Covered Entity Details

CAH261336-01 IRON COUNTY HOSPITAL (Active) - information as of 6/16/2025 1:08:13 AM

Main Details

Name

IRON COUNTY HOSPITAL

Subdivision Name

RURAL HEALTH CLINIC

Type

Critical Access Hospital

Rural

340B ID

CAH261336-01

Medicare Provider Number

261336

Outpatient Facility Provider Number

268642

Additional Details

Current Program Status

Active

Registration Date

7/8/2016

Participating Start Date

10/1/2016

Participating Approval Date

8/15/2016

Last Recertification Date

8/27/2024

Contacts

Authorizing Official

Iron County Hospital District
Brittany Mooney, Controller
(573) 546-8096

Primary Contact

Iron County Hospital District
Zachary Gibson, Pharmacist
(573) 546-8047

Addresses

Street Address

301 N. Hwy 21
RURAL HEALTH CLINIC
PILOT KNOB, MO 63663-0329

Billing Address

Iron County Medical Center
301 N. Hwy 21
P.O. Box 548
Pilot Knob, MO 63663

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
MO	596463505	1073799367

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
CAH261336-01	Child	CAH	IRON COUNTY HOSPITAL	RURAL HEALTH CLINIC	301 N. Hwy 21	PILOT KNOB	MO	Active
CAH261336-02	Child	CAH	IRON COUNTY HOSPITAL	RURAL HEALTH CLINIC	600 N MAIN	PILOT KNOB	MO	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/30/2023 6:22:46 AM	8/27/2024 2:51:29 PM	8/27/2024 2:51 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
Addresses	Shipping Address	Delete	Recertification	Iron County Medical Center 301 N. Hwy 21 Pilot Knob, MO 63663		8/30/2023 6:22 AM
Addresses	Main Address	Update	Recertification	301 NORTH HIGHWAY 21 SPECIALTY CARE CLINIC PILOT KNOB, MO 63663-0329	301 N. Hwy 21 RURAL HEALTH CLINIC PILOT KNOB, MO 63663-0329	8/30/2023 6:22 AM
Details	Last Recertification Date	Update	Recertification	9/14/2022 7:36:00 AM	8/30/2023 6:22:46 AM	8/30/2023 6:22 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	8/19/2021 3:04:09 PM	9/14/2022 7:36:00 AM	9/14/2022 7:36 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	Chifalu, Emmanuel Pharmacist Iron County Medical Center 5735468047	Gibson, Zachary Pharmacist Iron County Hospital District 5735468047	4/22/2022 9:15 AM
Details	Last Recertification Date	Update	Recertification	8/26/2020 12:15:41 PM	8/19/2021 3:04:09 PM	8/19/2021 3:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/26/2021 2:28 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		596463505	7/26/2021 2:28 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	7/26/2021 2:28 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	019899608 (MO)		7/26/2021 2:28 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1073799367	7/26/2021 2:28 PM
Medicaid Billing	NPI: State	Insert	Change Request		MO	7/26/2021 2:28 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 ( )		8/26/2020 12:15 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 9:50:41 AM	8/26/2020 12:15:41 PM	8/26/2020 12:15 PM
Details	Entity Subname	Update	Recertification	PRIMARY CARE CLINIC	RURAL HEALTH CLINIC	8/26/2020 12:15 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 2:22:09 PM	8/20/2019 9:50:41 AM	8/20/2019 9:50 AM
Details	Last Recertification Date	Update	Recertification	11/7/2017 11:32:31 AM	8/17/2018 2:22:09 PM	8/17/2018 2:22 PM
Addresses	Billing Address	Insert	Change Request		Iron County Medical Center 301 N. Hwy 21 P.O. Box 548 Pilot Knob, MO 63663	1/29/2018 12:57 PM
Addresses	Shipping Address	Insert	Change Request		Iron County Medical Center 301 N. Hwy 21 Pilot Knob, MO 63663	1/29/2018 12:57 PM
Details	Last Recertification Date	Update	Recertification	10/25/2017 10:35:21 AM	11/7/2017 11:32:31 AM	11/7/2017 11:32 AM
Contacts	Primary Contact	Update	Recertification	Gilmore, Joshua Chief Executive Officer 5735468003	Sadler, Cindy Diane Chief Nursing Officer Iron County Hospital District 5735468061	10/25/2017 10:35 AM
Details	Last Recertification Date	Update	Recertification		10/25/2017 10:35:21 AM	10/25/2017 10:35 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
Addresses	Main Address	Insert			301 NORTH HIGHWAY 21 SPECIALTY CARE CLINIC PILOT KNOB, MO 63663-0329	7/18/2017 3:45 PM
Contacts	Authorizing Official	Insert			Gilmore, Joshua Chief Executive Officer 5735468003	7/18/2017 3:45 PM
Contacts	Primary Contact	Insert			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
Dates	Participating Approval Date	Update			8/15/2016 12:00:00 AM	8/15/2016 4:14 PM
Details	State	Update		Pending	Active	8/15/2016 4:14 PM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	8/15/2016 4:14 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_71187	CAH261336-01	7/14/2016 10:13 AM
Details	Entity Subname	Update		IRON COUNTY HOSPITAL BOARD / Rural Health Clinic	PRIMARY CARE CLINIC	7/14/2016 10:13 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_71187	7/8/2016 11:02 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/8/2016 11:02 AM
Medicaid Billing	Medicaid: Number	Insert			019899608	7/8/2016 11:02 AM
Medicaid Billing	Medicaid: State	Insert			MO	7/8/2016 11:02 AM
Medicaid Billing	NPI: Number	Insert			1477648178	7/8/2016 11:02 AM
Details	Last Recertification Date	Insert				7/8/2016 11:02 AM
Details	Grant Number	Insert				7/8/2016 11:02 AM
Details	340B ID	Insert				7/8/2016 11:02 AM
Details	Is Authorizing Official EHB Data	Insert				7/8/2016 11:02 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/8/2016 11:02 AM
Details	Medicare Provider Number	Insert			261336	7/8/2016 11:02 AM
Details	Entity Name	Insert			IRON COUNTY HOSPITAL	7/8/2016 11:02 AM
Details	Program Code	Insert			CAH	7/8/2016 11:02 AM
Details	Entity Subname	Insert			IRON COUNTY HOSPITAL BOARD / Rural Health Clinic	7/8/2016 11:02 AM
Dates	Participating Approval Date	Insert				7/8/2016 11:02 AM
Details	State	Insert			Pending	7/8/2016 11:02 AM
Dates	Registration Date	Insert			7/8/2016 12:00:00 AM	7/8/2016 11:02 AM
Dates	Signed By Date	Insert			7/8/2016 12:00:00 AM	7/8/2016 11:02 AM
Dates	Start Date	Insert				7/8/2016 11:02 AM
Terminations	Termination Comments	Insert				7/8/2016 11:02 AM
Terminations	Termination Date	Insert				7/8/2016 11:02 AM
Terminations	Termination Effective Date	Insert				7/8/2016 11:02 AM
Terminations	Termination Reason	Insert				7/8/2016 11:02 AM