Covered Entity Details

CAH151304-04 RUSH MEMORIAL HOSPITAL (Active) - information as of 5/19/2025 12:56:06 AM

Main Details

Name

RUSH MEMORIAL HOSPITAL

Subdivision Name

RMH Women's Care

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH151304-04

Medicare Provider Number

151304

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

6/13/2024

Participating Start Date

7/1/2024

Participating Approval Date

6/14/2024

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Rush Memorial Hospital
BRADLEY SMITH, CEO
(765) 932-7513

Primary Contact

Rush Memorial Hospital
Greg Pratt, Director of Pharmacy
(765) 932-7497

Addresses

Street Address

110 E. 13th Street
RUSHVILLE, IN 46173-1116

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participated starting 1/1/2015, terminated 10/1/2020. Reinstated 7/1/2024.	06/14/2024
Participating Start Date 1/1/2015, Termination Date 10/1/2020, Reinstatement 7/12024	04/18/2024

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
CAH151304-01	Child	CAH	RUSH MEMORIAL HOSPITAL	RMH Rheumatology Services	110 E. 13TH STREET	RUSHVILLE	IN	Active
CAH151304-02	Child	CAH	RUSH MEMORIAL HOSPITAL	RMH Orthopaedics	110 E. 13TH STREET	RUSHVILLE	IN	Active
CAH151304-03	Child	CAH	RUSH MEMORIAL HOSPITAL	RMH Surgical Associates	110 E. 13TH STREET	RUSHVILLE	IN	Active
CAH151304-04	Child	CAH	RUSH MEMORIAL HOSPITAL	RMH Women's Care	110 E. 13th Street	RUSHVILLE	IN	Active
CAH151304-05	Child	CAH	RUSH MEMORIAL HOSPITAL	RMH Pediatrics	1339 N CHERRY ST	RUSHVILLE	IN	Active
CAH151304-06	Child	CAH	RUSH MEMORIAL HOSPITAL	RMH HEALTHCARE ASSOCIATES	110 E. 13TH STREET	RUSHVILLE	IN	Terminated
CAH151304-07	Child	CAH	RUSH MEMORIAL HOSPITAL	RMH Healthcare Associates South	110 E 13TH ST	RUSHVILLE	IN	Terminated
CAH151304-08	Child	CAH	RUSH MEMORIAL HOSPITAL	RMH Healthcare Associates North	201 CONRAD HARCOURT WAY	RUSHVILLE	IN	Active
CAH151304-09	Child	CAH	RUSH MEMORIAL HOSPITAL	SHEEHAN CLINIC / Oncology	110 E 13TH ST	RUSHVILLE	IN	Active
CAH151304-10	Child	CAH	RUSH MEMORIAL HOSPITAL	Rush Memorial Hospital Walk In Care	323 Conrad Harcourt Way	Rushville	IN	Active
CAH151304-11	Child	CAH	RUSH MEMORIAL HOSPITAL	Rush Memorial Hospital - RMH Pain Management	1310 N. Main Street	Rushville	IN	Active
CAH151304-12	Child	CAH	RUSH MEMORIAL HOSPITAL	RUSH MEMORIAL HOSPITAL - RMH Multi-Specialty	110 EAST 13TH STREET	RUSHVILLE	IN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		8/20/2024 4:33:09 PM	8/20/2024 4:33 PM
Addresses	Main Address	Update	Change Request	201 Conrad Harcourt Way RUSHVILLE, IN 46173-1116	110 E. 13th Street RUSHVILLE, IN 46173-1116	7/10/2024 12:57 PM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Details	Last Recertification Date	Update	Reinstatement	9/9/2019 4:01:38 PM		6/14/2024 8:50 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	7/16/2020 12:00:00 AM		6/14/2024 8:50 AM
Dates	Participating Approval Date	Update	Reinstatement	12/11/2014 12:00:00 AM	6/14/2024 8:50:37 AM	6/14/2024 8:50 AM
Details	State	Update	Reinstatement	Terminated	Approved	6/14/2024 8:50 AM
Dates	Registration Date	Update	Reinstatement	10/14/2014 12:00:00 AM	6/13/2024 1:58:52 PM	6/14/2024 8:50 AM
Dates	Signed By Date	Update	Reinstatement	10/14/2014 12:00:00 AM	6/13/2024 4:56:21 PM	6/14/2024 8:50 AM
Dates	Start Date	Update	Reinstatement	1/1/2015 12:00:00 AM	7/1/2024 12:00:00 AM	6/14/2024 8:50 AM
Terminations	Termination Comments	Update	Reinstatement	yes- 7/16/2020 is the last purchase date.		6/14/2024 8:50 AM
Terminations	Termination Date	Update	Reinstatement	10/1/2020 12:00:00 AM		6/14/2024 8:50 AM
Terminations	Termination Effective Date	Update	Reinstatement	10/1/2020 12:00:00 AM		6/14/2024 8:50 AM
Terminations	Termination Reason	Update	Reinstatement	Business decision by the Covered Entity		6/14/2024 8:50 AM
