Covered Entity Details

CAH141344-01 LAWRENCE COUNTY MEMORIAL HOSPITAL (Active) - information as of 5/13/2025 1:38:46 AM

Main Details

Name

LAWRENCE COUNTY MEMORIAL HOSPITAL

Subdivision Name

Lawrence County Memorial Hospital Primary Care Clinic

Type

Critical Access Hospital

Rural

340B ID

CAH141344-01

Medicare Provider Number

141344

Outpatient Facility Provider Number

143499

Additional Details

Current Program Status

Active

Registration Date

10/3/2016

Participating Start Date

1/1/2017

Participating Approval Date

10/5/2016

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Lawrence County Memorial Hospital
Carl H Aten, Board Chairman
(618) 843-8424

Primary Contact

Lawrence County Memorial Hospital
Shana C Strange, CFO
(618) 943-7202

Addresses

Street Address

2111 Lexington Avenue
Lawrenceville, IL 62439-2085

Billing Address

Lawrence County Memorial Hospital Primary Care Clinic
2200 State Street
Lawrenceville, IL 62439

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
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH141344-01	Child	CAH	LAWRENCE COUNTY MEMORIAL HOSPITAL	Lawrence County Memorial Hospital Primary Care Clinic	2111 Lexington Avenue	Lawrenceville	IL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/30/2023 2:14:56 PM	8/28/2024 12:42:59 PM	8/28/2024 12:42 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 12:53:51 PM	8/30/2023 2:14:56 PM	8/30/2023 2:14 PM
Contacts	Primary Contact	Update	Group Change Request	Robbins, Don E CEO Lawrence County Memorial Hospital 6189437200	Strange, Shana C CFO Lawrence County Memorial Hospital 6189437202	4/20/2023 11:04 AM
Details	Last Recertification Date	Update	Recertification	9/10/2021 1:06:07 PM	9/14/2022 12:53:51 PM	9/14/2022 12:53 PM
Contacts	Primary Contact	Update	Recertification	Spour, Larry Chief Financial Officer Lawrence County Memorial Hospital 6189437202	Robbins, Don E CEO Lawrence County Memorial Hospital 6189437200	9/10/2021 1:06 PM
Details	Last Recertification Date	Update	Recertification	9/8/2020 2:32:41 PM	9/10/2021 1:06:07 PM	9/10/2021 1:06 PM
Details	Last Recertification Date	Update	Recertification	9/9/2019 2:18:53 PM	9/8/2020 2:32:41 PM	9/8/2020 2:32 PM
Details	Last Recertification Date	Update	Recertification	8/23/2018 5:32:04 PM	9/9/2019 2:18:53 PM	9/9/2019 2:18 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 12:35:07 PM	8/23/2018 5:32:04 PM	8/23/2018 5:32 PM
Details	Last Recertification Date	Update	Recertification		11/29/2017 12:35:07 PM	11/29/2017 12:35 PM
Contacts	Authorizing Official	Update	Change Request	Florkowski, Doug CEO 6189437200	Aten, Carl H Board Chairman Lawrence County Memorial Hospital 6188438424	10/23/2017 6:09 AM
Contacts	Primary Contact	Update		Spour, Larry Chief Financial Officer 6189437202	Spour, Larry Chief Financial Officer Lawrence County Memorial Hospital 6189437202	10/12/2017 5:31 PM
Contacts	Signed By	Update		Florkowski, Doug CEO 6189437200	Florkowski, Doug CEO Lawrence County Memorial Hospital 6189437200	10/12/2017 3:59 PM
Addresses	Main Address	Insert			2111 Lexington Avenue Lawrenceville, IL 62439-2085	10/17/2016 2:59 PM
Addresses	Billing Address	Insert			Lawrence County Memorial Hospital Primary Care Clinic 2200 State Street Lawrenceville, IL 62439	10/17/2016 2:59 PM
Contacts	Primary Contact	Insert			Spour, Larry Chief Financial Officer 6189437202	10/17/2016 2:59 PM
Contacts	Authorizing Official	Insert			Florkowski, Doug CEO 6189437200	10/17/2016 2:59 PM
Contacts	Signed By	Insert			Florkowski, Doug CEO 6189437200	10/17/2016 2:59 PM
Dates	Participating Approval Date	Update			10/5/2016 12:00:00 AM	10/5/2016 4:57 PM
Details	State	Update		Pending	Active	10/5/2016 4:57 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	10/5/2016 4:57 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_72287	CAH141344-01	10/4/2016 10:21 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_72287	10/3/2016 4:56 PM
Details	Last Recertification Date	Insert				10/3/2016 4:56 PM
Details	Grant Number	Insert				10/3/2016 4:56 PM
Details	340B ID	Insert				10/3/2016 4:56 PM
Details	Is Authorizing Official EHB Data	Insert				10/3/2016 4:56 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/3/2016 4:56 PM
Details	Medicare Provider Number	Insert			141344	10/3/2016 4:56 PM
Details	Entity Name	Insert			LAWRENCE COUNTY MEMORIAL HOSPITAL	10/3/2016 4:56 PM
Details	Program Code	Insert			CAH	10/3/2016 4:56 PM
Details	Entity Subname	Insert			Lawrence County Memorial Hospital Primary Care Clinic	10/3/2016 4:56 PM
Dates	Participating Approval Date	Insert				10/3/2016 4:56 PM
Details	State	Insert			Pending	10/3/2016 4:56 PM
Dates	Registration Date	Insert			10/3/2016 12:00:00 AM	10/3/2016 4:56 PM
Dates	Signed By Date	Insert			10/3/2016 12:00:00 AM	10/3/2016 4:56 PM
Dates	Start Date	Insert				10/3/2016 4:56 PM
Terminations	Termination Comments	Insert				10/3/2016 4:56 PM
Terminations	Termination Date	Insert				10/3/2016 4:56 PM
Terminations	Termination Effective Date	Insert				10/3/2016 4:56 PM
Terminations	Termination Reason	Insert				10/3/2016 4:56 PM