Covered Entity Details

DSH180012F Baptist Health Hardin (Active) - information as of 4/28/2025 1:49:49 AM

Main Details

Name

Baptist Health Hardin

Subdivision Name

Baptist Health Hardin Cancer Care Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH180012F

Medicare Provider Number

180012

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

2/6/2017

Participating Start Date

4/1/2017

Participating Approval Date

3/15/2017

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Baptist Health Hardin
Thomas Carrico, Chief Operating Officer
(270) 706-5321

Primary Contact

Baptist Health Hardin
Christopher Michael Diem, System 340B Director
(270) 979-3725

Addresses

Street Address

200 Cardinal Drive
Suite 301
Elizabethtown, KY 42701

Billing Address

Baptist Health Hardin
913 North Dixie Avenue
Elizabethtown, KY 42701

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
KY		1689282147,1720696149,1497585624
IN		1689282147
TN		1689282147

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
DSH180012A	Child	DSH	HARDIN MEMORIAL HOSPITAL	HELMWOOD RADIOLOGY	914 NORTH DIXIE AVENUE 307	ELIZABETHTOWN	KY	Terminated
DSH180012B	Child	DSH	HARDIN MEMORIAL HOSPITAL	HEARTLAND DIAGNOSTIC CENTER	1700 RING ROAD	ELIZABETHTOWN	KY	Terminated
DSH180012C	Child	DSH	HARDIN MEMORIAL HOSPITAL	NORTH HARDIN DIAGNOSTIC CENTER	1360 ROGERSVILLE ROAD	RADCLIFF	KY	Terminated
DSH180012D	Child	DSH	HARDIN MEMORIAL HOSPITAL	BARDSTOWN DIAGNOSTIC CENTER	201 S. 5TH STREET	BARDSTOWN	KY	Terminated
DSH180012F	Child	DSH	Baptist Health Hardin	Baptist Health Hardin Cancer Care Center	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012G	Child	DSH	HARDIN MEMORIAL HOSPITAL	ELIZABETHTOWN DIAGNOSTIC IMAGING	2409 RING ROAD,	ELIZABETHTOWN	KY	Terminated
DSH180012H	Child	DSH	Baptist Health Hardin	HMH-SURGICAL CENTER OF ELIZABETHTOWN	108 FINANCIAL PL	ELIZABETHTOWN	KY	Terminated
DSH180012J	Child	DSH	Baptist Health Hardin	Medical Oncology Clinic - Medical Oncology Physician Clinic	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012K	Child	DSH	HARDIN MEMORIAL HOSPITAL	Wound Care Clinic - Wound and Vascular physician clinic	1010 Woodland Drive	Elizabethtown	KY	Terminated
DSH180012L	Child	DSH	Baptist Health Hardin	HMH DIAB MGMT/HMH DISEASE MGMT - Diabetes	521 Robinbrooke Blvd	Elizabethtown	KY	Active
DSH180012M	Child	DSH	Baptist Health Hardin	Operating Rooms - Outpatient Surgery	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012N	Child	DSH	Baptist Health Hardin	Clinic - Complex Care	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012P	Child	DSH	Baptist Health Hardin	Operating Rooms - Preadmission Testing	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012Q	Child	DSH	Baptist Health Hardin	RADIOLOGY-DIAGNOSTIC - Radiology Diagnostic	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012R	Child	DSH	Baptist Health Hardin	LABORATORY - Laboratory	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012S	Child	DSH	Baptist Health Hardin	CARDIAC CATHETERIZATION - Cardiac Cath Lab	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012T	Child	DSH	Baptist Health Hardin	RESPIRATORY THERAPY - Respiratory Therapy	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012U	Child	DSH	Baptist Health Hardin	RADIOLOGY - THERAPEUTIC - Radiation Oncology Clinic	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012V	Child	DSH	Baptist Health Hardin	ELECTROCARDIOLOGY - Cardiology	200 Cardinal Drive	Elizabethtown	KY	Active
DSH180012W	Child	DSH	Baptist Health Hardin	RADIOLOGY - THERAPEUTIC - Radition Therapy	200 Cardinal Drive	Elizabethtown	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Dates	Last Date That 340B Drugs Purchased	Update	OPA Cancel Termination Request	1/1/2025 12:00:00 AM		11/25/2024 1:51 PM
Details	State	Update	OPA Cancel Termination Request	To Be Terminated	Active	11/25/2024 1:51 PM
Terminations	Termination Date	Update	OPA Cancel Termination Request	1/1/2025 12:00:00 AM		11/25/2024 1:51 PM
Terminations	Termination Effective Date	Update	OPA Cancel Termination Request	1/1/2025 12:00:00 AM		11/25/2024 1:51 PM