Details	Comments Public	Insert	Reinstatement		Participated starting 1/1/2015, terminated 10/1/2020. Reinstated 7/1/2024.	6/14/2024 8:40 AM
Details	Comments Public	Insert	Reinstatement		Participating Start Date 1/1/2015, Termination Date 10/1/2020, Reinstatement 7/12024	4/18/2024 6:51 AM
Terminations	Termination Effective Date	Update	OPA Edit Termination Info	4/1/2020 12:00:00 AM	10/1/2020 12:00:00 AM	12/30/2020 9:03 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/16/2020 12:00:00 AM	7/17/2020 7:37 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/17/2020 7:37 AM
Terminations	Termination Comments	Update	Termination Request		yes- 7/16/2020 is the last purchase date.	7/17/2020 7:37 AM
Terminations	Termination Date	Update	Termination Request		10/1/2020 12:00:00 AM	7/17/2020 7:37 AM
Terminations	Termination Effective Date	Update	Termination Request		4/1/2020 12:00:00 AM	7/17/2020 7:37 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	7/17/2020 7:37 AM
Details	Last Recertification Date	Update	Recertification	9/3/2018 7:52:51 AM	9/9/2019 4:01:38 PM	9/9/2019 4:01 PM
Addresses	Main Address	Update	Recertification	1310 NORTH MAIN STREET RUSHVILLE, IN 46173-1116	201 Conrad Harcourt Way RUSHVILLE, IN 46173-1116	9/3/2018 7:52 AM
Details	Last Recertification Date	Update	Recertification	11/21/2017 9:48:23 AM	9/3/2018 7:52:51 AM	9/3/2018 7:52 AM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/21/2017 9:48:23 AM	11/21/2017 9:48 AM
Contacts	Primary Contact	Insert	Change Request		Pratt, Greg Director of Pharmacy Rush Memorial Hospital 7659327497	9/28/2017 9:27 AM
Contacts	Authorizing Official	Update		SMITH, BRADLEY CEO 7659327513	SMITH, BRADLEY CEO Rush Memorial Hospital 7659327513	9/28/2017 9:15 AM
Contacts	Signed By	Update		SMITH, BRADLEY CEO 7659327513	SMITH, BRADLEY CEO Rush Memorial Hospital 7659327513	9/28/2017 9:15 AM
Contacts	Authorizing Official	Insert			SMITH, BRADLEY CEO 7659327513	7/25/2017 11:46 AM
Contacts	Signed By	Insert			SMITH, BRADLEY CEO 7659327513	7/25/2017 11:46 AM
Addresses	Main Address	Insert			1310 NORTH MAIN STREET RUSHVILLE, IN 46173-1116	10/17/2016 1:35 PM
Details	Last Recertification Date	Update		8/12/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 1:12 PM
Details	Last Recertification Date	Update			8/12/2015 12:00:00 AM	8/12/2015 10:30 AM
Dates	Participating Approval Date	Update			12/11/2014 12:00:00 AM	12/11/2014 5:58 AM
Details	State	Update		Pending	Active	12/11/2014 5:58 AM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	12/11/2014 5:58 AM
Details	Entity Subname	Update		RUSH MEMORIAL HOSPITAL	RMH Women's Care	12/8/2014 10:24 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_47365	CAH151304-04	10/16/2014 9:35 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_47365	10/14/2014 3:31 PM
Details	Last Recertification Date	Insert				10/14/2014 3:31 PM
Details	Grant Number	Insert				10/14/2014 3:31 PM
Details	340B ID	Insert				10/14/2014 3:31 PM
Details	Is Authorizing Official EHB Data	Insert				10/14/2014 3:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/14/2014 3:31 PM
Details	Medicare Provider Number	Insert			151304	10/14/2014 3:31 PM
Details	Entity Name	Insert			RUSH MEMORIAL HOSPITAL	10/14/2014 3:31 PM
Details	Program Code	Insert			CAH	10/14/2014 3:31 PM
Details	Entity Subname	Insert			RUSH MEMORIAL HOSPITAL	10/14/2014 3:31 PM
Dates	Participating Approval Date	Insert				10/14/2014 3:31 PM
Details	State	Insert			Pending	10/14/2014 3:31 PM
Dates	Registration Date	Insert			10/14/2014 12:00:00 AM	10/14/2014 3:31 PM
Dates	Signed By Date	Insert			10/14/2014 12:00:00 AM	10/14/2014 3:31 PM
Dates	Start Date	Insert				10/14/2014 3:31 PM
Terminations	Termination Comments	Insert				10/14/2014 3:31 PM
Terminations	Termination Date	Insert				10/14/2014 3:31 PM
Terminations	Termination Effective Date	Insert				10/14/2014 3:31 PM
Terminations	Termination Reason	Insert				10/14/2014 3:31 PM