Covered Entity Details

CAH141316-22 Carle Hoopeston Regional Health Center (Active) - information as of 6/3/2025 11:59:10 AM

Main Details

Name

Carle Hoopeston Regional Health Center

Subdivision Name

MILFORD MEDICAL CLINIC / Family Medicine

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH141316-22

Medicare Provider Number

141316

Outpatient Facility Provider Number

148526

Additional Details

Current Program Status

Active

Registration Date

10/14/2014

Participating Start Date

1/1/2015

Participating Approval Date

11/13/2014

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Carle Foundation Hospital
Dennis P. Hesch, Executive VP and CFO
(217) 326-8231

Primary Contact

Carle Foundation Hospital
Katie Koch, Director of 340B and Retail Pharmacy Operations
(217) 904-7016

Addresses

Street Address

322 N. CHICAGO ST
MILFORD, IL 60953

Billing Address

The Carle Foundation Hospital
611 West Park Street
Urbana, IL 61801-2529

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
IN	201265720A	1992059976
IL	36-3637465010	1992059976

Shipping Addresses

Shipping Address 1

The Carle Foundation Hospital
502 North Busey
Urbana, IL 61801

Shipping Address 2

The Carle Foundation Hospital
611 West Park Street
Urbana, IL 61801

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
CAH141316-01	Child	CAH	Carle Hoopeston Regional Health Center	Cissna Park Medical Clinic	141 West Garfield Avenue	Cissna Park	IL	Active
CAH141316-02	Child	CAH	Carle Hoopeston Regional Health Center	Charlotte Ann Russel Medical Center	801 East Orange Street	Hoopeston	IL	Active
CAH141316-03	Child	CAH	Carle Hoopeston Regional Health Center	Rossville Medical Clinic	619 NORTH CHICAGO STREET	Rossville	IL	Active
CAH141316-04	Child	CAH	Carle Hoopeston Regional Health Center	DANV Hoopeston - Psychiatry	516 W. Madison	Danville	IL	Active
CAH141316-05	Child	CAH	Carle Hoopeston Regional Health Center	DANV Hoopeston - Pediatrics	516 W. Madison	Danville	IL	Active
CAH141316-06	Child	CAH	Carle Hoopeston Regional Health Center	DANV Hoopeston - Ob/Gyn	516 W. Madison	Danville	IL	Active
CAH141316-07	Child	CAH	Carle Hoopeston Regional Health Center	DANV Hoopeston - Family Prac	516 W. Madison	Danville	IL	Active
CAH141316-08	Child	CAH	Carle Hoopeston Regional Health Center	DANV Hoopeston - CONV Care	516 W. Madison	Danville	IL	Active
CAH141316-09	Child	CAH	Carle Hoopeston Regional Health Center	DANV Hoopeston - Adult Medicine	516 W. Madison	Danville	IL	Active
CAH141316-10	Child	CAH	Carle Hoopeston Regional Health Center	Watseka Clinic	1490 E. Walnut Street, Suite C	Watseka	IL	Active
CAH141316-11	Child	CAH	Carle Hoopeston Regional Health Center	MILFORD CLINIC	322 N. Chicago Street	Milford	IL	Active
CAH141316-12	Child	CAH	Carle Hoopeston Regional Health Center	CARLE DANVILLE ON FAIRCHILD / Endo	311 W. Fairchild St.	Danville	IL	Terminated
CAH141316-13	Child	CAH	Carle Hoopeston Regional Health Center	CARLE DANVILLE ON FAIRCHILD / Plastic Surgery	311 W. Fairchild St.	Danville	IL	Terminated
CAH141316-14	Child	CAH	Carle Hoopeston Regional Health Center	CARLE DANVILLE ON FAIRCHILD / Allergy	311 W. Fairchild St.	Danville	IL	Terminated
CAH141316-15	Child	CAH	Carle Hoopeston Regional Health Center	CARLE DANVILLE ON FAIRCHILD / Family Medicine E	311 W. Fairchild St.	Danville	IL	Terminated
