Covered Entity Details

CAH251323-03 SCOTT REGIONAL HOSPITAL (Active) - information as of 5/3/2025 12:39:21 AM

Main Details

Name

SCOTT REGIONAL HOSPITAL

Subdivision Name

RHC Clark Med Clinic SRHC HW33 - RUSH CMCC FAMILY MEDICINE

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH251323-03

Medicare Provider Number

251323

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

Scott Regional
Gera Bynum, Director of Pharmacy
(601) 732-6301

Addresses

Street Address

321 HIGHWAY 13 SOUTH
MORTON, MS 39117

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	9772891	1003166117

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
CAH251323-01	Child	CAH	SCOTT REGIONAL HOSPITAL	RHC Lake SRHC HW30 - RUSH FPVC FAMILY MEDICINE	24489 Highway 80	Lake	MS	Active
CAH251323-02	Child	CAH	SCOTT REGIONAL HOSPITAL	Forest	1080 Highway 35 South	Forest	MS	Terminated
CAH251323-03	Child	CAH	SCOTT REGIONAL HOSPITAL	RHC Clark Med Clinic SRHC HW33 - RUSH CMCC FAMILY MEDICINE	321 HIGHWAY 13 SOUTH	MORTON	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Bynum, Gera Director of Pharmacy Scott Regional Hospital 6017326301	Bynum, Gera Director of Pharmacy Scott Regional 6017326301	2/25/2025 6:36 AM
Details	Last Recertification Date	Update	Recertification	8/31/2023 3:53:00 PM	9/3/2024 10:38:16 AM	9/3/2024 10:38 AM
Details	Entity Subname	Update	Recertification	Clark Clinic-Morton Family Clinic	RHC Clark Med Clinic SRHC HW33 - RUSH CMCC 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 6:56 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 1:26:42 PM	8/31/2023 3:53:00 PM	8/31/2023 3:53 PM
Details	Last Recertification Date	Update	Recertification	8/27/2021 10:45:57 AM	9/7/2022 1:26:42 PM	9/7/2022 1:26 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	8/2/2022 6:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/10/2022 4:41 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9772891	6/10/2022 4:41 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	6/10/2022 4:41 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1003166117	6/10/2022 4:41 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	6/10/2022 4:41 PM
Contacts	Primary Contact	Update	Recertification	Bynum, Gera Pharmacist Scott Regional Hospital 6017326301-1001	Bynum, Gera Director of Pharmacy Scott Regional Hospital 6017326301	8/27/2021 10:45 AM
Details	Last Recertification Date	Update	Recertification	8/17/2020 11:05:56 AM	8/27/2021 10:45:57 AM	8/27/2021 10:45 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 10:31 AM
Details	Last Recertification Date	Update	Recertification	8/27/2019 11:07:40 AM	8/17/2020 11:05:56 AM	8/17/2020 11:05 AM
Details	Last Recertification Date	Update	Recertification	8/17/2018 12:10:07 PM	8/27/2019 11:07:40 AM	8/27/2019 11:07 AM
Details	Last Recertification Date	Update	Recertification	11/3/2017 3:51:12 PM	8/17/2018 12:10:07 PM	8/17/2018 12:10 PM
Details	Last Recertification Date	Update	Recertification	10/24/2017 3:14:48 PM	11/3/2017 3:51:12 PM	11/3/2017 3:51 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	10/24/2017 3:14:48 PM	10/24/2017 3:14 PM
Contacts	Authorizing Official	Insert	AO Change Request		Mize, Suzanne 340B Administrator Rush Health Systems 2054599180	10/12/2017 4:14 PM
Contacts	Signed By	Update		EDWARDS, MICHAEL ADMINISTRATOR 6017326301-1060	EDWARDS, MICHAEL ADMINISTRATOR Scott Regional Hospital 6017326301-1060	9/25/2017 3:04 PM
Contacts	Primary Contact	Update		Bynum, Gera Pharmacist 6017326301-1001	Bynum, Gera Pharmacist Scott Regional Hospital 6017326301-1001	9/25/2017 11:15 AM
Contacts	Signed By	Insert			EDWARDS, MICHAEL ADMINISTRATOR 6017326301-1060	4/4/2017 3:15 PM
Addresses	Main Address	Insert			321 HIGHWAY 13 SOUTH MORTON, MS 39117	8/10/2016 11:42 AM
Contacts	Primary Contact	Insert			Bynum, Gera Pharmacist 6017326301-1001	8/10/2016 11:42 AM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 11:42 AM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 10:14 AM
Details	Last Recertification Date	Update			8/6/2014 12:00:00 AM	8/6/2014 10:09 AM
Dates	Participating Approval Date	Update			4/15/2014 12:00:00 AM	4/15/2014 3:12 PM
Details	State	Update		Pending	Active	4/15/2014 3:12 PM
Dates	Start Date	Update			7/1/2014 12:00:00 AM	4/15/2014 3:12 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	CAH251323-03	4/15/2014 9:54 AM
Details	Last Recertification Date	Insert				4/10/2014 3:15 PM
Details	Grant Number	Insert				4/10/2014 3:15 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	4/10/2014 3:15 PM
Details	Is Authorizing Official EHB Data	Insert				4/10/2014 3:15 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/10/2014 3:15 PM
Details	Medicare Provider Number	Insert			251323	4/10/2014 3:15 PM
Details	Entity Name	Insert			SCOTT REGIONAL HOSPITAL	4/10/2014 3:15 PM
Details	Program Code	Insert			CAH	4/10/2014 3:15 PM
Details	Entity Subname	Insert			Clark Clinic-Morton Family Clinic	4/10/2014 3:15 PM
Dates	Participating Approval Date	Insert				4/10/2014 3:15 PM
Details	State	Insert			Pending	4/10/2014 3:15 PM
Dates	Registration Date	Insert			4/10/2014 12:00:00 AM	4/10/2014 3:15 PM
Dates	Signed By Date	Insert			4/10/2014 12:00:00 AM	4/10/2014 3:15 PM
Dates	Start Date	Insert				4/10/2014 3:15 PM
Terminations	Termination Comments	Insert				4/10/2014 3:15 PM
Terminations	Termination Date	Insert				4/10/2014 3:15 PM
Terminations	Termination Effective Date	Insert				4/10/2014 3:15 PM
Terminations	Termination Reason	Insert				4/10/2014 3:15 PM