Covered Entity Details

CAH161335-00 PEOPLES MEMORIAL HOSPITAL dba Buchanan County Health Center (Active) - information as of 6/21/2025 12:06:22 AM

Main Details

Name

PEOPLES MEMORIAL HOSPITAL dba Buchanan County Health Center

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH161335-00

Medicare Provider Number

161335

Additional Details

Current Program Status

Active

Registration Date

10/15/2015

Participating Start Date

1/1/2016

Participating Approval Date

11/20/2015

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Buchanan County Health Center
Wade Eugene Weis, CEO
(319) 332-0900

Primary Contact

Buchanan County Health Center
Christopher Clayton, Director of Pharmacy
(319) 332-0894

Addresses

Street Address

1600 First Street East
INDEPENDENCE, IA 50644

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?
Yes

State	Medicaid Number	NPI Number
IA	0226542,06-00866	1265595144,1386201333,1558920447,1518417518

Shipping Addresses

Shipping Address 1

PEOPLES MEMORIAL HOSPITAL dba Buchanan County Health Center
1600 First Street East
INDEPENDENCE, IA 50644

Shipping Address 2

PEOPLES MEMORIAL HOSPITAL dba BCHC Oelwein Pharmacy
2405 Rock Island Rd
Oelwein, IA 50662

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	HARTIG DRUG CO INC	DBA HARTIG DRUG CO #14	201 1ST ST W	INDEPENDENCE	IA	50644	07/06/2018	10/01/2018		10/01/2018
Contract Detail	HY-VEE, INC.	HY-VEE PHARMACY #1459	1345 S FREDERICK AVE	OELWEIN	IA	50662-3060	10/06/2020	01/01/2021		01/01/2021
Contract Detail	MERCYONE JESUP PHARMACY	1094 220TH ST		JESUP	IA	50648-9400	10/06/2020	01/01/2021		01/01/2021
Contract Detail	OELWEIN FAMILY PHARMACY	DON'S PHARMACY, LTD	32 SOUTH FREDERICK	OELWEIN	IA	50662	10/01/2019	01/01/2020	09/04/2020	09/04/2020
Contract Detail	OELWEIN FAMILY PHARMACY ROCK ISLAND ROAD	2405 ROCK ISLAND RD		OELWEIN	IA	50662	04/10/2020	07/01/2020	09/04/2020	09/04/2020
Contract Detail	RYAN PHARMACY	1600 1ST ST E		INDEPENDENCE	IA	50644-3155	07/12/2018	10/01/2018		10/01/2018
Contract Detail	SCOTT PHARMACY	238 S MAIN ST	PO BOX 188	FAYETTE	IA	52142	01/07/2019	04/01/2019	04/01/2019	04/01/2019
Contract Detail	SCOTT PHARMACY	238 S MAIN ST	PO BOX 188	FAYETTE	IA	52142	04/03/2019	07/01/2019		07/01/2019
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/03/2018	10/01/2018		10/01/2018
Contract Detail	WAL-MART PHARMACY 10-0750	302 ENTERPRISE DRIVE SW		INDEPENDENCE	IA	50644	07/03/2018	10/01/2018		10/01/2018
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/03/2018	10/01/2018		10/01/2018