CAH141316-16	Child	CAH	Carle Hoopeston Regional Health Center	CARLE DANVILLE ON FAIRCHILD / Family Medicine W	311W FAIRCHILD ST	DANVILLE	IL	Terminated
CAH141316-17	Child	CAH	Carle Hoopeston Regional Health Center	ROBERTS CLINIC / General Radiology	1490 E. Walnut Street, Suite C	Watseka	IL	Terminated
CAH141316-18	Child	CAH	Carle Hoopeston Regional Health Center	Watseka / Lab	1490 E. Walnut Street, Suite C	Watseka	IL	Active
CAH141316-19	Child	CAH	Carle Hoopeston Regional Health Center	Watseka / Family Medicine	1490 E. Walnut Street, Suite C	WATSEKA	IL	Active
CAH141316-20	Child	CAH	Carle Hoopeston Regional Health Center	MILFORD CLINIC / General Radiology	322 N. Chicago St.	Milford	IL	Active
CAH141316-21	Child	CAH	Carle Hoopeston Regional Health Center	MILFORD CLINIC / Lab	322 N. Chicago St.	Milford	IL	Active
CAH141316-22	Child	CAH	Carle Hoopeston Regional Health Center	MILFORD MEDICAL CLINIC / Family Medicine	322 N. CHICAGO ST	MILFORD	IL	Active
CAH141316-23	Child	CAH	HOOPESTON COMMUNITY MEMORIAL HOSPITA	CHARLOTTE ANN RUSSELL MEDICAL CENTE / Pulmonary Function lab	801 East Orange Street	Hoopeston	IL	Terminated
CAH141316-24	Child	CAH	Carle Hoopeston Regional Health Center	CHARLOTTE ANN RUSSELL MEDICAL CENTE / Lab	801 East Orange Street	Hoopeston	IL	Active
CAH141316-25	Child	CAH	HOOPESTON COMMUNITY MEMORIAL HOSPITA	CHARLOTTE ANN RUSSELL MEDICAL CENTE / Urology	801 East Orange Street	Hoopeston	IL	Terminated
CAH141316-26	Child	CAH	HOOPESTON COMMUNITY MEMORIAL HOSPITA	CHARLOTTE ANN RUSSELL MEDICAL CENTE / Podiatry	801 East Orange Street	Hoopeston	IL	Terminated
CAH141316-27	Child	CAH	Carle Hoopeston Regional Health Center	CHARLOTTE ANN RUSSELL MEDICAL CENTE / Orthopedics	801 East Orange Street	Hoopeston	IL	Active
CAH141316-28	Child	CAH	HOOPESTON COMMUNITY MEMORIAL HOSPITA	CHARLOTTE ANN RUSSELL MEDICAL CENTE / Oncology	801 East Orange Street	Hoopeston	IL	Terminated
CAH141316-29	Child	CAH	Carle Hoopeston Regional Health Center	CHARLOTTE ANN RUSSELL MEDICAL CENTE / General Surgery	801 East Orange Street	Hoopeston	IL	Active
CAH141316-30	Child	CAH	Carle Hoopeston Regional Health Center	CHARLOTTE ANN RUSSELL MEDICAL CENTE / Gynecology	801 East Orange Street	Hoopeston	IL	Active
CAH141316-31	Child	CAH	Carle Hoopeston Regional Health Center	CHARLOTTE ANN RUSSELL MEDICAL CENTE / Cardiology	801 East Orange Street	Hoopeston	IL	Active
CAH141316-32	Child	CAH	Carle Hoopeston Regional Health Center	CHARLOTTE ANN RUSSELL MEDICAL CENTE / Family Medicine	801 East Orange Street	Hoopeston	IL	Active
CAH141316-33	Child	CAH	Carle Hoopeston Regional Health Center	CHARLOTTE ANN RUSSELL MEDICAL CENTE / Adult Medicine	801E ORANGE ST	HOOPESTON	IL	Active
CAH141316-34	Child	CAH	HOOPESTON COMMUNITY MEMORIAL HOSPITA	Rossville Medical Clinic / General Radiology	619 North Chicago St	Rossville	IL	Terminated
CAH141316-35	Child	CAH	Carle Hoopeston Regional Health Center	Rossville Medical Clinic / Lab	619 North Chicago St	Rossville	IL	Active
CAH141316-36	Child	CAH	Carle Hoopeston Regional Health Center	ROSSVILLE MEDICAL CLINIC / Family Medicine	619 N CHICAGO ST	ROSSVILLE	IL	Active