Terminations	Termination Reason	Update	OPA Cancel Termination Request	Change of covered entity type		11/25/2024 1:51 PM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	11/13/2024 3:29 PM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	11/13/2024 3:29 PM
Terminations	Termination Date	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	11/13/2024 3:29 PM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	11/13/2024 3:29 PM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	11/13/2024 3:29 PM
Addresses	Billing Address	Insert	Group Change Request		Baptist Health Hardin 913 North Dixie Avenue Elizabethtown, KY 42701	11/1/2024 8:02 AM
Addresses	Main Address	Update	Group Change Request	521 ROBINBROOKE BLVD ELIZABETHTOWN, KY 42701-5906	200 Cardinal Drive Suite 301 Elizabethtown, KY 42701	11/1/2024 8:02 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1720696149	10/15/2024 3:13 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	10/15/2024 3:13 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1497585624	10/15/2024 3:13 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	10/15/2024 3:13 PM
Details	Last Recertification Date	Update	Recertification	8/15/2023 11:04:18 AM	8/13/2024 10:50:03 AM	8/13/2024 10:50 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	7100716050 (KY)		10/9/2023 8:34 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	300056417 (IN)		10/9/2023 8:34 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	Q077818 (TN)		10/9/2023 8:34 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	01009844 (KY)		10/9/2023 8:34 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1619931466 (KY)		10/9/2023 8:34 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1619931466 (IN)		10/9/2023 8:34 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1619931466 (TN)		10/9/2023 8:34 AM
Details	Last Recertification Date	Update	Recertification	9/9/2022 12:05:33 PM	8/15/2023 11:04:18 AM	8/15/2023 11:04 AM
Contacts	Primary Contact	Update	Profile Change Request	Diem, Christopher Michael Pharmacy Program Manager Baptist Health Hardin 2709793725	Diem, Christopher Michael System 340B Director Baptist Health Hardin 2709793725	5/4/2023 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/18/2023 8:39 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		300056417	4/18/2023 8:39 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	4/18/2023 8:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/18/2023 8:39 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q077818	4/18/2023 8:39 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	4/18/2023 8:39 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1619931466	4/18/2023 8:39 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	4/18/2023 8:39 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1689282147	4/18/2023 8:39 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	4/18/2023 8:39 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1619931466	4/18/2023 8:39 AM
Medicaid Billing	NPI: State	Insert	Change Request		TN	4/18/2023 8:39 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1689282147	4/18/2023 8:39 AM
Medicaid Billing	NPI: State	Insert	Change Request		TN	4/18/2023 8:39 AM
Details	Last Recertification Date	Update	Recertification	8/23/2021 9:11:31 AM	9/9/2022 12:05:33 PM	9/9/2022 12:05 PM
Details	Entity Subname	Update	Recertification	HMH CANCER CARE CENTER	Baptist Health Hardin Cancer Care Center	9/9/2022 12:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/6/2022 12:36 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7100716050	7/6/2022 12:36 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	7/6/2022 12:36 PM
Contacts	Authorizing Official	Update	Change Request	Carrico, Thomas Chief Operating Officer Hardin Memorial Hospital 2707065321	Carrico, Thomas Chief Operating Officer Baptist Health Hardin 2707065321	3/8/2022 7:08 AM
Contacts	Authorizing Official	Update	Profile Change Request	Carrico, Thomas VP Operations Hardin Memorial Hospital 2707065321	Carrico, Thomas Chief Operating Officer Hardin Memorial Hospital 2707065321	3/7/2022 4:58 PM
Contacts	Primary Contact	Update	Change Request	Diem, Christopher Director, Retail Pharmacy Operations Hardin Memorial Health 2709793725	Diem, Christopher Michael Pharmacy Program Manager Baptist Health Hardin 2709793725	2/22/2022 12:19 PM
