| Details | Last Recertification Date | Update | Recertification | 8/15/2023 2:08:14 PM | 9/3/2024 11:34:28 AM | 9/3/2024 11:34 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2022 11:22:42 AM | 8/15/2023 2:08:14 PM | 8/15/2023 2:08 PM |
| Contacts | Authorizing Official | Update | Change Request | Harris, Hollie P
President & CEO
Appalachian Regional Healthcare, Inc
8592262511 | Braman, Maria
Chief Medical Officer
ARH
4064658506 | 6/1/2023 7:33 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Herald, Michael
Interim CEO of Pharmaceutical Services
Appalachian Regional Healthcare, Inc
6064381210 | Herald, Michael
Associate Vice President of Pharmaceutical Services
Appalachian Regional Healthcare, Inc
6064381210 | 2/15/2023 3:07 PM |
| Contacts | Primary Contact | Update | Group Change Request | Akers, Jeffrey
CEO of Pharmaceutical Services
Appalachian Regional Healthcare
6066162296 | Herald, Michael
Interim CEO of Pharmaceutical Services
Appalachian Regional Healthcare, Inc
6064381210 | 9/13/2022 2:22 PM |
| Details | Last Recertification Date | Update | Recertification | 9/9/2021 9:27:14 AM | 8/26/2022 11:22:42 AM | 8/26/2022 11:22 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Akers, Jeffrey
System Director of Pharmacy
Appalachian Regional Healthcare
6066162296 | Akers, Jeffrey
CEO of Pharmaceutical Services
Appalachian Regional Healthcare
6066162296 | 2/8/2022 7:53 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Harris, Hollie P
President & CEO
Appalachian Regional Healthcare, Inc
8592262468 | Harris, Hollie P
President & CEO
Appalachian Regional Healthcare, Inc
8592262511 | 1/28/2022 9:09 AM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1578647657 (KY) | | 1/17/2022 11:45 AM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1053904573 (KY) | | 1/17/2022 11:45 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1023114469 | 1/17/2022 11:45 AM |
| Medicaid Billing | NPI: State | Insert | Change Request | | KY | 1/17/2022 11:45 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1669078879 | 1/17/2022 11:45 AM |
| Medicaid Billing | NPI: State | Insert | Change Request | | KY | 1/17/2022 11:45 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1144814757 | 9/9/2021 9:27 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | KY | 9/9/2021 9:27 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1154917391 | 9/9/2021 9:27 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | KY | 9/9/2021 9:27 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1871189019 | 9/9/2021 9:27 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | KY | 9/9/2021 9:27 AM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2020 3:27:05 PM | 9/9/2021 9:27:14 AM | 9/9/2021 9:27 AM |
| Addresses | Main Address | Update | Change Request |
30 Ky. Rt. 306
Bypro, KY 41612 |
62 KY Route 306
Bypro, KY 41612 | 7/8/2021 12:44 PM |
| Medicaid Billing | Medicaid: Number | Delete | Group Change Request | 1053904573 (KY) | | 6/30/2021 5:07 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Group Change Request | | False | 6/30/2021 5:07 PM |
| Medicaid Billing | Medicaid: Number | Insert | Group Change Request | | 7100732480 | 6/30/2021 5:07 PM |
| Medicaid Billing | Medicaid: State | Insert | Group Change Request | | KY | 6/30/2021 5:07 PM |
| Medicaid Billing | NPI: Number | Insert | Group Change Request | | 1053904573 | 6/30/2021 5:07 PM |
| Medicaid Billing | NPI: State | Insert | Group Change Request | | KY | 6/30/2021 5:07 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Group Change Request | | False | 6/30/2021 4:51 PM |
| Medicaid Billing | Medicaid: Number | Insert | Group Change Request | | 1053904573 | 6/30/2021 4:51 PM |
| Medicaid Billing | Medicaid: State | Insert | Group Change Request | | KY | 6/30/2021 4:51 PM |
| Contacts | Authorizing Official | Update | Change Request | Grossman, Joseph
PRESIDENT and CEO
Appalachian Regional Healthcare
8592262450 | Harris, Hollie P
President & CEO
Appalachian Regional Healthcare, Inc
8592262468 | 5/14/2021 11:21 AM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 7100039160 (KY) | | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 7100499680 | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | KY | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 7100499660 | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | KY | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 7100503250 | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | KY | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 101494300 | 8/25/2020 3:27 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | KY | 8/25/2020 3:27 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1861671117 ( ) | | 8/25/2020 3:27 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1649209263 | 8/25/2020 3:27 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | KY | 8/25/2020 3:27 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1861671117 | 8/25/2020 3:27 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | KY | 8/25/2020 3:27 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1275607822 | 8/25/2020 3:27 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | KY | 8/25/2020 3:27 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1578647657 | 8/25/2020 3:27 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | KY | 8/25/2020 3:27 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1649209263 ( ) | | 8/25/2020 3:27 PM |
| Details | Last Recertification Date | Update | Recertification | 9/4/2019 10:44:20 AM | 8/25/2020 3:27:05 PM | 8/25/2020 3:27 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Akers, Jeffrey
System Director of Pharmacy
Appalachian Regional Healthcare
6064396988 | Akers, Jeffrey
System Director of Pharmacy
Appalachian Regional Healthcare
6066162296 | 1/8/2020 11:00 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/4/2019 10:44 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 7100039160 | 9/4/2019 10:44 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | KY | 9/4/2019 10:44 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1861671117 | 9/4/2019 10:44 AM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2018 11:28:31 AM | 9/4/2019 10:44:20 AM | 9/4/2019 10:44 AM |
| Addresses | Billing Address | Update | Change Request | Appalachian Regional Healthcare, Inc.
