Covered Entity Details

CAH151330-01 ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL (Terminated) - information as of 4/28/2025 1:48:23 AM

Main Details

Name

ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL

Subdivision Name

OUTPATIENT BEHAVIOR HEALTH

Type

Critical Access Hospital

Rural

340B ID

CAH151330-01

Medicare Provider Number

151330

Outpatient Facility Provider Number

151330

Additional Details

Current Program Status

Terminated

Registration Date

7/15/2014

Participating Start Date

10/1/2014

Participating Approval Date

9/4/2014

Last Recertification Date

8/13/2015

Termination Date
Termination Reason

10/1/2015
Site closure

Contacts

Authorizing Official

Adams Memorial Hospital
Scott Smith, Executive Director
(260) 724-2145 Ext: 11002

Primary Contact

TONY CURRIE, DIR OF PHARMACY
(260) 724-2145 Ext: 2604

Addresses

Street Address

200 NORTH HOSPITAL CIRCLE DRIVE
DECATUR, IN 46733

Billing Address

ADAMS COUNTY MEMORIAL HOSPITAL
1100 Mercer Avenue
DECATUR, IN 46733

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

Shipping Address 1

ADAMS COUNTY MEMORIAL HOSPITAL
1100 Mercer Avenue
DECATUR, IN 46733

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
CAH151330-01	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	OUTPATIENT BEHAVIOR HEALTH	200 NORTH HOSPITAL CIRCLE DRIVE	DECATUR	IN	Terminated
CAH151330-02	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	NEUROLOGY	1100 Mercer Ave	DECATUR	IN	Active
CAH151330-03	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	ORTHOPEDICS	1100 Mercer Ave	Decatur	IN	Active
CAH151330-04	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	GENERAL SURGERY	1100 Mercer Ave	Decatur	IN	Active
CAH151330-06	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	Decatur FAMILY MEDICINE	1100 Mercer Ave	DECATUR	IN	Active
CAH151330-07	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	ADAMS COUNTY MEMORIAL HOSPITAL - Monroe Family Medicine	205 TOWER DR	MONROE	IN	Active
CAH151330-08	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	ADAMS COUNTY MEMORIAL HOSPITAL - Stat Care	1401 N 13th Street	DECATUR	IN	Active
CAH151330-09	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	ADAMS COUNTY MEMORIAL HOSPITAL - Woodcrest Family Medicine	1300 MERCER AVE	DECATUR	IN	Active
CAH151330-10	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	ADAMS COUNTY MEMORIAL HOSPITAL - Adams Medical Group -- High Street	955 HIGH ST STE 1	DECATUR	IN	Active
CAH151330-11	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	Adams Medical Group -- Berne - Adams Medical Group -- Berne	1521 W. Main St.	Berne	IN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	New Registration	Smith, Scott Executive Director Adams Memorial Hospital 2607242145	Smith, Scott Executive Director Adams Memorial Hospital 2607242145-11002	4/7/2020 12:42 PM
Contacts	Authorizing Official	Update	AO Change Request	EIDAM, JO-ELLEN CEO AHN 2607242145-11001	Smith, Scott Executive Director Adams Memorial Hospital 2607242145	9/4/2019 10:35 AM
Contacts	Authorizing Official	Update		EIDAM, JO-ELLEN CEO 2607242145-11001	EIDAM, JO-ELLEN CEO AHN 2607242145-11001	10/11/2017 10:21 AM
