Covered Entity Details

CAH161300-01 BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER (Terminated) - information as of 5/17/2025 10:58:49 PM

Main Details

Name

BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER

Subdivision Name

RURAL HEALTH CLINIC IV

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH161300-01

Medicare Provider Number

161300

Outpatient Facility Provider Number

163492

Additional Details

Current Program Status

Terminated

Registration Date

4/10/2017

Participating Start Date

7/1/2017

Participating Approval Date

4/19/2017

Last Recertification Date

8/14/2023

Termination Date
Termination Reason

4/1/2024
Site closure

Contacts

Authorizing Official

MercyOne
Jesica Hanson, VP of Finance
(712) 279-5850

Primary Contact

MercyOne
Brett Bieber, Director of Pharmacy
(712) 279-5992

Addresses

Street Address

231 N EIGHTH AVE W
HARTLEY, IA 51346-1077

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?
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
CAH161300-01	Child	CAH	BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER	RURAL HEALTH CLINIC IV	231 N EIGHTH AVE W	HARTLEY	IA	Terminated
CAH161300-02	Child	CAH	BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER	RURAL HEALTH CLINIC III	108 WEST 2ND ST	SUTHERLAND	IA	Terminated
CAH161300-03	Child	CAH	BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER	RURAL HEALTH CLINIC II	108 E GROESBECK	PAULLINA	IA	Terminated
CAH161300-04	Child	CAH	BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER	RURAL HEALTH CLINCI	240 N RERICK AVE	PRIMGHAR	IA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		6/30/2022 12:00:00 AM	1/17/2024 9:28 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/17/2024 9:28 AM
Terminations	Termination Date	Update	Termination Request		4/1/2024 12:00:00 AM	1/17/2024 9:28 AM
Terminations	Termination Effective Date	Update	Termination Request		6/30/2022 12:00:00 AM	1/17/2024 9:28 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	1/17/2024 9:28 AM
Contacts	Primary Contact	Update	PC Change Request	Mathis, Adam 340B Program Coordinator MercyOne Siouxland Medical Center 7122792310	Bieber, Brett Director of Pharmacy MercyOne 7122795992	1/16/2024 7:17 AM
Details	Last Recertification Date	Update	Recertification	9/8/2022 11:44:12 AM	8/14/2023 4:50:51 PM	8/14/2023 4:50 PM
Details	Last Recertification Date	Update	Recertification	8/30/2021 10:27:37 AM	9/8/2022 11:44:12 AM	9/8/2022 11:44 AM
Details	Last Recertification Date	Update	Recertification	9/11/2020 5:01:10 PM	8/30/2021 10:27:37 AM	8/30/2021 10:27 AM
Contacts	Authorizing Official	Update	Change Request	Hughes, Jessica Director of Finance MercyOne Medical Center Sioux City 7122792157	Hanson, Jesica VP of Finance MercyOne 7122795850	4/14/2021 2:56 PM
Contacts	Primary Contact	Update	Recertification	VanderPol, Rose RN/CPhT/Pharmacy/Informatics/ER/Trauma Coordinator Baum Harmon Mercy Hospital DBA MercyOne Primghar Medical Center 7129572300	Mathis, Adam 340B Program Coordinator MercyOne Siouxland Medical Center 7122792310	9/11/2020 5:01 PM
Details	Last Recertification Date	Update	Recertification	9/10/2019 5:30:04 PM	9/11/2020 5:01:10 PM	9/11/2020 5:01 PM
Contacts	Authorizing Official	Update	Profile Change Request	Hughes, Jessica Director of Finance Hawarden Regional Healthcare 7125513105	Hughes, Jessica Director of Finance MercyOne Medical Center Sioux City 7122792157	9/11/2020 2:58 PM
Contacts	Authorizing Official	Update	AO Change Request	MCCAULEY, SUE E CAH FINANCE MANAGER-BHMH OMH Baum Harmon Mercy Hospital 7129572300-2303	Hughes, Jessica Director of Finance Hawarden Regional Healthcare 7125513105	9/11/2020 1:29 PM
Contacts	Primary Contact	Update	Profile Change Request	VanderPol, Rose Informatics Baum Harmon Mercy Hospital DBA MercyOne Primghar Medical Center 7129572300	VanderPol, Rose RN/CPhT/Pharmacy/Informatics/ER/Trauma Coordinator Baum Harmon Mercy Hospital DBA MercyOne Primghar Medical Center 7129572300	1/14/2020 12:47 PM
Details	Entity Name	Update	Change Request	BAUM HARMON MERCY HOSPITAL	BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER	1/7/2020 8:51 AM
