| Details | Last Recertification Date | Update | Recertification | 8/28/2023 6:38:14 AM | 8/27/2024 3:10:13 PM | 8/27/2024 3:10 PM |
| Contacts | Authorizing Official | Update | Change Request | Chamberlain, Kayla
CFO
Iron County Medical Center
5735468051 | Mooney, Brittany
Controller
Iron County Hospital District
5735468096 | 5/13/2024 6:17 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Chamberlain, Kayla
Controller-CFO
Iron County Medical Center
5735468051 | Chamberlain, Kayla
CFO
Iron County Medical Center
5735468051 | 8/28/2023 7:16 AM |
| Details | Last Recertification Date | Update | Recertification | 9/14/2022 9:12:25 AM | 8/28/2023 6:38:14 AM | 8/28/2023 6:38 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1477648178 | 12/6/2022 3:20 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | MO | 12/6/2022 3:20 PM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2021 3:03:24 PM | 9/14/2022 9:12:25 AM | 9/14/2022 9:12 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Gilmore, Joshua
Chief Executive Officer
Iron County Hospital District
5735468003 | Chamberlain, Kayla
Controller-CFO
Iron County Medical Center
5735468051 | 9/13/2022 2:28 PM |
| Contacts | Primary Contact | Update | Change Request | Walker, Kassie Jo
Pharmacist
IRON COUNTY HOSPITAL
5735468047 | Gibson, Zachary
Pharmacist
Iron County Hospital District
5735468047 | 3/30/2022 11:53 AM |
| Contacts | Primary Contact | Update | Change Request | Chifalu, Emmanuel
Pharmacist
Iron County Medical Center
5735468047 | Walker, Kassie Jo
Pharmacist
IRON COUNTY HOSPITAL
5735468047 | 10/13/2021 11:57 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2020 12:09:27 PM | 8/19/2021 3:03:24 PM | 8/19/2021 3:03 PM |
| Contacts | Primary Contact | Update | Change Request | Sadler, Cindy Diane
Chief Nursing Officer
Iron County Hospital District
5735468061 | Chifalu, Emmanuel
Pharmacist
Iron County Medical Center
5735468047 | 6/21/2021 6:16 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1477648178 ( ) | | 8/21/2020 12:09 PM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2019 11:43:06 AM | 8/21/2020 12:09:27 PM | 8/21/2020 12:09 PM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2018 3:08:55 PM | 8/21/2019 11:43:06 AM | 8/21/2019 11:43 AM |
| Details | Last Recertification Date | Update | Recertification | 11/7/2017 11:31:52 AM | 8/21/2018 3:08:55 PM | 8/21/2018 3:08 PM |
| Details | Last Recertification Date | Update | Recertification | 10/25/2017 10:44:57 AM | 11/7/2017 11:31:52 AM | 11/7/2017 11:31 AM |
| Contacts | Primary Contact | Update | Recertification | Wade, Debbie
Pharmacy Manager
5735468009 | Sadler, Cindy Diane
Chief Nursing Officer
Iron County Hospital District
5735468061 | 10/25/2017 10:44 AM |
| Details | Last Recertification Date | Update | Recertification | | 10/25/2017 10:44:57 AM | 10/25/2017 10:44 AM |
| Contacts | Authorizing Official | Update | | Gilmore, Joshua
Chief Executive Officer
5735468003 | Gilmore, Joshua
Chief Executive Officer
Iron County Hospital District
5735468003 | 10/13/2017 12:39 PM |
| Contacts | Authorizing Official | Update | | Basler, Cyndi
Interim CEO
5735461260-8003 | Gilmore, Joshua
Chief Executive Officer
5735468003 | 7/18/2017 3:45 PM |
| Contacts | Signed By | Insert | | | Nichols, Terry W.