CAH141316-37	Child	CAH	Carle Hoopeston Regional Health Center	CISSNA PARK MEDICAL CLINIC / Lab	141 West Garfield Avenue	Cissna Park	IL	Active
CAH141316-38	Child	CAH	Carle Hoopeston Regional Health Center	CISSNA PARK MEDICAL CLINIC / Family Medicine	141 W GARFIELD AVE	CISSNA PARK	IL	Active
CAH141316-39	Child	CAH	Carle Hoopeston Regional Health Center	Tuscola Clinic	301 E. Southline Rd.	Tuscola	IL	Active
CAH141316-40	Child	CAH	Carle Hoopeston Regional Health Center	Hoopeston Community Memorial Hospit/Mattoon Primary Care	2512 HURST DRIVE, SUITE 130	MATTOON	IL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Recertification	The Carle Foundation Hospital 611 West Park Street Urbana, IL 60801-2529	The Carle Foundation Hospital 611 West Park Street Urbana, IL 61801-2529	8/28/2024 4:57 PM
Details	Last Recertification Date	Update	Recertification	9/11/2023 8:23:21 PM	8/28/2024 4:57:44 PM	8/28/2024 4:57 PM
Details	Last Recertification Date	Update	Recertification	9/16/2022 11:06:50 AM	9/11/2023 8:23:21 PM	9/11/2023 8:23 PM
Contacts	Primary Contact	Update	Recertification	Fred, Linda Vice President of Pharmacy Services Carle Health 2179025803	Koch, Katie Director of 340B and Retail Pharmacy Operations Carle Foundation Hospital 2179047016	9/16/2022 11:06 AM
Details	Last Recertification Date	Update	Recertification	8/27/2021 11:26:09 AM	9/16/2022 11:06:50 AM	9/16/2022 11:06 AM
Details	Last Recertification Date	Update	Recertification	9/11/2020 7:32:54 AM	8/27/2021 11:26:09 AM	8/27/2021 11:26 AM
Contacts	Primary Contact	Update	Profile Change Request	Fred, Linda Pharmacy Director Carle Foundation Hospital 2179047001	Fred, Linda Vice President of Pharmacy Services Carle Health 2179025803	10/15/2020 1:21 PM
Addresses	Main Address	Update	Recertification	322 CHICAGO ST MILFORD, IL 60953	322 N. CHICAGO ST MILFORD, IL 60953	9/11/2020 7:32 AM
Medicaid Billing	NPI: State	Update	Recertification		IL	9/11/2020 7:32 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1992059976	9/11/2020 7:32 AM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/11/2020 7:32 AM
Details	Last Recertification Date	Update	Recertification	9/10/2019 1:38:37 PM	9/11/2020 7:32:54 AM	9/11/2020 7:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2019 1:38 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		201265720A	9/10/2019 1:38 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		IN	9/10/2019 1:38 PM
Details	Last Recertification Date	Update	Recertification	8/29/2018 12:42:47 PM	9/10/2019 1:38:37 PM	9/10/2019 1:38 PM
Details	Last Recertification Date	Update	Recertification	11/16/2017 4:43:30 PM	8/29/2018 12:42:47 PM	8/29/2018 12:42 PM
Details	Last Recertification Date	Update	Recertification	9/6/2016 12:00:00 AM	11/16/2017 4:43:30 PM	11/16/2017 4:43 PM
Details	Entity Name	Update	Recertification	HOOPESTON COMMUNITY MEMORIAL HOSPITA	Carle Hoopeston Regional Health Center	11/16/2017 4:23 PM
Contacts	Authorizing Official	Update		Hesch, Dennis P. Executive VP and CFO 2173268231	Hesch, Dennis P. Executive VP and CFO Carle Foundation Hospital 2173268231	10/10/2017 12:03 PM
Contacts	Signed By	Update		Hesch, Dennis P. Executive VP and CFO 2173268231	Hesch, Dennis P. Executive VP and CFO Carle Foundation Hospital 2173268231	10/10/2017 12:03 PM
