Covered Entity Details

CAH181304-01 Trigg County Hospital, Inc. (Active) - information as of 6/4/2025 12:06:31 PM

Main Details

Name

Trigg County Hospital, Inc.

Subdivision Name

Trigg County Primary Care

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH181304-01

Medicare Provider Number

181304

Outpatient Facility Provider Number

183406

Additional Details

Current Program Status

Active

Registration Date

1/5/2016

Participating Start Date

4/1/2016

Participating Approval Date

2/12/2016

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Trigg County Hospital
John Sumner, CEO
(270) 522-3215 Ext: 3601

Primary Contact

Trigg County Hospital
Ashland Todd Price, R.Ph.
(270) 522-2551

Addresses

Street Address

214 Main St
Cadiz, KY 42211

Billing Address

Trigg County Primary Care
P.O. Box 1724
Cadiz, KY 42211

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
Contract Detail	MCS PHARMACEUTICS, LLC	DBA CADIZ PHARMACY	435 LAKOTA DR	CADIZ	KY	42211-7970	04/05/2023	07/01/2023			07/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH181304-01	Child	CAH	Trigg County Hospital, Inc.	Trigg County Primary Care	214 Main St	Cadiz	KY	Active
CAH181304-02	Child	CAH	Trigg County Hospital, Inc.	MAIN ST RHC - RURAL HEALTH CLINIC	266 MAIN ST	CADIZ	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 9:48:40 AM	8/13/2024 1:07:44 PM	8/13/2024 1:07 PM
Details	Last Recertification Date	Update	Recertification	9/6/2022 3:49:49 PM	8/14/2023 9:48:40 AM	8/14/2023 9:48 AM
Details	Last Recertification Date	Update	Recertification	8/17/2021 9:19:21 AM	9/6/2022 3:49:49 PM	9/6/2022 3:49 PM
Details	Last Recertification Date	Update	Recertification	9/2/2020 3:32:16 PM	8/17/2021 9:19:21 AM	8/17/2021 9:19 AM
Contacts	Primary Contact	Update	Change Request	Rutland, David Forest Director of Pharmacy Trigg County Hospital 2705223215-3629	Price, Ashland Todd R.Ph. Trigg County Hospital 2705222551	10/13/2020 9:10 AM
Details	Last Recertification Date	Update	Recertification	8/21/2019 3:06:05 PM	9/2/2020 3:32:16 PM	9/2/2020 3:32 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 4:01:28 PM	8/21/2019 3:06:05 PM	8/21/2019 3:06 PM
Contacts	Primary Contact	Update	Contract Pharmacy Registration	Rutland, David Director of Pharmacy Trigg County Hospital 2705223215-3629	Rutland, David Forest Director of Pharmacy Trigg County Hospital 2705223215-3629	4/2/2019 3:41 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 3:55:03 PM	8/21/2018 4:01:28 PM	8/21/2018 4:01 PM
Details	Entity Name	Update	Recertification	TRIGG COUNTY HOSPITAL	Trigg County Hospital, Inc.	11/29/2017 3:55 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/29/2017 3:55:03 PM	11/29/2017 3:55 PM
Contacts	Authorizing Official	Update		Sumner, John CEO 2705223215-3601	Sumner, John CEO Trigg County Hospital 2705223215-3601	10/20/2017 10:35 AM
Contacts	Signed By	Update		Sumner, John CEO 2705223215-3601	Sumner, John CEO Trigg County Hospital 2705223215-3601	10/20/2017 10:35 AM
Contacts	Primary Contact	Update		Rutland, David Director of Pharmacy 2705223215-3629	Rutland, David Director of Pharmacy Trigg County Hospital 2705223215-3629	10/20/2017 9:57 AM
Addresses	Main Address	Insert			214 Main St Cadiz, KY 42211	8/10/2016 2:57 PM
Contacts	Authorizing Official	Insert			Sumner, John CEO 2705223215-3601	8/10/2016 2:57 PM
Contacts	Signed By	Insert			Sumner, John CEO 2705223215-3601	8/10/2016 2:57 PM
Contacts	Primary Contact	Insert			Rutland, David Director of Pharmacy 2705223215-3629	8/10/2016 2:57 PM
Details	Last Recertification Date	Update			8/10/2016 12:00:00 AM	8/10/2016 2:57 PM
Addresses	Billing Address	Insert			Trigg County Primary Care P.O. Box 1724 Cadiz, KY 42211	2/12/2016 4:04 PM
Dates	Participating Approval Date	Update			2/12/2016 12:00:00 AM	2/12/2016 4:04 PM
Details	State	Update		Pending	Active	2/12/2016 4:04 PM
Dates	Start Date	Update			4/1/2016 12:00:00 AM	2/12/2016 4:04 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_56581	CAH181304-01	1/6/2016 9:41 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_56581	1/5/2016 2:42 PM
Details	Last Recertification Date	Insert				1/5/2016 2:42 PM
Details	Grant Number	Insert				1/5/2016 2:42 PM
Details	340B ID	Insert				1/5/2016 2:42 PM
Details	Is Authorizing Official EHB Data	Insert				1/5/2016 2:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/5/2016 2:42 PM
Details	Medicare Provider Number	Insert			181304	1/5/2016 2:42 PM
Details	Entity Name	Insert			TRIGG COUNTY HOSPITAL	1/5/2016 2:42 PM
Details	Program Code	Insert			CAH	1/5/2016 2:42 PM
Details	Entity Subname	Insert			Trigg County Primary Care	1/5/2016 2:42 PM
Dates	Participating Approval Date	Insert				1/5/2016 2:42 PM
Details	State	Insert			Pending	1/5/2016 2:42 PM
Dates	Registration Date	Insert			1/5/2016 12:00:00 AM	1/5/2016 2:42 PM
Dates	Signed By Date	Insert			1/5/2016 12:00:00 AM	1/5/2016 2:42 PM
Dates	Start Date	Insert				1/5/2016 2:42 PM
Terminations	Termination Comments	Insert				1/5/2016 2:42 PM
Terminations	Termination Date	Insert				1/5/2016 2:42 PM
Terminations	Termination Effective Date	Insert				1/5/2016 2:42 PM
Terminations	Termination Reason	Insert				1/5/2016 2:42 PM