Covered Entity Details

CAH281359-01 MEMORIAL COMMUNITY HOSPITAL (Active) - information as of 4/25/2025 9:23:00 PM

Main Details

Name

MEMORIAL COMMUNITY HOSPITAL

Subdivision Name

Blair Clinic MCH Physicians

Type

Critical Access Hospital

Rural

340B ID

CAH281359-01

Medicare Provider Number

281359

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/6/2015

Participating Start Date

4/1/2015

Participating Approval Date

2/10/2015

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

MEMORIAL COMMUNITY HOSPITAL
JENNIFER NEWBY, Operations Director, Finance and Support Services
(402) 426-1295

Primary Contact

MEMORIAL COMMUNITY HOSPITAL
BRAD STUVA, PHARMACY MANAGER
(402) 426-1159

Addresses

Street Address

812 North 22nd Street
Blair, NE 68008

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
CAH281359-01	Child	CAH	MEMORIAL COMMUNITY HOSPITAL	Blair Clinic MCH Physicians	812 North 22nd Street	Blair	NE	Active
CAH281359-02	Child	CAH	MEMORIAL COMMUNITY HOSPITAL	Cottonwood RHC	3519 Hwy 32	Tekamah	NE	Active
CAH281359-03	Child	CAH	MEMORIAL COMMUNITY HOSPITAL	Fort Calhoun RHC	4929 County Road P-43	Fort Calhoun	NE	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Banner, Manuela President/CEO Memorial Community Hospital and Health System 4024261261	STUVA, BRAD PHARMACY MANAGER MEMORIAL COMMUNITY HOSPITAL 4024261159	8/20/2024 11:20 AM
Details	Last Recertification Date	Update	Recertification	8/23/2023 12:23:25 PM	8/14/2024 10:43:13 AM	8/14/2024 10:43 AM
Details	Last Recertification Date	Update	Recertification	9/12/2022 11:05:26 AM	8/23/2023 12:23:25 PM	8/23/2023 12:23 PM
Contacts	Primary Contact	Update	PC Change Request	SMITH, PATTY PHARMACY MANAGER MEMORIAL COMMUNITY HOSPITAL 4024261159	Banner, Manuela President/CEO Memorial Community Hospital and Health System 4024261261	1/18/2023 1:48 PM
Addresses	Main Address	Update	Recertification	812 N. 22nd Street Blair, NE 68008	812 North 22nd Street Blair, NE 68008	9/12/2022 11:05 AM
Details	Last Recertification Date	Update	Recertification	8/25/2021 6:58:51 PM	9/12/2022 11:05:26 AM	9/12/2022 11:05 AM
Contacts	Authorizing Official	Update	AO Change Request	SCHNACK, TIM CHIEF FINANCIAL OFFICER Memorial Community Hospital 4024262182	NEWBY, JENNIFER Operations Director, Finance and Support Services MEMORIAL COMMUNITY HOSPITAL 4024261295	9/7/2022 9:36 AM
Details	Last Recertification Date	Update	Recertification	9/8/2020 3:05:50 PM	8/25/2021 6:58:51 PM	8/25/2021 6:58 PM
Details	Last Recertification Date	Update	Recertification	9/6/2019 8:07:12 AM	9/8/2020 3:05:50 PM	9/8/2020 3:05 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 3:47:34 PM	9/6/2019 8:07:12 AM	9/6/2019 8:07 AM
Details	Entity Name	Update	Recertification	MEMORIAL COMMUNITY HOSPITAL CORPORATION	MEMORIAL COMMUNITY HOSPITAL	8/27/2018 9:13 AM
Details	Last Recertification Date	Update	Recertification	11/17/2017 6:42:20 PM	8/21/2018 3:47:34 PM	8/21/2018 3:47 PM
Details	Entity Subname	Update	Recertification	RHC-Blair	Blair Clinic MCH Physicians	8/21/2018 3:47 PM
Details	Entity Name	Update	Recertification	MEMORIAL COMMUNITY HOSPITAL	MEMORIAL COMMUNITY HOSPITAL CORPORATION	11/18/2017 12:11 PM
Contacts	Primary Contact	Update	Recertification	SCHNACK, TIM CHIEF FINANCIAL OFFICER 4024262182	SMITH, PATTY PHARMACY MANAGER MEMORIAL COMMUNITY HOSPITAL 4024261159	11/17/2017 6:42 PM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	11/17/2017 6:42:20 PM	11/17/2017 6:42 PM
Contacts	Authorizing Official	Update		SCHNACK, TIM CHIEF FINANCIAL OFFICER 4024262182	SCHNACK, TIM CHIEF FINANCIAL OFFICER Memorial Community Hospital 4024262182	9/29/2017 9:02 AM
Contacts	Signed By	Update		SCHNACK, TIM CHIEF FINANCIAL OFFICER 4024262182	SCHNACK, TIM CHIEF FINANCIAL OFFICER Memorial Community Hospital 4024262182	9/29/2017 9:02 AM
Addresses	Main Address	Insert			812 N. 22nd Street Blair, NE 68008	8/11/2016 10:16 AM
Contacts	Authorizing Official	Insert			SCHNACK, TIM CHIEF FINANCIAL OFFICER 4024262182	8/11/2016 10:16 AM
Contacts	Primary Contact	Insert			SCHNACK, TIM CHIEF FINANCIAL OFFICER 4024262182	8/11/2016 10:16 AM
Contacts	Signed By	Insert			SCHNACK, TIM CHIEF FINANCIAL OFFICER 4024262182	8/11/2016 10:16 AM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 10:16 AM
Details	Last Recertification Date	Update			8/17/2015 12:00:00 AM	8/17/2015 8:43 AM
Dates	Participating Approval Date	Update			2/10/2015 12:00:00 AM	2/10/2015 5:42 AM
Details	State	Update		Pending	Active	2/10/2015 5:42 AM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	2/10/2015 5:42 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_48251	CAH281359-01	1/7/2015 5:48 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_48251	1/6/2015 2:01 PM
Details	Last Recertification Date	Insert				1/6/2015 2:01 PM
Details	Grant Number	Insert				1/6/2015 2:01 PM
Details	340B ID	Insert				1/6/2015 2:01 PM
Details	Is Authorizing Official EHB Data	Insert				1/6/2015 2:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/6/2015 2:01 PM
Details	Medicare Provider Number	Insert			281359	1/6/2015 2:01 PM
Details	Entity Name	Insert			MEMORIAL COMMUNITY HOSPITAL	1/6/2015 2:01 PM
Details	Program Code	Insert			CAH	1/6/2015 2:01 PM
Details	Entity Subname	Insert			RHC-Blair	1/6/2015 2:01 PM
Dates	Participating Approval Date	Insert				1/6/2015 2:01 PM
Details	State	Insert			Pending	1/6/2015 2:01 PM
Dates	Registration Date	Insert			1/6/2015 12:00:00 AM	1/6/2015 2:01 PM
Dates	Signed By Date	Insert			1/6/2015 12:00:00 AM	1/6/2015 2:01 PM
Dates	Start Date	Insert				1/6/2015 2:01 PM
Terminations	Termination Comments	Insert				1/6/2015 2:01 PM
Terminations	Termination Date	Insert				1/6/2015 2:01 PM
Terminations	Termination Effective Date	Insert				1/6/2015 2:01 PM
Terminations	Termination Reason	Insert				1/6/2015 2:01 PM