Covered Entity Details

CAH361309-01 HENRY COUNTY HOSPITAL (Terminated) - information as of 4/27/2025 12:55:26 AM

Main Details

Name

HENRY COUNTY HOSPITAL

Subdivision Name

HENRY COUNTY HOSPITAL INC / Emergency Care Services

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH361309-01

Medicare Provider Number

361309

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/8/2016

Participating Start Date

10/1/2016

Participating Approval Date

8/22/2016

Last Recertification Date

8/29/2019

Termination Date
Termination Reason

1/1/2020
Outpatient facility moved within the 4 walls of the parent hospital

Contacts

Authorizing Official

Henry County Hospital
KIMBERLY H. BORDENKIRCHER, CEO
(419) 591-3837

Primary Contact

Henry County Hospital
Austin Dunlap, Manager of Pharmacy Services
(419) 591-3870

Addresses

Street Address

1600 E RIVERVIEW AVE
NAPOLEON, OH 43545-9399

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
OH	3822751
		1407880909

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
CAH361309-01	Child	CAH	HENRY COUNTY HOSPITAL	HENRY COUNTY HOSPITAL INC / Emergency Care Services	1600 E RIVERVIEW AVE	NAPOLEON	OH	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2020 12:05 AM
Details	State	Update	Termination Request	Active	To Be Terminated	10/16/2019 6:08 AM
Terminations	Termination Comments	Update	Termination Request		This facility has always been inside the 4 walls of the hospital and therefore does not need to be registered as a child site.	10/16/2019 6:08 AM
Terminations	Termination Date	Update	Termination Request		1/1/2020 12:00:00 AM	10/16/2019 6:08 AM
Terminations	Termination Effective Date	Update	Termination Request		1/1/2020 12:00:00 AM	10/16/2019 6:08 AM
Terminations	Termination Reason	Update	Termination Request		Outpatient facility moved within the 4 walls of the parent hospital	10/16/2019 6:08 AM
Contacts	Primary Contact	Update	Recertification	Sigg, William Manager Emergency Care Services Henry County Hospital 4195913307	Dunlap, Austin Manager of Pharmacy Services Henry County Hospital 4195913870	8/29/2019 2:17 PM
Details	Last Recertification Date	Update	Recertification	9/7/2018 4:32:47 PM	8/29/2019 2:17:26 PM	8/29/2019 2:17 PM
Details	Last Recertification Date	Update	Recertification	12/5/2017 2:41:37 PM	9/7/2018 4:32:47 PM	9/7/2018 4:32 PM
Contacts	Primary Contact	Update	Recertification	BORDENKIRCHER, KIMBERLY H. CEO Henry County Hospital 4195913837	Sigg, William Manager Emergency Care Services Henry County Hospital 4195913307	12/5/2017 2:41 PM
Details	Last Recertification Date	Update	Recertification		12/5/2017 2:41:37 PM	12/5/2017 2:41 PM
Details	Entity Name	Update	Recertification	HENRY COUNTY HOSPITAL (CAH)	HENRY COUNTY HOSPITAL	12/1/2017 2:27 PM
Contacts	Authorizing Official	Update		BORDENKIRCHER, KIMBERLY H. CEO 4195913837	BORDENKIRCHER, KIMBERLY H. CEO Henry County Hospital 4195913837	10/25/2017 10:15 AM
Contacts	Primary Contact	Update		BORDENKIRCHER, KIMBERLY H. CEO 4195913837	BORDENKIRCHER, KIMBERLY H. CEO Henry County Hospital 4195913837	10/25/2017 10:15 AM
Contacts	Signed By	Update		BORDENKIRCHER, KIMBERLY H. CEO 4195913837	BORDENKIRCHER, KIMBERLY H. CEO Henry County Hospital 4195913837	10/25/2017 10:15 AM
Contacts	Authorizing Official	Insert			BORDENKIRCHER, KIMBERLY H. CEO 4195913837	7/26/2017 9:16 AM
Contacts	Primary Contact	Insert			BORDENKIRCHER, KIMBERLY H. CEO 4195913837	7/26/2017 9:16 AM
Contacts	Signed By	Insert			BORDENKIRCHER, KIMBERLY H. CEO 4195913837	7/26/2017 9:16 AM
Addresses	Main Address	Insert			1600 E RIVERVIEW AVE NAPOLEON, OH 43545-9399	8/22/2016 5:45 PM
Dates	Participating Approval Date	Update			8/22/2016 12:00:00 AM	8/22/2016 5:45 PM
Details	State	Update		Pending	Active	8/22/2016 5:45 PM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	8/22/2016 5:45 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_71244	CAH361309-01	8/19/2016 1:47 PM
Details	Entity Subname	Update		HENRY COUNTY HOSPITAL INC / Riverview Women's Care, Lindsey Surgical, Family Medical Care, Pain Mangement, Help Center, Oncology, Emergency Care Services	HENRY COUNTY HOSPITAL INC / Emergency Care Services	8/19/2016 1:47 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_71244	7/8/2016 3:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/8/2016 3:06 PM
Medicaid Billing	Medicaid: Number	Insert			3822751	7/8/2016 3:06 PM
Medicaid Billing	Medicaid: State	Insert			OH	7/8/2016 3:06 PM
Medicaid Billing	NPI: Number	Insert			1407880909	7/8/2016 3:06 PM
Details	Last Recertification Date	Insert				7/8/2016 3:06 PM
Details	Grant Number	Insert				7/8/2016 3:06 PM
Details	340B ID	Insert				7/8/2016 3:06 PM
Details	Is Authorizing Official EHB Data	Insert				7/8/2016 3:06 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/8/2016 3:06 PM
Details	Medicare Provider Number	Insert			361309	7/8/2016 3:06 PM
Details	Entity Name	Insert			HENRY COUNTY HOSPITAL (CAH)	7/8/2016 3:06 PM
Details	Program Code	Insert			CAH	7/8/2016 3:06 PM
Details	Entity Subname	Insert			HENRY COUNTY HOSPITAL INC / Riverview Women's Care, Lindsey Surgical, Family Medical Care, Pain Mangement, Help Center, Oncology, Emergency Care Services	7/8/2016 3:06 PM
Dates	Participating Approval Date	Insert				7/8/2016 3:06 PM
Details	State	Insert			Pending	7/8/2016 3:06 PM
Dates	Registration Date	Insert			7/8/2016 12:00:00 AM	7/8/2016 3:06 PM
Dates	Signed By Date	Insert			7/8/2016 12:00:00 AM	7/8/2016 3:06 PM
Dates	Start Date	Insert				7/8/2016 3:06 PM
Terminations	Termination Comments	Insert				7/8/2016 3:06 PM
Terminations	Termination Date	Insert				7/8/2016 3:06 PM
Terminations	Termination Effective Date	Insert				7/8/2016 3:06 PM
Terminations	Termination Reason	Insert				7/8/2016 3:06 PM