Last Recertification Date	Update	Recertification	8/17/2020 11:04:14 AM	8/19/2021 9:36:42 AM	8/19/2021 9:36 AM
Contacts	Authorizing Official	Update	Change Request	Mize, Suzanne 340B Administrator Rush Health Systems 2054599180	Mize, Suzanne H 340B Administrator Rush Health Systems 2054599180	4/9/2021 10:41 AM
Details	Last Recertification Date	Update	Recertification	8/28/2019 8:01:34 AM	8/17/2020 11:04:14 AM	8/17/2020 11:04 AM
Addresses	Main Address	Update	Change Request	14365 Hwy 16 West DeKalb, MS 39328	5334 Dale Drive Marion, MS 39342	12/6/2019 6:40 AM
Contacts	Primary Contact	Update	Recertification	Mize, Suzanne 340B Administrator Rush Health Systems 2054599180	Kilpatrick, Willis Director of Pharmacy John C. Stennis Memorial Hospital 7694861055	8/28/2019 8:01 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 10:42:28 AM	8/28/2019 8:01:34 AM	8/28/2019 8:01 AM
Contacts	Authorizing Official	Update	Change Request	Palmer, Justin Administrator John C. Stennis Memorial Hospital 7694861038	Mize, Suzanne 340B Administrator Rush Health Systems 2054599180	1/15/2019 8:12 AM
Details	Last Recertification Date	Update	Recertification	11/7/2017 4:52:16 PM	8/21/2018 10:42:28 AM	8/21/2018 10:42 AM
Details	Last Recertification Date	Update	Recertification	10/25/2017 11:50:26 AM	11/7/2017 4:52:16 PM	11/7/2017 4:52 PM
Contacts	Primary Contact	Update	Recertification	Trosper, Mitzi Director of Pharmacy 7694861055	Mize, Suzanne 340B Administrator Rush Health Systems 2054599180	10/25/2017 11:50 AM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	10/25/2017 11:50:26 AM	10/25/2017 11:50 AM
Contacts	Authorizing Official	Update		Palmer, Justin Administrator 7694861038	Palmer, Justin Administrator John C. Stennis Memorial Hospital 7694861038	10/25/2017 11:18 AM
Contacts	Signed By	Update		Nester, Michael ADMINISTRATOR 6017766925-2180	Nester, Michael ADMINISTRATOR H.C. Watkins Memorial Hospital 6017766925-2180	10/24/2017 4:12 PM
Contacts	Authorizing Official	Update		Nester, Michael ADMINISTRATOR 6017766925-2180	Palmer, Justin Administrator 7694861038	9/11/2017 3:29 PM
Contacts	Authorizing Official	Insert			Nester, Michael ADMINISTRATOR 6017766925-2180	7/17/2017 10:26 AM
Contacts	Signed By	Insert			Nester, Michael ADMINISTRATOR 6017766925-2180	7/17/2017 10:26 AM
Addresses	Main Address	Insert			14365 Hwy 16 West DeKalb, MS 39328	8/10/2016 4:33 PM
Contacts	Primary Contact	Insert			Trosper, Mitzi Director of Pharmacy 7694861055	8/10/2016 4:33 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 4:33 PM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 9:17 AM
Details	Last Recertification Date	Update			8/7/2014 12:00:00 AM	8/7/2014 8:58 AM
Dates	Participating Approval Date	Update			4/15/2014 12:00:00 AM	4/15/2014 2:41 PM
Details	State	Update		Pending	Active	4/15/2014 2:41 PM
Dates	Start Date	Update			7/1/2014 12:00:00 AM	4/15/2014 2:41 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	CAH251335-05	4/15/2014 9:21 AM
Details	Last Recertification Date	Insert				4/10/2014 9:37 AM
Details	Grant Number	Insert				4/10/2014 9:37 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	4/10/2014 9:37 AM
Details	Is Authorizing Official EHB Data	Insert				4/10/2014 9:37 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/10/2014 9:37 AM
Details	Medicare Provider Number	Insert			251335	4/10/2014 9:37 AM
Details	Entity Name	Insert			Kemper CAH, Inc d/b/a John C. Stennis Memorial Hospital	4/10/2014 9:37 AM
Details	Program Code	Insert			CAH	4/10/2014 9:37 AM
Details	Entity Subname	Insert			Marion Primary Care Center	4/10/2014 9:37 AM
Dates	Participating Approval Date	Insert				4/10/2014 9:37 AM
Details	State	Insert			Pending	4/10/2014 9:37 AM
Dates	Registration Date	Insert			4/10/2014 12:00:00 AM	4/10/2014 9:37 AM
Dates	Signed By Date	Insert			4/10/2014 12:00:00 AM	4/10/2014 9:37 AM
Dates	Start Date	Insert				4/10/2014 9:37 AM
Terminations	Termination Comments	Insert				4/10/2014 9:37 AM
Terminations	Termination Date	Insert				4/10/2014 9:37 AM
Terminations	Termination Effective Date	Insert				4/10/2014 9:37 AM
Terminations	Termination Reason	Insert				4/10/2014 9:37 AM