Covered Entity Details

CAH161301-01 BELMOND COMMUNITY HOSPITAL (Active) - information as of 5/13/2025 1:44:50 AM

Main Details

Name

BELMOND COMMUNITY HOSPITAL

Subdivision Name

Belmond Community Hospital / Hampton Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH161301-01

Medicare Provider Number

161301

Outpatient Facility Provider Number

168559

Additional Details

Current Program Status

Active

Registration Date

1/2/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/13/2015

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Iowa Specialty Hospital - Clarion and Belmond Community Hospital
GREG POLZIN, CFO
(641) 444-5623

Primary Contact

Iowa Specialty Hospital
REAGAN SWISHER, CCO
(641) 444-5624

Addresses

Street Address

700 2ND ST SE
Suite 101
HAMPTON, IA 50441-2655

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
CAH161301-01	Child	CAH	BELMOND COMMUNITY HOSPITAL	Belmond Community Hospital / Hampton Clinic	700 2ND ST SE	HAMPTON	IA	Active
CAH161301-02	Child	CAH	BELMOND COMMUNITY HOSPITAL	BELMOND COMMUNITY HOSPITAL / Belmond Clinic	403 1ST ST SE	BELMOND	IA	Active
CAH161301-03	Child	CAH	BELMOND COMMUNITY HOSPITAL	BELMOND COMMUNITY HOSPITAL - Garner Clinic - Rural Health Clinic	840 W US HIGHWAY 18	GARNER	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 10:25:19 AM	8/21/2024 11:22:15 AM	8/21/2024 11:22 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 9:02:42 AM	8/17/2023 10:25:19 AM	8/17/2023 10:25 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 9:06:12 AM	8/29/2022 9:02:42 AM	8/29/2022 9:02 AM
Details	Last Recertification Date	Update	Recertification	8/17/2020 9:22:10 AM	8/16/2021 9:06:12 AM	8/16/2021 9:06 AM
Details	Last Recertification Date	Update	Recertification	8/19/2019 9:27:20 AM	8/17/2020 9:22:10 AM	8/17/2020 9:22 AM
Details	Last Recertification Date	Update	Recertification	8/16/2018 5:07:17 PM	8/19/2019 9:27:20 AM	8/19/2019 9:27 AM
Details	Last Recertification Date	Update	Recertification	11/6/2017 4:34:58 PM	8/16/2018 5:07:17 PM	8/16/2018 5:07 PM
Details	Entity Name	Update	Recertification	IOWA SPECIALTY HOSPITAL	BELMOND COMMUNITY HOSPITAL	11/8/2017 10:19 AM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/6/2017 4:34:58 PM	11/6/2017 4:34 PM
Contacts	Primary Contact	Update		SWISHER, REAGAN CCO 6414445624	SWISHER, REAGAN CCO Iowa Specialty Hospital 6414445624	9/25/2017 11:16 AM
Contacts	Authorizing Official	Update		POLZIN, GREG CFO 6414445623	POLZIN, GREG CFO Iowa Specialty Hospital - Clarion and Belmond Community Hospital 6414445623	9/25/2017 10:21 AM
Contacts	Signed By	Update		POLZIN, GREG CFO 6414445623	POLZIN, GREG CFO Iowa Specialty Hospital - Clarion and Belmond Community Hospital 6414445623	9/25/2017 10:21 AM
Contacts	Authorizing Official	Insert			POLZIN, GREG CFO 6414445623	7/13/2017 8:43 AM
Contacts	Signed By	Insert			POLZIN, GREG CFO 6414445623	7/13/2017 8:43 AM
Contacts	Primary Contact	Insert			SWISHER, REAGAN CCO 6414445624	12/9/2016 4:57 PM
Addresses	Main Address	Insert			700 2ND ST SE Suite 101 HAMPTON, IA 50441-2655	12/9/2016 4:56 PM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 9:51 AM
Details	Last Recertification Date	Update			8/10/2015 12:00:00 AM	8/10/2015 9:58 AM
Dates	Participating Approval Date	Update			3/13/2015 12:00:00 AM	3/13/2015 10:49 AM
Details	State	Update		Pending	Active	3/13/2015 10:49 AM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/13/2015 10:49 AM
Details	Entity Subname	Update		Belmond / Hampton Clinic	Belmond Community Hospital / Hampton Clinic	1/5/2015 7:15 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_48209	CAH161301-01	1/5/2015 7:11 PM
Details	Entity Name	Update		IOWA SPECIALTY HOSPITAL - BELMOND	IOWA SPECIALTY HOSPITAL	1/5/2015 7:11 PM
Details	Entity Subname	Update		HAMPTON CLINIC / Hampton Clinic	Belmond / Hampton Clinic	1/5/2015 7:11 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_48209	1/2/2015 4:22 PM
Details	Last Recertification Date	Insert				1/2/2015 4:22 PM
Details	Grant Number	Insert				1/2/2015 4:22 PM
Details	340B ID	Insert				1/2/2015 4:22 PM
Details	Is Authorizing Official EHB Data	Insert				1/2/2015 4:22 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/2/2015 4:22 PM
Details	Medicare Provider Number	Insert			161301	1/2/2015 4:22 PM
Details	Entity Name	Insert			IOWA SPECIALTY HOSPITAL - BELMOND	1/2/2015 4:22 PM
Details	Program Code	Insert			CAH	1/2/2015 4:22 PM
Details	Entity Subname	Insert			HAMPTON CLINIC / Hampton Clinic	1/2/2015 4:22 PM
Dates	Participating Approval Date	Insert				1/2/2015 4:22 PM
Details	State	Insert			Pending	1/2/2015 4:22 PM
Dates	Registration Date	Insert			1/2/2015 12:00:00 AM	1/2/2015 4:22 PM
Dates	Signed By Date	Insert			1/2/2015 12:00:00 AM	1/2/2015 4:22 PM
Dates	Start Date	Insert				1/2/2015 4:22 PM
Terminations	Termination Comments	Insert				1/2/2015 4:22 PM
Terminations	Termination Date	Insert				1/2/2015 4:22 PM
Terminations	Termination Effective Date	Insert				1/2/2015 4:22 PM
Terminations	Termination Reason	Insert				1/2/2015 4:22 PM