Chief Executive Officer
5735468003 | 7/18/2017 3:45 PM |
| Addresses | Main Address | Insert | | |
301 NORTH HWY 21
PILOT KNOB, MO 63663 | 7/18/2017 3:45 PM |
| Addresses | Billing Address | Insert | | | IRON COUNTY HOSPITAL
P.O. BOX 548
PILOT KNOB, MO 63663 | 7/18/2017 3:45 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/15/2016 4:10 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 019899608 | 8/15/2016 4:10 PM |
| Medicaid Billing | Medicaid: State | Insert | | | MO | 8/15/2016 4:10 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1477648178 | 8/15/2016 4:10 PM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | | 8/15/2016 4:10 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | 7/1/2013 12:00:00 AM | | 8/15/2016 4:10 PM |
| Dates | Participating Approval Date | Update | | 2/16/2011 12:00:00 AM | 8/15/2016 12:00:00 AM | 8/15/2016 4:10 PM |
| Details | State | Update | | Terminated | Active | 8/15/2016 4:10 PM |
| Dates | Registration Date | Update | | 11/29/2010 12:00:00 AM | 7/8/2016 12:00:00 AM | 8/15/2016 4:10 PM |
| Dates | Signed By Date | Update | | 11/29/2010 12:00:00 AM | 7/8/2016 12:00:00 AM | 8/15/2016 4:10 PM |
| Dates | Start Date | Update | | 4/1/2011 12:00:00 AM | 10/1/2016 12:00:00 AM | 8/15/2016 4:10 PM |
| Terminations | Termination Comments | Update | | 4/26/13 - Entity request for site to be terminated per letter response from OPA request for site to be removed from 340B program. other | | 8/15/2016 4:10 PM |
| Terminations | Termination Date | Update | | 7/1/2013 12:00:00 AM | | 8/15/2016 4:10 PM |
| Terminations | Termination Effective Date | Update | | 7/1/2013 12:00:00 AM | | 8/15/2016 4:10 PM |
| Terminations | Termination Reason | Update | | Other | | 8/15/2016 4:10 PM |
| Details | Comments Public | Insert | | | 8/15/16 Participating 4/1/2011 until terminated effective 7/1/2013, reinstated effective 10/1/2016 | 8/15/2016 4:10 PM |
| Contacts | Authorizing Official | Update | | SCHWENT, JOHN
CEO
5735461260-8002 | Basler, Cyndi
Interim CEO
5735461260-8003 | 7/3/2014 4:20 PM |
| Contacts | Primary Contact | Update | | MASSENGILL, JESSE
DIRECTOR OF PATIENT CARE
5735468010 | Wade, Debbie
Pharmacy Manager
5735468009 | 7/3/2014 4:20 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 7/1/2013 12:00:00 AM | 7/3/2014 4:20 PM |
| Terminations | Termination Comments | Update | | | 4/26/13 - Entity request for site to be terminated per letter response from OPA request for site to be removed from 340B program. other | 7/3/2014 4:20 PM |
| Terminations | Termination Effective Date | Update | | | 7/1/2013 12:00:00 AM | 7/3/2014 4:20 PM |
| Details | State | Update | | Active | Terminated | 4/26/2013 2:01 PM |
| Terminations | Termination Date | Update | | | 7/1/2013 12:00:00 AM | 4/26/2013 2:01 PM |
| Terminations | Termination Reason | Update | | | Other | 4/26/2013 2:01 PM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 6/29/2012 12:50 PM |
| Contacts | Primary Contact | Insert | | | MASSENGILL, JESSE
DIRECTOR OF PATIENT CARE
5735468010 | 2/16/2011 5:26 PM |
| Contacts | Authorizing Official | Insert | | | SCHWENT, JOHN
CEO
5735461260-8002 | 2/16/2011 5:26 PM |
| Details | Last Recertification Date | Insert | | | | 2/16/2011 5:26 PM |
| Details | Grant Number | Insert | | | | 2/16/2011 5:26 PM |
| Details | 340B ID | Insert | | | CAH261336-00 | 2/16/2011 5:26 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 2/16/2011 5:26 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 2/16/2011 5:26 PM |
| Details | Medicare Provider Number | Insert | | | 261336 | 2/16/2011 5:26 PM |
| Details | Entity Name | Insert | | | IRON COUNTY HOSPITAL | 2/16/2011 5:26 PM |
| Details | Program Code | Insert | | | CAH | 2/16/2011 5:26 PM |
| Details | Entity Subname | Insert | | | | 2/16/2011 5:26 PM |
| Dates | Participating Approval Date | Insert | | | 2/16/2011 12:00:00 AM | 2/16/2011 5:26 PM |
| Details | State | Insert | | | Active | 2/16/2011 5:26 PM |
| Dates | Registration Date | Insert | | | 11/29/2010 12:00:00 AM | 2/16/2011 5:26 PM |
| Dates | Signed By Date | Insert | | | 11/29/2010 12:00:00 AM | 2/16/2011 5:26 PM |
| Dates | Start Date | Insert | | | 4/1/2011 12:00:00 AM | 2/16/2011 5:26 PM |
| Terminations | Termination Comments | Insert | | | | 2/16/2011 5:26 PM |
| Terminations | Termination Date | Insert | | | | 2/16/2011 5:26 PM |
| Terminations | Termination Effective Date | Insert | | | | 2/16/2011 5:26 PM |
| Terminations | Termination Reason | Insert | | | | 2/16/2011 5:26 PM |