Covered Entity Details

CAH191315-02 HARDTNER MEDICAL CENTER (Active) - information as of 5/19/2025 12:52:17 AM

Main Details

Name

HARDTNER MEDICAL CENTER

Subdivision Name

LASALLE PARISH HOSPITAL SERVICE DIS / HARDTNER FAMILY CLINIC

Type

Critical Access Hospital

Rural

340B ID

CAH191315-02

Medicare Provider Number

191315

Outpatient Facility Provider Number

193493

Additional Details

Current Program Status

Active

Registration Date

7/11/2016

Participating Start Date

10/1/2016

Participating Approval Date

8/23/2016

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

Hardtner Medical Center
Paul G. Mathews, Administrator
(318) 495-3131 Ext: 109

Primary Contact

Hardtner Medical Center
Anna P White, Sr. Accountant
(318) 495-3131 Ext: 112

Addresses

Street Address

1102 NORTH PINE RD
HARDTNER MEDICAL CENTER
OLLA, LA 71465-4804

Billing Address

HARDTNER FAMILY CLINIC
15712 Hwy 165
OLLA, LA 71465

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	Termination Date	Last Updated On
Contract Detail	BULLARD DRUG AND WELLNESS, LLC	BULLARD DRUG AND WELLNESS	3515 MAIN STREET 165	OLLA	LA	71465	04/12/2022	07/01/2022		07/01/2022
Contract Detail	CALDWELL DRUG, LLC	8141 HIGHWAY 165		COLUMBIA	LA	71418-4341	10/14/2024	01/01/2025		01/01/2025
Contract Detail	CENTERWELL PHARMACY, INC.	10737 MARKS WAY		MIRAMAR	FL	33025	10/15/2021	01/01/2022	07/07/2023	10/16/2023
Contract Detail	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	10/15/2021	01/01/2022		01/01/2022
Contract Detail	CENTERWELL PHARMACY, INC.	11010 FLORIDA CROWN DRIVE, SUITE 200		ORLANDO	FL	32824	10/16/2023	01/01/2024		01/01/2024
Contract Detail	J & K DRUGS	7190 HIGHWAY 165		COLUMBIA	LA	71418-3302	01/15/2020	04/01/2020		04/01/2020
Contract Detail	RELIANT HEALTHCARE	RELIANT MEDICAL LLC	4315 TEXAS BLVD	TEXARKANA	TX	75503	10/10/2019	01/01/2020		01/01/2020
Contract Detail	RELIANT MEDICAL LLC DBA RELIANT HEALTHCA	1004 N 19TH ST		MONROE	LA	71201-5734	10/10/2019	01/01/2020		01/01/2020
Contract Detail	THE MEDICINE CABINET	7623 HIGHWAY 165		COLUMBIA	LA	71418	10/16/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/15/2021	01/01/2022		01/01/2022
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/12/2023	07/01/2023		07/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/16/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH191315-01	Child	CAH	HARDTNER MEDICAL CENTER	HARDTNER MEDICAL CLINIC	1049 NORTH PINE RD	OLLA	LA	Active
CAH191315-02	Child	CAH	HARDTNER MEDICAL CENTER	LASALLE PARISH HOSPITAL SERVICE DIS / HARDTNER FAMILY CLINIC	1102 NORTH PINE RD	OLLA	LA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/23/2023 1:06:56 PM	9/4/2024 10:26:54 AM	9/4/2024 10:26 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 5:13:56 PM	8/23/2023 1:06:56 PM	8/23/2023 1:06 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 10:47:19 AM	8/29/2022 5:13:56 PM	8/29/2022 5:13 PM
Addresses	Billing Address	Update	Recertification	HARDTNER FAMILY CLINIC 1136 NORTH PINE ROAD OLLA, LA 71465	HARDTNER FAMILY CLINIC 15712 Hwy 165 OLLA, LA 71465	8/16/2021 10:47 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 10:49:46 AM	8/16/2021 10:47:19 AM	8/16/2021 10:47 AM