Contacts	Primary Contact	Update		Fred, Linda Pharmacy Director 2179047001	Fred, Linda Pharmacy Director Carle Foundation Hospital 2179047001	10/10/2017 10:00 AM
Contacts	Authorizing Official	Insert			Hesch, Dennis P. Executive VP and CFO 2173268231	8/14/2017 12:51 PM
Contacts	Signed By	Insert			Hesch, Dennis P. Executive VP and CFO 2173268231	8/14/2017 12:51 PM
Contacts	Primary Contact	Insert			Fred, Linda Pharmacy Director 2179047001	8/1/2017 2:24 PM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	9/6/2016 12:00:00 AM	9/6/2016 7:13 PM
Addresses	Main Address	Insert			322 CHICAGO ST MILFORD, IL 60953	9/6/2016 7:13 PM
Addresses	Shipping Address	Insert			The Carle Foundation Hospital 502 North Busey Urbana, IL 61801	8/31/2015 8:40 AM
Addresses	Shipping Address	Insert			The Carle Foundation Hospital 611 West Park Street Urbana, IL 61801	8/31/2015 8:40 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/31/2015 8:40 AM
Medicaid Billing	Medicaid: Number	Insert			36-3637465010	8/31/2015 8:40 AM
Medicaid Billing	Medicaid: State	Insert			IL	8/31/2015 8:40 AM
Details	Last Recertification Date	Update			8/31/2015 12:00:00 AM	8/31/2015 8:40 AM
Addresses	Billing Address	Insert			The Carle Foundation Hospital 611 West Park Street Urbana, IL 60801-2529	7/30/2015 1:59 PM
Details	Entity Subname	Update		MILFORD MEDICAL CLINIC / Family Medicine / Family Medicine	MILFORD MEDICAL CLINIC / Family Medicine	12/12/2014 11:21 AM
Details	Entity Subname	Update		MILFORD MEDICAL CLINIC / Family Medicine	MILFORD MEDICAL CLINIC / Family Medicine / Family Medicine	11/13/2014 7:19 PM
Dates	Participating Approval Date	Update			11/13/2014 12:00:00 AM	11/13/2014 7:19 PM
Details	State	Update		Pending	Active	11/13/2014 7:19 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	11/13/2014 7:19 PM
Details	Entity Subname	Update		MILFORD MEDICAL CLINIC	MILFORD MEDICAL CLINIC / Family Medicine	10/29/2014 9:25 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_47383	CAH141316-22	10/29/2014 9:24 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_47383	10/14/2014 3:57 PM
Medicaid Billing	NPI: Number	Insert			1992059976	10/14/2014 3:56 PM
Details	Last Recertification Date	Insert				10/14/2014 3:56 PM
Details	Grant Number	Insert				10/14/2014 3:56 PM
Details	340B ID	Insert				10/14/2014 3:56 PM
Details	Is Authorizing Official EHB Data	Insert				10/14/2014 3:56 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/14/2014 3:56 PM
Details	Medicare Provider Number	Insert			141316	10/14/2014 3:56 PM
Details	Entity Name	Insert			HOOPESTON COMMUNITY MEMORIAL HOSPITA	10/14/2014 3:56 PM
Details	Program Code	Insert			CAH	10/14/2014 3:56 PM
Details	Entity Subname	Insert			MILFORD MEDICAL CLINIC	10/14/2014 3:56 PM
Dates	Participating Approval Date	Insert				10/14/2014 3:56 PM
Details	State	Insert			Pending	10/14/2014 3:56 PM
Dates	Registration Date	Insert			10/14/2014 12:00:00 AM	10/14/2014 3:56 PM
Dates	Signed By Date	Insert			10/14/2014 12:00:00 AM	10/14/2014 3:56 PM
Dates	Start Date	Insert				10/14/2014 3:56 PM
Terminations	Termination Comments	Insert				10/14/2014 3:56 PM
Terminations	Termination Date	Insert				10/14/2014 3:56 PM
Terminations	Termination Effective Date	Insert				10/14/2014 3:56 PM
Terminations	Termination Reason	Insert				10/14/2014 3:56 PM