Covered Entity Details

CAH521354-01 SOUTHWEST HEALTH CENTER (Active) - information as of 5/1/2025 11:49:19 PM

Main Details

Name

SOUTHWEST HEALTH CENTER

Subdivision Name

SOUTHWEST HEALTH PLATTEVILLE CLINIC - Family Practice, General Surgery

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH521354-01

Medicare Provider Number

521354

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/8/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/13/2015

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Southwest Health Center, Inc.
Jesse William Sookochoff, Chief Financial Officer
(608) 342-4705

Primary Contact

Southwest Health
Jeff McDonald, Outpatient Pharmacy Director
(608) 342-6333

Addresses

Street Address

1450 EASTSIDE RD
PLATTEVILLE, WI 53818-9800

Billing Address

Southwest Health
1400 East Side Road
Platteville, WI 53818-9800

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
CAH521354-01	Child	CAH	SOUTHWEST HEALTH CENTER	SOUTHWEST HEALTH PLATTEVILLE CLINIC - Family Practice, General Surgery	1450 EASTSIDE RD	PLATTEVILLE	WI	Active
CAH521354-02	Child	CAH	SOUTHWEST HEALTH CENTER	CUBA CITY CLINIC	2388 State Rd 80	CUBA CITY	WI	Active
CAH521354-03	Child	CAH	SOUTHWEST HEALTH CENTER	Kieler Clinic - Outpatient Clinic	3695 Prism Ln	Kieler	WI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/16/2023 4:52:45 PM	8/13/2024 5:02:06 PM	8/13/2024 5:02 PM
Addresses	Billing Address	Insert	Change Request		Southwest Health 1400 East Side Road Platteville, WI 53818-9800	5/24/2024 12:13 PM
Details	Last Recertification Date	Update	Recertification	9/6/2022 8:19:37 AM	8/16/2023 4:52:45 PM	8/16/2023 4:52 PM
Contacts	Authorizing Official	Update	AO Change Request	Rohrbach, Dan CEO Southwest Health 6083424701	Sookochoff, Jesse William Chief Financial Officer Southwest Health Center, Inc. 6083424705	7/18/2023 10:49 AM
Contacts	Primary Contact	Update	Group Change Request	Schobert, Bryant Director of Outpatient Pharmacy Services Southwest Health, Inc. 6083426200	McDonald, Jeff Outpatient Pharmacy Director Southwest Health 6083426333	3/15/2023 12:38 PM
Details	Last Recertification Date	Update	Recertification	8/17/2021 2:12:08 PM	9/6/2022 8:19:37 AM	9/6/2022 8:19 AM
Details	Last Recertification Date	Update	Recertification	8/17/2020 11:20:42 AM	8/17/2021 2:12:08 PM	8/17/2021 2:12 PM
Details	Last Recertification Date	Update	Recertification	8/19/2019 9:14:08 AM	8/17/2020 11:20:42 AM	8/17/2020 11:20 AM
Details	Last Recertification Date	Update	Recertification	8/16/2018 10:01:17 AM	8/19/2019 9:14:08 AM	8/19/2019 9:14 AM
Contacts	Primary Contact	Update	Recertification	Purcell, Kevin Director of Pharmacy Southwest Health 6083424753	Schobert, Bryant Director of Outpatient Pharmacy Services Southwest Health, Inc. 6083426200	8/16/2018 10:01 AM
Details	Last Recertification Date	Update	Recertification	11/9/2017 9:34:57 AM	8/16/2018 10:01:17 AM	8/16/2018 10:01 AM
Details	Last Recertification Date	Update	Recertification	10/25/2017 5:08:39 PM	11/9/2017 9:34:57 AM	11/9/2017 9:34 AM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	10/25/2017 5:08:39 PM	10/25/2017 5:08 PM
Contacts	Authorizing Official	Update		Rohrbach, Dan CEO 6083424701	Rohrbach, Dan CEO Southwest Health 6083424701	10/18/2017 11:18 AM
Contacts	Primary Contact	Update		Purcell, Kevin Director of Pharmacy 6083424753	Purcell, Kevin Director of Pharmacy Southwest Health 6083424753	9/25/2017 3:47 PM
Contacts	Authorizing Official	Insert			Rohrbach, Dan CEO 6083424701	8/9/2017 2:59 PM
Contacts	Primary Contact	Insert			Purcell, Kevin Director of Pharmacy 6083424753	7/26/2017 3:39 PM
Addresses	Main Address	Insert			1450 EASTSIDE RD PLATTEVILLE, WI 53818-9800	8/11/2016 12:04 PM
Contacts	Signed By	Insert			Streeter, Matthew CFO 6083424705	8/11/2016 12:04 PM
Details	Last Recertification Date	Update		9/8/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 12:04 PM
Details	Last Recertification Date	Update			9/8/2015 12:00:00 AM	9/8/2015 10:00 AM
Dates	Participating Approval Date	Update			3/13/2015 12:00:00 AM	3/13/2015 10:47 AM
Details	State	Update		Pending	Active	3/13/2015 10:47 AM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/13/2015 10:47 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_48446	CAH521354-01	2/26/2015 4:30 PM
Details	Entity Subname	Update		SOUTHWEST HEALTH PLATTEVILLE CLINIC / Family Practice, General Surgery	SOUTHWEST HEALTH PLATTEVILLE CLINIC - Family Practice, General Surgery	2/26/2015 4:30 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_48446	1/8/2015 3:14 PM
Details	Last Recertification Date	Insert				1/8/2015 3:14 PM
Details	Grant Number	Insert				1/8/2015 3:14 PM
Details	340B ID	Insert				1/8/2015 3:14 PM
Details	Is Authorizing Official EHB Data	Insert				1/8/2015 3:14 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/8/2015 3:14 PM
Details	Medicare Provider Number	Insert			521354	1/8/2015 3:14 PM
Details	Entity Name	Insert			SOUTHWEST HEALTH CENTER	1/8/2015 3:14 PM
Details	Program Code	Insert			CAH	1/8/2015 3:14 PM
Details	Entity Subname	Insert			SOUTHWEST HEALTH PLATTEVILLE CLINIC / Family Practice, General Surgery	1/8/2015 3:14 PM
Dates	Participating Approval Date	Insert				1/8/2015 3:14 PM
Details	State	Insert			Pending	1/8/2015 3:14 PM
Dates	Registration Date	Insert			1/8/2015 12:00:00 AM	1/8/2015 3:14 PM
Dates	Signed By Date	Insert			1/8/2015 12:00:00 AM	1/8/2015 3:14 PM
Dates	Start Date	Insert				1/8/2015 3:14 PM
Terminations	Termination Comments	Insert				1/8/2015 3:14 PM
Terminations	Termination Date	Insert				1/8/2015 3:14 PM
Terminations	Termination Effective Date	Insert				1/8/2015 3:14 PM
Terminations	Termination Reason	Insert				1/8/2015 3:14 PM