Covered Entity Details

CAH281340-02 DUNDY COUNTY HOSPITAL (Active) - information as of 5/6/2025 11:03:46 PM

Main Details

Name

DUNDY COUNTY HOSPITAL

Subdivision Name

QUALITY HEALTHCARE SVCS MED CLINIC

Type

Critical Access Hospital

Rural

340B ID

CAH281340-02

Medicare Provider Number

281340

Outpatient Facility Provider Number

283441

Additional Details

Current Program Status

Active

Registration Date

10/15/2015

Participating Start Date

1/1/2016

Participating Approval Date

11/9/2015

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Dundy County Hospital
Jeremiah Hanes, CEO
(308) 423-2204

Primary Contact

Dundy County Hospital
Miranda Marlin, Director of Quality
(308) 423-2204 Ext: 2205

Addresses

Street Address

903 BAILEY ST
STRATTON, NE 69043-5121

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
CAH281340-01	Child	CAH	DUNDY COUNTY HOSPITAL	QUALITY HEALTHCARE SVCS MED CLINIC	1313 N CHEYENNE ST	BENKELMAN	NE	Active
CAH281340-02	Child	CAH	DUNDY COUNTY HOSPITAL	QUALITY HEALTHCARE SVCS MED CLINIC	903 BAILEY ST	STRATTON	NE	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Noffsinger, Sandy M Administrator Dundy County Hospital 3084237002	Hanes, Jeremiah CEO Dundy County Hospital 3084232204	10/18/2024 9:38 AM
Details	Last Recertification Date	Update	Recertification	9/5/2023 4:21:25 PM	8/16/2024 1:07:18 PM	8/16/2024 1:07 PM
Contacts	Authorizing Official	Update	AO Change Request	Mathews, Kristopher Scott CEO Dundy County Hospital 3084237000	Noffsinger, Sandy M Administrator Dundy County Hospital 3084237002	5/28/2024 7:55 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 10:06:55 AM	9/5/2023 4:21:25 PM	9/5/2023 4:21 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 4:09:42 PM	9/1/2022 10:06:55 AM	9/1/2022 10:06 AM
Contacts	Authorizing Official	Update	AO Change Request	Jones, Rita A. CEO Dundy County Hospital 3084232204-2200	Mathews, Kristopher Scott CEO Dundy County Hospital 3084237000	3/24/2022 11:14 AM
Details	Last Recertification Date	Update	Recertification	8/28/2020 11:16:09 AM	8/23/2021 4:09:42 PM	8/23/2021 4:09 PM
Details	Last Recertification Date	Update	Recertification	8/22/2019 1:14:53 PM	8/28/2020 11:16:09 AM	8/28/2020 11:16 AM
Contacts	Authorizing Official	Update	Profile Change Request	Jones, Rita A. CEO Dundy County Hospital 3084232204	Jones, Rita A. CEO Dundy County Hospital 3084232204-2200	8/28/2020 10:55 AM
Contacts	Primary Contact	Update	Recertification	Fink, Renee CFO Dundy County Hospital 3084232204-212	Marlin, Miranda Director of Quality Dundy County Hospital 3084232204-2205	8/22/2019 1:14 PM
Details	Last Recertification Date	Update	Recertification	8/24/2018 4:13:36 PM	8/22/2019 1:14:53 PM	8/22/2019 1:14 PM
Contacts	Authorizing Official	Update	Change Request	Jones, Rita Hospital CEO Dundy County Hospital 3084232204-2200	Jones, Rita A. CEO Dundy County Hospital 3084232204	7/10/2019 1:58 PM
Details	Last Recertification Date	Update	Recertification	11/6/2017 4:56:10 PM	8/24/2018 4:13:36 PM	8/24/2018 4:13 PM
Details	Last Recertification Date	Update	Recertification	8/26/2016 12:00:00 AM	11/6/2017 4:56:10 PM	11/6/2017 4:56 PM
Contacts	Primary Contact	Update	Recertification	Fink, Renee CFO 3084232204-212	Fink, Renee CFO Dundy County Hospital 3084232204-212	11/6/2017 4:56 PM
