Covered Entity Details

CAH181310-03 CARROLL COUNTY MEMORIAL HOSPITAL (Terminated) - information as of 5/9/2025 12:18:06 AM

Main Details

Name

CARROLL COUNTY MEMORIAL HOSPITAL

Subdivision Name

Carroll County Family Practice/Rural Health Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH181310-03

Medicare Provider Number

181310

Outpatient Facility Provider Number

183985

Additional Details

Current Program Status

Terminated

Registration Date

7/15/2014

Participating Start Date

10/1/2014

Participating Approval Date

9/3/2014

Last Recertification Date

8/15/2018

Termination Date
Termination Reason

4/1/2019
Business decision by the Covered Entity

Contacts

Authorizing Official

Carroll Co Hospital
Kimberly Haverly, CEO
(502) 732-3275

Primary Contact

Carroll Co. Hospital
Larry L Abplanalp, Director Pharmacy
(812) 599-2859

Addresses

Street Address

309 11th St
Carrollton, KY 41008

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?
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
CAH181310-01	Child	CAH	CARROLL COUNTY MEMORIAL HOSPITAL	CARROLL COUNTY RURAL HEALTH CLINIC	309 11TH STREET	CARROLLTON	KY	Active
CAH181310-02	Child	CAH	CARROLL COUNTY MEMORIAL HOSPITAL	Warsaw Family Practice	302 West Main St.	Warsaw	KY	Active
CAH181310-03	Child	CAH	CARROLL COUNTY MEMORIAL HOSPITAL	Carroll County Family Practice/Rural Health Clinic	309 11th St	Carrollton	KY	Terminated
CAH181310-04	Child	CAH	CARROLL COUNTY MEMORIAL HOSPITAL	Bedford Family Practice	470 Highway 421 N	Bedford	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Dees, Kim CEO Carroll Co Hospital 5027327411	Haverly, Kimberly CEO Carroll Co Hospital 5027323275	6/29/2020 11:07 AM
Contacts	Authorizing Official	Update	Change Request	Hays, Harry CEO Carroll County Memorial Hospital 5027323200	Dees, Kim CEO Carroll Co Hospital 5027327411	7/17/2019 7:28 AM
Details	State	Update		To Be Terminated	Terminated	4/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/28/2019 12:00:00 AM	1/29/2019 6:42 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/29/2019 6:42 AM
Terminations	Termination Date	Update	Termination Request		4/1/2019 12:00:00 AM	1/29/2019 6:42 AM
Terminations	Termination Effective Date	Update	Termination Request		1/28/2019 12:00:00 AM	1/29/2019 6:42 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	1/29/2019 6:42 AM
Details	Last Recertification Date	Update	Recertification	11/21/2017 3:54:21 PM	8/15/2018 9:41:15 AM	8/15/2018 9:41 AM
Contacts	Primary Contact	Update	Recertification	Swab, Joseph CFO 5027323275	Abplanalp, Larry L Director Pharmacy Carroll Co. Hospital 8125992859	11/21/2017 3:54 PM
Details	Last Recertification Date	Update	Recertification	9/5/2016 12:00:00 AM	11/21/2017 3:54:21 PM	11/21/2017 3:54 PM
Contacts	Authorizing Official	Update		Hays, Harry CEO 5027323200	Hays, Harry CEO Carroll County Memorial Hospital 5027323200	10/2/2017 11:05 AM
Contacts	Authorizing Official	Insert			Hays, Harry CEO 5027323200	4/7/2017 9:46 AM
Contacts	Signed By	Insert			Kozar, Michael A. CEO 5027323200	9/5/2016 8:59 AM
Addresses	Main Address	Insert			309 11th St Carrollton, KY 41008	9/5/2016 8:59 AM
Details	Last Recertification Date	Update		8/20/2015 12:00:00 AM	9/5/2016 12:00:00 AM	9/5/2016 8:59 AM
Contacts	Primary Contact	Insert			Swab, Joseph CFO 5027323275	8/20/2015 3:57 PM
Details	Last Recertification Date	Update			8/20/2015 12:00:00 AM	8/20/2015 3:57 PM
Dates	Participating Approval Date	Update			9/3/2014 12:00:00 AM	9/3/2014 1:43 PM
Details	State	Update		Pending	Active	9/3/2014 1:43 PM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	9/3/2014 1:43 PM
Details	340B ID	Update		CAH181310-01	CAH181310-03	8/28/2014 11:06 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_45978	CAH181310-01	8/5/2014 1:11 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_45978	7/15/2014 1:33 PM
Details	Last Recertification Date	Insert				7/15/2014 1:33 PM
Details	Grant Number	Insert				7/15/2014 1:33 PM
Details	340B ID	Insert				7/15/2014 1:33 PM
Details	Is Authorizing Official EHB Data	Insert				7/15/2014 1:33 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2014 1:33 PM
Details	Medicare Provider Number	Insert			181310	7/15/2014 1:33 PM
Details	Entity Name	Insert			CARROLL COUNTY MEMORIAL HOSPITAL	7/15/2014 1:33 PM
Details	Program Code	Insert			CAH	7/15/2014 1:33 PM
Details	Entity Subname	Insert			Carroll County Family Practice/Rural Health Clinic	7/15/2014 1:33 PM
Dates	Participating Approval Date	Insert				7/15/2014 1:33 PM
Details	State	Insert			Pending	7/15/2014 1:33 PM
Dates	Registration Date	Insert			7/15/2014 12:00:00 AM	7/15/2014 1:33 PM
Dates	Signed By Date	Insert			7/15/2014 12:00:00 AM	7/15/2014 1:33 PM
Dates	Start Date	Insert				7/15/2014 1:33 PM
Terminations	Termination Comments	Insert				7/15/2014 1:33 PM
Terminations	Termination Date	Insert				7/15/2014 1:33 PM
Terminations	Termination Effective Date	Insert				7/15/2014 1:33 PM
Terminations	Termination Reason	Insert				7/15/2014 1:33 PM