Contacts	Primary Contact	Update	Change Request	VanderPol, Rose Informatics Baum Harmon Mercy Hospital 7129572300	VanderPol, Rose Informatics Baum Harmon Mercy Hospital DBA MercyOne Primghar Medical Center 7129572300	12/31/2019 4:56 PM
Details	Last Recertification Date	Update	Recertification	9/10/2018 12:25:18 PM	9/10/2019 5:30:04 PM	9/10/2019 5:30 PM
Contacts	Authorizing Official	Update	Profile Change Request	MCCAULEY, SUE E CAH FINANCE MANAGER Baum Harmon Mercy Hospital 7129572300-2303	MCCAULEY, SUE E CAH FINANCE MANAGER-BHMH OMH Baum Harmon Mercy Hospital 7129572300-2303	9/12/2018 4:23 PM
Contacts	Signed By	Update	Profile Change Request	MCCAULEY, SUE E CAH FINANCE MANAGER Baum Harmon Mercy Hospital 7129572300-2303	MCCAULEY, SUE E CAH FINANCE MANAGER-BHMH OMH Baum Harmon Mercy Hospital 7129572300-2303	9/12/2018 4:23 PM
Contacts	Authorizing Official	Update	Profile Change Request	MCCAULEY, SUE E DIRECTOR OF FINANCE Baum Harmon Mercy HOspital 7129572300-2303	MCCAULEY, SUE E CAH FINANCE MANAGER Baum Harmon Mercy Hospital 7129572300-2303	9/12/2018 4:22 PM
Contacts	Signed By	Update	Profile Change Request	MCCAULEY, SUE E DIRECTOR OF FINANCE Baum Harmon Mercy HOspital 7129572300-2303	MCCAULEY, SUE E CAH FINANCE MANAGER Baum Harmon Mercy Hospital 7129572300-2303	9/12/2018 4:22 PM
Details	Last Recertification Date	Update	Recertification	12/4/2017 12:18:30 PM	9/10/2018 12:25:18 PM	9/10/2018 12:25 PM
Contacts	Primary Contact	Update	Recertification	MCCAULEY, SUE E DIRECTOR OF FINANCE Baum Harmon Mercy HOspital 7129572300-2303	VanderPol, Rose Informatics Baum Harmon Mercy Hospital 7129572300	12/4/2017 12:18 PM
Details	Last Recertification Date	Update	Recertification		12/4/2017 12:18:30 PM	12/4/2017 12:18 PM
Contacts	Authorizing Official	Update		MCCAULEY, SUE DIRECTOR OF FINANCE 7129572300-2303	MCCAULEY, SUE E DIRECTOR OF FINANCE Baum Harmon Mercy HOspital 7129572300-2303	12/4/2017 11:53 AM
Contacts	Primary Contact	Update		MCCAULEY, SUE DIRECTOR OF FINANCE 7129572300-2303	MCCAULEY, SUE E DIRECTOR OF FINANCE Baum Harmon Mercy HOspital 7129572300-2303	12/4/2017 11:53 AM
Contacts	Signed By	Update		MCCAULEY, SUE DIRECTOR OF FINANCE 7129572300-2303	MCCAULEY, SUE E DIRECTOR OF FINANCE Baum Harmon Mercy HOspital 7129572300-2303	12/4/2017 11:53 AM
Contacts	Authorizing Official	Insert			MCCAULEY, SUE DIRECTOR OF FINANCE 7129572300-2303	7/13/2017 10:49 AM
Contacts	Primary Contact	Insert			MCCAULEY, SUE DIRECTOR OF FINANCE 7129572300-2303	7/13/2017 10:49 AM
Contacts	Signed By	Insert			MCCAULEY, SUE DIRECTOR OF FINANCE 7129572300-2303	7/13/2017 10:49 AM
Addresses	Main Address	Insert			231 N EIGHTH AVE W HARTLEY, IA 51346-1077	4/19/2017 10:37 AM
Dates	Participating Approval Date	Update			4/19/2017 12:00:00 AM	4/19/2017 10:35 AM
Details	State	Update		Pending	Active	4/19/2017 10:35 AM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	4/19/2017 10:35 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_76382	CAH161300-01	4/13/2017 1:09 PM
Details	Entity Subname	Update		BAUM HARMON MERCY HOSPITAL	RURAL HEALTH CLINIC IV	4/13/2017 1:09 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_76382	4/10/2017 5:20 PM
Details	Last Recertification Date	Insert				4/10/2017 5:20 PM
Details	Grant Number	Insert				4/10/2017 5:20 PM
Details	340B ID	Insert				4/10/2017 5:20 PM
Details	Is Authorizing Official EHB Data	Insert				4/10/2017 5:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/10/2017 5:20 PM
Details	Medicare Provider Number	Insert			161300	4/10/2017 5:20 PM
Details	Entity Name	Insert			BAUM HARMON MERCY HOSPITAL	4/10/2017 5:20 PM
Details	Program Code	Insert			CAH	4/10/2017 5:20 PM
Details	Entity Subname	Insert			BAUM HARMON MERCY HOSPITAL	4/10/2017 5:20 PM
Dates	Participating Approval Date	Insert				4/10/2017 5:20 PM
Details	State	Insert			Pending	4/10/2017 5:20 PM
Dates	Registration Date	Insert			4/10/2017 12:00:00 AM	4/10/2017 5:20 PM
Dates	Signed By Date	Insert			4/10/2017 12:00:00 AM	4/10/2017 5:20 PM
Dates	Start Date	Insert				4/10/2017 5:20 PM
Terminations	Termination Comments	Insert				4/10/2017 5:20 PM
Terminations	Termination Date	Insert				4/10/2017 5:20 PM
Terminations	Termination Effective Date	Insert				4/10/2017 5:20 PM
Terminations	Termination Reason	Insert				4/10/2017 5:20 PM