Contacts	Authorizing Official	Update	Profile Change Request	Jones, Rita Hospital Administrator Dundy County Hospital 3084232204-2200	Jones, Rita Hospital CEO Dundy County Hospital 3084232204-2200	10/10/2017 3:43 PM
Contacts	Signed By	Update	Profile Change Request	Jones, Rita Hospital Administrator Dundy County Hospital 3084232204-2200	Jones, Rita Hospital CEO Dundy County Hospital 3084232204-2200	10/10/2017 3:43 PM
Contacts	Authorizing Official	Update	Profile Change Request	Jones, Rita Hospital Administrator Dundy County Hospital 3084232204-200	Jones, Rita Hospital Administrator Dundy County Hospital 3084232204-2200	10/10/2017 3:43 PM
Contacts	Signed By	Update	Profile Change Request	Jones, Rita Hospital Administrator Dundy County Hospital 3084232204-200	Jones, Rita Hospital Administrator Dundy County Hospital 3084232204-2200	10/10/2017 3:43 PM
Contacts	Authorizing Official	Update		Jones, Rita Hospital Administrator 3084232204-200	Jones, Rita Hospital Administrator Dundy County Hospital 3084232204-200	10/10/2017 3:40 PM
Contacts	Signed By	Update		Jones, Rita Hospital Administrator 3084232204-200	Jones, Rita Hospital Administrator Dundy County Hospital 3084232204-200	10/10/2017 3:40 PM
Contacts	Authorizing Official	Insert			Jones, Rita Hospital Administrator 3084232204-200	5/9/2017 6:43 PM
Contacts	Signed By	Insert			Jones, Rita Hospital Administrator 3084232204-200	5/9/2017 6:43 PM
Addresses	Main Address	Insert			903 BAILEY ST STRATTON, NE 69043-5121	8/26/2016 1:55 PM
Contacts	Primary Contact	Insert			Fink, Renee CFO 3084232204-212	8/26/2016 1:55 PM
Details	Last Recertification Date	Update			8/26/2016 12:00:00 AM	8/26/2016 1:55 PM
Dates	Participating Approval Date	Update			11/9/2015 12:00:00 AM	11/9/2015 5:29 PM
Details	State	Update		Pending	Active	11/9/2015 5:29 PM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	11/9/2015 5:29 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_55930	CAH281340-02	10/29/2015 8:23 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_55930	10/15/2015 12:16 PM
Details	Last Recertification Date	Insert				10/15/2015 12:16 PM
Details	Grant Number	Insert				10/15/2015 12:16 PM
Details	340B ID	Insert				10/15/2015 12:16 PM
Details	Is Authorizing Official EHB Data	Insert				10/15/2015 12:16 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2015 12:16 PM
Details	Medicare Provider Number	Insert			281340	10/15/2015 12:16 PM
Details	Entity Name	Insert			DUNDY COUNTY HOSPITAL	10/15/2015 12:16 PM
Details	Program Code	Insert			CAH	10/15/2015 12:16 PM
Details	Entity Subname	Insert			QUALITY HEALTHCARE SVCS MED CLINIC	10/15/2015 12:16 PM
Dates	Participating Approval Date	Insert				10/15/2015 12:16 PM
Details	State	Insert			Pending	10/15/2015 12:16 PM
Dates	Registration Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 12:16 PM
Dates	Signed By Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 12:16 PM
Dates	Start Date	Insert				10/15/2015 12:16 PM
Terminations	Termination Comments	Insert				10/15/2015 12:16 PM
Terminations	Termination Date	Insert				10/15/2015 12:16 PM
Terminations	Termination Effective Date	Insert				10/15/2015 12:16 PM
Terminations	Termination Reason	Insert				10/15/2015 12:16 PM