Details	Last Recertification Date	Update	Recertification	8/28/2019 4:42:24 PM	9/10/2020 10:49:46 AM	9/10/2020 10:49 AM
Contacts	Primary Contact	Update	Profile Change Request	White, Anna P Sr. Accountant Hardtner Medical Center 3184955018-112	White, Anna P Sr. Accountant Hardtner Medical Center 3184953131-112	10/9/2019 2:29 PM
Details	Last Recertification Date	Update	Recertification	8/28/2018 1:15:05 PM	8/28/2019 4:42:24 PM	8/28/2019 4:42 PM
Details	Last Recertification Date	Update	Recertification	11/9/2017 11:57:19 AM	8/28/2018 1:15:05 PM	8/28/2018 1:15 PM
Details	Last Recertification Date	Update	Recertification	10/26/2017 1:33:55 PM	11/9/2017 11:57:19 AM	11/9/2017 11:57 AM
Details	Last Recertification Date	Update	Recertification		10/26/2017 1:33:55 PM	10/26/2017 1:33 PM
Contacts	Primary Contact	Insert	Change Request		White, Anna P Sr. Accountant Hardtner Medical Center 3184955018-112	10/12/2017 5:14 PM
Contacts	Authorizing Official	Update		Mathews, Paul G. Administrator 3184953131-109	Mathews, Paul G. Administrator Hardtner Medical Center 3184953131-109	10/12/2017 3:52 PM
Contacts	Signed By	Update		Mathews, Paul G. Administrator 3184953131-109	Mathews, Paul G. Administrator Hardtner Medical Center 3184953131-109	10/12/2017 3:52 PM
Contacts	Authorizing Official	Insert			Mathews, Paul G. Administrator 3184953131-109	1/10/2017 3:53 PM
Contacts	Signed By	Insert			Mathews, Paul G. Administrator 3184953131-109	1/10/2017 3:53 PM
Addresses	Main Address	Insert			1102 NORTH PINE RD HARDTNER MEDICAL CENTER OLLA, LA 71465-4804	8/23/2016 12:09 PM
Addresses	Billing Address	Insert			HARDTNER FAMILY CLINIC 1136 NORTH PINE ROAD OLLA, LA 71465	8/23/2016 12:09 PM
Dates	Participating Approval Date	Update			8/23/2016 12:00:00 AM	8/23/2016 12:09 PM
Details	State	Update		Pending	Active	8/23/2016 12:09 PM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	8/23/2016 12:09 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_71336	CAH191315-02	8/17/2016 9:57 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_71336	7/11/2016 2:28 PM
Details	Last Recertification Date	Insert				7/11/2016 2:28 PM
Details	Grant Number	Insert				7/11/2016 2:28 PM
Details	340B ID	Insert				7/11/2016 2:28 PM
Details	Is Authorizing Official EHB Data	Insert				7/11/2016 2:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/11/2016 2:28 PM
Details	Medicare Provider Number	Insert			191315	7/11/2016 2:28 PM
Details	Entity Name	Insert			HARDTNER MEDICAL CENTER	7/11/2016 2:28 PM
Details	Program Code	Insert			CAH	7/11/2016 2:28 PM
Details	Entity Subname	Insert			LASALLE PARISH HOSPITAL SERVICE DIS / HARDTNER FAMILY CLINIC	7/11/2016 2:28 PM
Dates	Participating Approval Date	Insert				7/11/2016 2:28 PM
Details	State	Insert			Pending	7/11/2016 2:28 PM
Dates	Registration Date	Insert			7/11/2016 12:00:00 AM	7/11/2016 2:28 PM
Dates	Signed By Date	Insert			7/11/2016 12:00:00 AM	7/11/2016 2:28 PM
Dates	Start Date	Insert				7/11/2016 2:28 PM
Terminations	Termination Comments	Insert				7/11/2016 2:28 PM
Terminations	Termination Date	Insert				7/11/2016 2:28 PM
Terminations	Termination Effective Date	Insert				7/11/2016 2:28 PM
Terminations	Termination Reason	Insert				7/11/2016 2:28 PM