Contacts	Authorizing Official	Update		EIDAM, JO-ELLEN CEO 2607242145-1400	EIDAM, JO-ELLEN CEO 2607242145-11001	9/11/2017 3:29 PM
Contacts	Authorizing Official	Insert			EIDAM, JO-ELLEN CEO 2607242145-1400	8/15/2016 11:11 AM
Contacts	Signed By	Insert			EIDAM, JO-ELLEN CEO 2607242145-1400	8/15/2016 11:11 AM
Contacts	Primary Contact	Insert			CURRIE, TONY DIR OF PHARMACY 2607242145-2604	8/31/2015 10:58 AM
Dates	Last Date That 340B Drugs Purchased	Update			8/14/2015 12:00:00 AM	8/31/2015 10:58 AM
Details	State	Update		Active	Terminated	8/31/2015 10:58 AM
Terminations	Termination Comments	Update			clinic moved location and no longer eligible for 340B program.	8/31/2015 10:58 AM
Terminations	Termination Date	Update			10/1/2015 12:00:00 AM	8/31/2015 10:58 AM
Terminations	Termination Effective Date	Update			8/14/2015 12:00:00 AM	8/31/2015 10:58 AM
Terminations	Termination Reason	Update			Site closure	8/31/2015 10:58 AM
Addresses	Main Address	Insert			200 NORTH HOSPITAL CIRCLE DRIVE DECATUR, IN 46733	8/31/2015 10:57 AM
Addresses	Billing Address	Insert			ADAMS COUNTY MEMORIAL HOSPITAL 1100 Mercer Avenue DECATUR, IN 46733	8/31/2015 10:57 AM
Addresses	Shipping Address	Insert			ADAMS COUNTY MEMORIAL HOSPITAL 1100 Mercer Avenue DECATUR, IN 46733	8/31/2015 10:57 AM
Details	Last Recertification Date	Update			8/13/2015 12:00:00 AM	8/13/2015 9:19 AM
Details	Entity Subname	Update		ADAMS MEMORIAL OUTPATIENT BEHAVIOR HEALTH SERVICES / OUTPATIENT BEHAVIOR HEALTH	OUTPATIENT BEHAVIOR HEALTH	12/31/2014 3:51 PM
Details	Entity Subname	Update		ADAMS MEMORIAL OUTPATIENT BEHAVIOR HEALTH SERVICES	ADAMS MEMORIAL OUTPATIENT BEHAVIOR HEALTH SERVICES / OUTPATIENT BEHAVIOR HEALTH	12/19/2014 2:16 PM
Dates	Participating Approval Date	Update			9/4/2014 12:00:00 AM	9/4/2014 6:02 PM
Details	State	Update		Pending	Active	9/4/2014 6:02 PM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	9/4/2014 6:02 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_46061	CAH151330-01	8/19/2014 9:52 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_46061	7/15/2014 4:20 PM
Details	Last Recertification Date	Insert				7/15/2014 4:20 PM
Details	Grant Number	Insert				7/15/2014 4:20 PM
Details	340B ID	Insert				7/15/2014 4:20 PM
Details	Is Authorizing Official EHB Data	Insert				7/15/2014 4:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2014 4:20 PM
Details	Medicare Provider Number	Insert			151330	7/15/2014 4:20 PM
Details	Entity Name	Insert			ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	7/15/2014 4:20 PM
Details	Program Code	Insert			CAH	7/15/2014 4:20 PM
Details	Entity Subname	Insert			ADAMS MEMORIAL OUTPATIENT BEHAVIOR HEALTH SERVICES	7/15/2014 4:20 PM
Dates	Participating Approval Date	Insert				7/15/2014 4:20 PM
Details	State	Insert			Pending	7/15/2014 4:20 PM
Dates	Registration Date	Insert			7/15/2014 12:00:00 AM	7/15/2014 4:20 PM
Dates	Signed By Date	Insert			7/15/2014 12:00:00 AM	7/15/2014 4:20 PM
Dates	Start Date	Insert				7/15/2014 4:20 PM
Terminations	Termination Comments	Insert				7/15/2014 4:20 PM
Terminations	Termination Date	Insert				7/15/2014 4:20 PM
Terminations	Termination Effective Date	Insert				7/15/2014 4:20 PM
Terminations	Termination Reason	Insert				7/15/2014 4:20 PM