Covered Entity Details

CAH371303-01 ROGER MILLS MEMORIAL HOSPITAL (Active) - information as of 6/20/2025 1:42:07 AM

Main Details

Name

ROGER MILLS MEMORIAL HOSPITAL

Subdivision Name

Buster Rural Health Clinic

Type

Critical Access Hospital

Rural

340B ID

CAH371303-01

Medicare Provider Number

371303

Outpatient Facility Provider Number

373999

Additional Details

Current Program Status

Active

Registration Date

4/11/2017

Participating Start Date

7/1/2017

Participating Approval Date

5/24/2017

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

Roger Mills Memorial Hospital
Cynthia E Duncan, CEO
(580) 497-3336 Ext: 224

Primary Contact

Roger Mills Memorial Hospital
Ellen Kirk, DON
(580) 497-3336

Addresses

Street Address

101 F. Buster Avenue
Cheyenne, OK 73628

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
CAH371303-01	Child	CAH	ROGER MILLS MEMORIAL HOSPITAL	Buster Rural Health Clinic	101 F. Buster Avenue	Cheyenne	OK	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 5:39:33 PM	8/29/2024 12:02:28 PM	8/29/2024 12:02 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 3:10:29 PM	8/29/2023 5:39:33 PM	8/29/2023 5:39 PM
Details	Last Recertification Date	Update	Recertification	8/26/2021 3:15:55 PM	8/30/2022 3:10:29 PM	8/30/2022 3:10 PM
Details	Last Recertification Date	Update	Recertification	8/27/2020 4:05:55 PM	8/26/2021 3:15:55 PM	8/26/2021 3:15 PM
Details	Last Recertification Date	Update	Recertification	9/4/2019 3:11:56 PM	8/27/2020 4:05:55 PM	8/27/2020 4:05 PM
Details	Last Recertification Date	Update	Recertification	8/15/2018 11:58:29 AM	9/4/2019 3:11:56 PM	9/4/2019 3:11 PM
Contacts	Authorizing Official	Update	Profile Change Request	Duncan, Cynhia E CEO Roger Mills Memorial Hospital 5804973336-224	Duncan, Cynthia E CEO Roger Mills Memorial Hospital 5804973336-224	3/25/2019 5:48 PM
Details	Last Recertification Date	Update	Recertification	11/16/2017 2:17:05 PM	8/15/2018 11:58:29 AM	8/15/2018 11:58 AM
Contacts	Primary Contact	Update	Recertification	Duncan, Cynhia CEO 5804973336-224	Kirk, Ellen DON Roger Mills Memorial Hospital 5804973336	11/16/2017 2:17 PM
Details	Last Recertification Date	Update	Recertification		11/16/2017 2:17:05 PM	11/16/2017 2:17 PM
Contacts	Authorizing Official	Update		Duncan, Cynhia CEO 5804973336-224	Duncan, Cynhia E CEO Roger Mills Memorial Hospital 5804973336-224	9/29/2017 2:44 PM
Contacts	Authorizing Official	Update		Duncan, Cynhia CEO 5804973336-224	Duncan, Cynhia CEO 5804973336-224	9/11/2017 3:29 PM
Addresses	Main Address	Insert			101 F. Buster Avenue Cheyenne, OK 73628	8/2/2017 7:34 AM
Contacts	Authorizing Official	Insert			Duncan, Cynhia CEO 5804973336-224	8/2/2017 7:34 AM
Contacts	Primary Contact	Insert			Duncan, Cynhia CEO 5804973336-224	8/2/2017 7:34 AM
Contacts	Signed By	Insert			Duncan, Cynhia CEO 5804973336-224	8/2/2017 7:34 AM
Dates	Participating Approval Date	Update			5/24/2017 12:00:00 AM	5/24/2017 11:49 AM
Details	State	Update		Pending	Active	5/24/2017 11:49 AM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	5/24/2017 11:49 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_76479	CAH371303-01	5/23/2017 7:30 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_76479	4/11/2017 11:44 AM
Details	Last Recertification Date	Insert				4/11/2017 11:44 AM
Details	Grant Number	Insert				4/11/2017 11:44 AM
Details	340B ID	Insert				4/11/2017 11:44 AM
Details	Is Authorizing Official EHB Data	Insert				4/11/2017 11:44 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/11/2017 11:44 AM
Details	Medicare Provider Number	Insert			371303	4/11/2017 11:44 AM
Details	Entity Name	Insert			ROGER MILLS MEMORIAL HOSPITAL	4/11/2017 11:44 AM
Details	Program Code	Insert			CAH	4/11/2017 11:44 AM
Details	Entity Subname	Insert			Buster Rural Health Clinic	4/11/2017 11:44 AM
Dates	Participating Approval Date	Insert				4/11/2017 11:44 AM
Details	State	Insert			Pending	4/11/2017 11:44 AM
Dates	Registration Date	Insert			4/11/2017 12:00:00 AM	4/11/2017 11:44 AM
Dates	Signed By Date	Insert			4/11/2017 12:00:00 AM	4/11/2017 11:44 AM
Dates	Start Date	Insert				4/11/2017 11:44 AM
Terminations	Termination Comments	Insert				4/11/2017 11:44 AM
Terminations	Termination Date	Insert				4/11/2017 11:44 AM
Terminations	Termination Effective Date	Insert				4/11/2017 11:44 AM
Terminations	Termination Reason	Insert				4/11/2017 11:44 AM