200 Hospital Drive
South Williamson, KY 41503 | McDowell ARH Hospital - Accounts Payable
200 Hospital Drive
South Williamson, KY 41503 | 9/4/2018 9:13 PM |
| Addresses | Billing Address | Insert | Recertification | | Appalachian Regional Healthcare, Inc.
200 Hospital Drive
South Williamson, KY 41503 | 8/31/2018 11:28 AM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 101494300 (KY) | | 8/31/2018 11:28 AM |
| Details | Last Recertification Date | Update | Recertification | 11/28/2017 9:33:40 AM | 8/31/2018 11:28:31 AM | 8/31/2018 11:28 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/11/2018 9:22 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 101494300 | 1/11/2018 9:22 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | KY | 1/11/2018 9:22 AM |
| Details | Entity Name | Update | Recertification | MCDOWELL ARH | APPALACHIAN REGIONAL HEALTHCARE INC. D/B/A MCDOWELL ARH HOSPITAL | 11/29/2017 11:26 AM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2016 12:00:00 AM | 11/28/2017 9:33:40 AM | 11/28/2017 9:33 AM |
| Contacts | Authorizing Official | Update | | Grossman, Joseph
PRESIDENT and CEO
8592262450 | Grossman, Joseph
PRESIDENT and CEO
Appalachian Regional Healthcare
8592262450 | 9/22/2017 4:03 PM |
| Contacts | Signed By | Update | | Grossman, Joseph
PRESIDENT and CEO
8592262450 | Grossman, Joseph
PRESIDENT and CEO
Appalachian Regional Healthcare
8592262450 | 9/22/2017 4:03 PM |
| Contacts | Primary Contact | Update | | Akers, Jeffrey
System Director of Pharmacy
6064396988 | Akers, Jeffrey
System Director of Pharmacy
Appalachian Regional Healthcare
6064396988 | 9/22/2017 3:59 PM |
| Contacts | Authorizing Official | Insert | | | Grossman, Joseph
PRESIDENT and CEO
8592262450 | 8/1/2017 2:30 PM |
| Contacts | Signed By | Insert | | | Grossman, Joseph
PRESIDENT and CEO
8592262450 | 8/1/2017 2:30 PM |
| Contacts | Primary Contact | Insert | | | Akers, Jeffrey
System Director of Pharmacy
6064396988 | 8/1/2017 2:30 PM |
| Addresses | Main Address | Insert | | |
30 Ky. Rt. 306
Bypro, KY 41612 | 8/15/2016 4:54 PM |
| Details | Last Recertification Date | Update | | | 8/15/2016 12:00:00 AM | 8/15/2016 4:54 PM |
| Dates | Participating Approval Date | Update | | | 8/12/2015 12:00:00 AM | 8/12/2015 5:50 PM |
| Details | State | Update | | Pending | Active | 8/12/2015 5:50 PM |
| Dates | Start Date | Update | | | 10/1/2015 12:00:00 AM | 8/12/2015 5:50 PM |
| Addresses | Shipping Address | Insert | | | McDowell ARH Hospital
Route 122
McDowell, KY 41647 | 8/12/2015 5:50 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_52999 | CAH181331-02 | 8/12/2015 4:07 PM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_52999 | 7/10/2015 11:57 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/10/2015 11:57 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 01014943 | 7/10/2015 11:57 AM |
| Medicaid Billing | Medicaid: State | Insert | | | KY | 7/10/2015 11:57 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1649209263 | 7/10/2015 11:57 AM |
| Details | Last Recertification Date | Insert | | | | 7/10/2015 11:57 AM |
| Details | Grant Number | Insert | | | | 7/10/2015 11:57 AM |
| Details | 340B ID | Insert | | | | 7/10/2015 11:57 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/10/2015 11:57 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/10/2015 11:57 AM |
| Details | Medicare Provider Number | Insert | | | 181331 | 7/10/2015 11:57 AM |
| Details | Entity Name | Insert | | | MCDOWELL ARH | 7/10/2015 11:57 AM |
| Details | Program Code | Insert | | | CAH | 7/10/2015 11:57 AM |
| Details | Entity Subname | Insert | | | ARH FAMILY CARE-WHEELWRIGHT | 7/10/2015 11:57 AM |
| Dates | Participating Approval Date | Insert | | | | 7/10/2015 11:57 AM |
| Details | State | Insert | | | Pending | 7/10/2015 11:57 AM |
| Dates | Registration Date | Insert | | | 7/10/2015 12:00:00 AM | 7/10/2015 11:57 AM |
| Dates | Signed By Date | Insert | | | 7/10/2015 12:00:00 AM | 7/10/2015 11:57 AM |
| Dates | Start Date | Insert | | | | 7/10/2015 11:57 AM |
| Terminations | Termination Comments | Insert | | | | 7/10/2015 11:57 AM |
| Terminations | Termination Date | Insert | | | | 7/10/2015 11:57 AM |
| Terminations | Termination Effective Date | Insert | | | | 7/10/2015 11:57 AM |
| Terminations | Termination Reason | Insert | | | | 7/10/2015 11:57 AM |