Covered Entity Details

SCH040011-04 CHAMBERS MEMORIAL HOSPITAL (Active) - information as of 6/1/2025 4:02:28 AM

Main Details

Name

CHAMBERS MEMORIAL HOSPITAL

Subdivision Name

Emergency

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH040011-04

Medicare Provider Number

040011

Outpatient Facility Provider Number

040011

Additional Details

Current Program Status

Active

Registration Date

7/11/2014

Participating Start Date

10/1/2014

Participating Approval Date

9/4/2014

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

John Ed Chambers Memorial Hospital, Inc.
Scott Peek, CEO
(479) 495-0020

Primary Contact

CHAMBERS MEMORIAL HOSPITAL
ALEXIS KEELING, Collections
(479) 886-8687

Addresses

Street Address

719 Detroit Street
Danville, AR 72833

Billing Address

Chambers Memorial Hospital
PO Box 639
Danville, AR 72833

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?
No

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
SCH040011-01	Child	SCH	CHAMBERS MEMORIAL HOSPITAL	Western Yell Co Medical Clinic	310 W Broadway	Havana	AR	Active
SCH040011-02	Child	SCH	CHAMBERS MEMORIAL HOSPITAL	Scenic 7 Medical Clinic	402 S Scenic 7 Drive	Ola	AR	Active
SCH040011-03	Child	SCH	CHAMBERS MEMORIAL HOSPITAL	Plainview Medical Clinic	102 N Garfield Ave	Plainview	AR	Active
SCH040011-04	Child	SCH	CHAMBERS MEMORIAL HOSPITAL	Emergency	719 Detroit Street	Danville	AR	Active
SCH040011-05	Child	SCH	CHAMBERS MEMORIAL HOSPITAL	Chambers Memorial Clinic	719 Detroit Street	Danville	AR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/23/2023 2:15:35 PM	8/16/2024 11:29:32 AM	8/16/2024 11:29 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 11:44:19 AM	8/23/2023 2:15:35 PM	8/23/2023 2:15 PM
Contacts	Primary Contact	Update	PC Change Request	Woods, Jeffrey Accountant Chambers Memorial Hospital 4794956369	KEELING, ALEXIS Collections CHAMBERS MEMORIAL HOSPITAL 4798868687	8/10/2023 3:39 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 9:31:49 AM	8/26/2022 11:44:19 AM	8/26/2022 11:44 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 3:49:19 PM	9/7/2021 9:31:49 AM	9/7/2021 9:31 AM
Contacts	Authorizing Official	Update	AO Change Request	McCoy, Mike CEO Hospital 4794956218	Peek, Scott CEO John Ed Chambers Memorial Hospital, Inc. 4794950020	8/19/2021 1:13 PM
Details	Last Recertification Date	Update	Recertification	8/22/2019 5:02:49 PM	9/3/2020 3:49:19 PM	9/3/2020 3:49 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 4:06:46 PM	8/22/2019 5:02:49 PM	8/22/2019 5:02 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 4:28:19 PM	8/22/2018 4:06:46 PM	8/22/2018 4:06 PM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/15/2017 4:28:19 PM	11/15/2017 4:28 PM
Contacts	Authorizing Official	Update		McCoy, Mike CEO 4794956218	McCoy, Mike CEO Hospital 4794956218	10/20/2017 9:56 AM
Contacts	Primary Contact	Update		Woods, Jeffrey Accountant 4794956369	Woods, Jeffrey Accountant Chambers Memorial Hospital 4794956369	9/19/2017 12:21 PM
Contacts	Authorizing Official	Insert			McCoy, Mike CEO 4794956218	8/9/2017 2:02 PM
Addresses	Main Address	Insert			719 Detroit Street Danville, AR 72833	8/16/2016 9:33 AM
Contacts	Primary Contact	Insert			Woods, Jeffrey Accountant 4794956369	8/16/2016 9:33 AM
Contacts	Signed By	Insert			Peek, Scott CEO 4794956218	8/16/2016 9:33 AM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 9:33 AM
Addresses	Billing Address	Insert			Chambers Memorial Hospital PO Box 639 Danville, AR 72833	6/7/2016 1:24 PM
Details	Last Recertification Date	Update			8/17/2015 12:00:00 AM	8/17/2015 1:07 PM
Details	Entity Subname	Update		Emergency / Emergency	Emergency	12/31/2014 3:51 PM
Details	Entity Subname	Update		Emergency	Emergency / Emergency	12/19/2014 2:16 PM
Dates	Participating Approval Date	Update			9/4/2014 12:00:00 AM	9/4/2014 5:53 PM
Details	State	Update		Pending	Active	9/4/2014 5:53 PM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	9/4/2014 5:53 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_45310	SCH040011-04	8/22/2014 11:58 AM
Details	Entity Subname	Update			Emergency	8/22/2014 11:58 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_45310	7/11/2014 12:57 PM
Details	Last Recertification Date	Insert				7/11/2014 12:57 PM
Details	Grant Number	Insert				7/11/2014 12:57 PM
Details	340B ID	Insert				7/11/2014 12:57 PM
Details	Is Authorizing Official EHB Data	Insert				7/11/2014 12:57 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/11/2014 12:57 PM
Details	Medicare Provider Number	Insert			040011	7/11/2014 12:57 PM
Details	Entity Name	Insert			CHAMBERS MEMORIAL HOSPITAL	7/11/2014 12:57 PM
Details	Program Code	Insert			SCH	7/11/2014 12:57 PM
Details	Entity Subname	Insert				7/11/2014 12:57 PM
Dates	Participating Approval Date	Insert				7/11/2014 12:57 PM
Details	State	Insert			Pending	7/11/2014 12:57 PM
Dates	Registration Date	Insert			7/11/2014 12:00:00 AM	7/11/2014 12:57 PM
Dates	Signed By Date	Insert			7/11/2014 12:00:00 AM	7/11/2014 12:57 PM
Dates	Start Date	Insert				7/11/2014 12:57 PM
Terminations	Termination Comments	Insert				7/11/2014 12:57 PM
Terminations	Termination Date	Insert				7/11/2014 12:57 PM
Terminations	Termination Effective Date	Insert				7/11/2014 12:57 PM
Terminations	Termination Reason	Insert				7/11/2014 12:57 PM