Contacts	Authorizing Official	Update	Profile Change Request	Carrico, Thomas VP Operations Hardin Memorial Hospital 2707065278	Carrico, Thomas VP Operations Hardin Memorial Hospital 2707065321	8/23/2021 9:19 AM
Details	Last Recertification Date	Update	Recertification	8/28/2020 4:56:19 PM	8/23/2021 9:11:31 AM	8/23/2021 9:11 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1689282147	10/15/2020 3:41 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	10/15/2020 3:41 PM
Details	Entity Name	Update	Recertification	HARDIN MEMORIAL HOSPITAL	Baptist Health Hardin	9/4/2020 7:02 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1619931466	8/28/2020 4:56 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	8/28/2020 4:56 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1619931466 ( )		8/28/2020 4:56 PM
Details	Last Recertification Date	Update	Recertification	8/23/2019 12:04:04 PM	8/28/2020 4:56:19 PM	8/28/2020 4:56 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 9:05:25 AM	8/23/2019 12:04:04 PM	8/23/2019 12:04 PM
Contacts	Primary Contact	Update	Recertification	Sullivan, Kevin Michael Director of Pharmacy Hardin Memorial Hospital 2707061108	Diem, Christopher Director, Retail Pharmacy Operations Hardin Memorial Health 2709793725	8/17/2018 9:05 AM
Details	Last Recertification Date	Update	Recertification	11/6/2017 2:34:02 PM	8/17/2018 9:05:25 AM	8/17/2018 9:05 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/30/2018 9:59 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01009844	4/30/2018 9:59 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	4/30/2018 9:59 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1619931466	4/30/2018 9:59 AM
Contacts	Primary Contact	Update	Recertification	Steward, Brian Reimbursement Manager 2707061663	Sullivan, Kevin Michael Director of Pharmacy Hardin Memorial Hospital 2707061108	11/6/2017 2:34 PM
Details	Last Recertification Date	Update	Recertification		11/6/2017 2:34:02 PM	11/6/2017 2:34 PM
Contacts	Authorizing Official	Update	Change Request	Johnson, Dennis CEO 2707061006	Carrico, Thomas VP Operations Hardin Memorial Hospital 2707065278	9/29/2017 8:28 AM
Contacts	Signed By	Update		Johnson, Dennis CEO 2707061006	Johnson, Dennis CEO Hardin Memorial Hospital 2707061006	9/28/2017 3:16 PM
Addresses	Main Address	Insert			521 ROBINBROOKE BLVD ELIZABETHTOWN, KY 42701-5906	8/30/2017 12:44 PM
Contacts	Primary Contact	Insert			Steward, Brian Reimbursement Manager 2707061663	8/30/2017 12:44 PM
Contacts	Authorizing Official	Insert			Johnson, Dennis CEO 2707061006	8/30/2017 12:44 PM
Contacts	Signed By	Insert			Johnson, Dennis CEO 2707061006	8/30/2017 12:44 PM
Dates	Participating Approval Date	Update			3/15/2017 12:00:00 AM	3/15/2017 1:43 PM
Details	State	Update		Pending	Active	3/15/2017 1:43 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	3/15/2017 1:43 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_75628	DSH180012F	2/8/2017 1:41 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_75628	2/6/2017 1:34 AM
Details	Last Recertification Date	Insert				2/6/2017 1:34 AM
Details	Grant Number	Insert				2/6/2017 1:34 AM
Details	340B ID	Insert				2/6/2017 1:34 AM
Details	Is Authorizing Official EHB Data	Insert				2/6/2017 1:34 AM
Dates	Last Date That 340B Drugs Purchased	Insert				2/6/2017 1:34 AM
Details	Medicare Provider Number	Insert			180012	2/6/2017 1:34 AM
Details	Entity Name	Insert			HARDIN MEMORIAL HOSPITAL	2/6/2017 1:34 AM
Details	Program Code	Insert			DSH	2/6/2017 1:34 AM
Details	Entity Subname	Insert			HMH CANCER CARE CENTER	2/6/2017 1:34 AM
Dates	Participating Approval Date	Insert				2/6/2017 1:34 AM
Details	State	Insert			Pending	2/6/2017 1:34 AM
Dates	Registration Date	Insert			2/6/2017 12:00:00 AM	2/6/2017 1:34 AM
Dates	Signed By Date	Insert			2/6/2017 12:00:00 AM	2/6/2017 1:34 AM
Dates	Start Date	Insert				2/6/2017 1:34 AM
Terminations	Termination Comments	Insert				2/6/2017 1:34 AM
Terminations	Termination Date	Insert				2/6/2017 1:34 AM
Terminations	Termination Effective Date	Insert				2/6/2017 1:34 AM
Terminations	Termination Reason	Insert				2/6/2017 1:34 AM