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH161335-01	Child	CAH	PEOPLES MEMORIAL HOSPITAL dba Buchanan County Health Center	PEOPLE'S MEMORIAL HOSPITAL - Primary Care	211 SOUTH ST W	JESUP	IA	Active
CAH161335-02	Child	CAH	PEOPLES MEMORIAL HOSPITAL dba Buchanan County Health Center	PEOPLE'S MEMORIAL HOSPITAL - Primary Care	2405 ROCK ISLAND RD	OELWEIN	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 8:58:43 AM	8/15/2024 2:44:15 PM	8/15/2024 2:44 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 1:05:38 PM	8/15/2023 8:58:43 AM	8/15/2023 8:58 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 10:24:16 AM	9/8/2022 1:05:38 PM	9/8/2022 1:05 PM
Contacts	Authorizing Official	Update	Change Request	Stevens, Benjamin W. Chief Financial Officer Buchanan County Health Center 3193320880	Weis, Wade Eugene CEO Buchanan County Health Center 3193320900	5/20/2022 1:48 PM
Details	Last Recertification Date	Update	Recertification	8/17/2020 8:06:20 AM	8/16/2021 10:24:16 AM	8/16/2021 10:24 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 3:31 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0226542	11/9/2020 3:31 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IA	11/9/2020 3:31 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1518417518	11/9/2020 3:31 PM
Medicaid Billing	NPI: State	Insert	Change Request		IA	11/9/2020 3:31 PM
Addresses	Shipping Address	Insert	Change Request		PEOPLES MEMORIAL HOSPITAL dba Buchanan County Health Center 1600 First Street East INDEPENDENCE, IA 50644	9/15/2020 10:26 AM
Addresses	Shipping Address	Insert	Change Request		PEOPLES MEMORIAL HOSPITAL dba BCHC Oelwein Pharmacy 2405 Rock Island Rd Oelwein, IA 50662	9/15/2020 10:26 AM
Contacts	Primary Contact	Update	Change Request	Haefner, Julie A Director of Pharmacy Buchanan County Health Center 3193320868	Clayton, Christopher Director of Pharmacy Buchanan County Health Center 3193320894	9/15/2020 10:26 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1518417518 ( )		8/17/2020 8:06 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1265595144	8/17/2020 8:06 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/17/2020 8:06 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1386201333	8/17/2020 8:06 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/17/2020 8:06 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1558920447	8/17/2020 8:06 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/17/2020 8:06 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265595144 ( )		8/17/2020 8:06 AM
Details	Last Recertification Date	Update	Recertification	8/19/2019 7:40:15 AM	8/17/2020 8:06:20 AM	8/17/2020 8:06 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1518417518	3/11/2020 9:42 AM
Contacts	Primary Contact	Update	Change Request	Clayton, Christopher Director of Pharmacy Buchanan County Health Center 3193320999	Haefner, Julie A Director of Pharmacy Buchanan County Health Center 3193320868	12/12/2019 1:53 PM
Details	Last Recertification Date	Update	Recertification	8/15/2018 7:36:44 AM	8/19/2019 7:40:15 AM	8/19/2019 7:40 AM
Contacts	Primary Contact	Update	Change Request	Hickey, William C. Pharmacy Manager Peoples Memorial Hospital 3193320868	Clayton, Christopher Director of Pharmacy Buchanan County Health Center 3193320999	6/3/2019 9:23 AM
Details	Last Recertification Date	Update	Recertification	12/5/2017 7:20:55 PM	8/15/2018 7:36:44 AM	8/15/2018 7:36 AM
Details	Entity Name	Update	Change Request	PEOPLES MEMORIAL HOSPITAL	PEOPLES MEMORIAL HOSPITAL dba Buchanan County Health Center	8/7/2018 9:17 AM
Details	Last Recertification Date	Update	Recertification	9/7/2016 12:00:00 AM	12/5/2017 7:20:55 PM	12/5/2017 7:20 PM
Contacts	Authorizing Official	Update		Stevens, Benjamin W. Chief Financial Officer 3193320880	Stevens, Benjamin W. Chief Financial Officer Buchanan County Health Center 3193320880	12/5/2017 5:46 PM
Contacts	Signed By	Update		Stevens, Benjamin W. Chief Financial Officer 3193320880	Stevens, Benjamin W. Chief Financial Officer Buchanan County Health Center 3193320880	12/5/2017 5:46 PM
Contacts	Primary Contact	Update		Hickey, William C. Pharmacy Manager 3193320868	Hickey, William C. Pharmacy Manager Peoples Memorial Hospital 3193320868	11/27/2017 12:26 PM
Addresses	Main Address	Insert			1600 FIRST STREET EAST INDEPENDENCE, IA 50644	9/7/2016 9:46 AM
Contacts	Primary Contact	Insert			Hickey, William C. Pharmacy Manager 3193320868	9/7/2016 9:46 AM
Contacts	Authorizing Official	Insert			Stevens, Benjamin W. Chief Financial Officer 3193320880	9/7/2016 9:46 AM
Contacts	Signed By	Insert			Stevens, Benjamin W. Chief Financial Officer 3193320880	9/7/2016 9:46 AM
Details	Last Recertification Date	Update			9/7/2016 12:00:00 AM	9/7/2016 9:46 AM
Dates	Participating Approval Date	Update			11/20/2015 12:00:00 AM	11/20/2015 3:20 PM
Details	State	Update		Pending	Active	11/20/2015 3:20 PM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	11/20/2015 3:20 PM
Details	340B ID	Update		ONLINE_REG_55879	CAH161335-00	11/20/2015 1:48 PM
Details	340B ID	Update			ONLINE_REG_55879	10/15/2015 10:16 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/15/2015 10:16 AM
Medicaid Billing	Medicaid: Number	Insert			06-00866	10/15/2015 10:16 AM
Medicaid Billing	Medicaid: State	Insert			IA	10/15/2015 10:16 AM
Medicaid Billing	NPI: Number	Insert			1265595144	10/15/2015 10:16 AM
Details	Last Recertification Date	Insert				10/15/2015 10:16 AM
Details	Grant Number	Insert				10/15/2015 10:16 AM
Details	340B ID	Insert				10/15/2015 10:16 AM
Details	Is Authorizing Official EHB Data	Insert				10/15/2015 10:16 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2015 10:16 AM
Details	Medicare Provider Number	Insert			161335	10/15/2015 10:16 AM
Details	Entity Name	Insert			PEOPLES MEMORIAL HOSPITAL	10/15/2015 10:16 AM
Details	Program Code	Insert			CAH	10/15/2015 10:16 AM
Details	Entity Subname	Insert				10/15/2015 10:16 AM
Dates	Participating Approval Date	Insert				10/15/2015 10:16 AM
Details	State	Insert			Pending	10/15/2015 10:16 AM
Dates	Registration Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 10:16 AM
Dates	Signed By Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 10:16 AM
Dates	Start Date	Insert				10/15/2015 10:16 AM
Terminations	Termination Comments	Insert				10/15/2015 10:16 AM
Terminations	Termination Date	Insert				10/15/2015 10:16 AM
Terminations	Termination Effective Date	Insert				10/15/2015 10:16 AM
Terminations	Termination Reason	Insert				10/15/2015 10:16 AM