Covered Entity Details

CAH041323-01 ASHLEY COUNTY MEDICAL CENTER (Active) - information as of 5/20/2025 12:52:54 AM

Main Details

Name

ASHLEY COUNTY MEDICAL CENTER

Subdivision Name

CROSSETT HEALTH FOUNDATION

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH041323-01

Medicare Provider Number

041323

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/11/2017

Participating Start Date

7/1/2017

Participating Approval Date

4/20/2017

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

ashley county medcal center
PHILLIP GILMORE, CHIEF EXECUTIVE OFFICER
(870) 364-4111 Ext: 271

Primary Contact

ashley county medical center
dawn lanae burchfield, director of pharmacy
(870) 364-1248

Addresses

Street Address

1003 FRED LAGRONE DRIVE
ASHLEY HEALTH SERVICES
CROSSETT, AR 71635-4546

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
CAH041323-01	Child	CAH	ASHLEY COUNTY MEDICAL CENTER	CROSSETT HEALTH FOUNDATION	1003 FRED LAGRONE DRIVE	CROSSETT	AR	Active
CAH041323-02	Child	CAH	ASHLEY COUNTY MEDICAL CENTER	HAMBURG HEALTH CLINIC	323 W Parker Street	HAMBURG	AR	Active
CAH041323-03	Child	CAH	ASHLEY COUNTY MEDICAL CENTER	CROSSETT HEALTH FOUNDATION - Ashley Family RHC	124 RAY LOCHALA RD	CROSSETT	AR	Active
CAH041323-04	Child	CAH	ASHLEY COUNTY MEDICAL CENTER	CROSSETT HEALTH FOUNDATION - Family Clinic Provider Based	909 UNITY RD STE B	CROSSETT	AR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/24/2023 11:21:20 AM	8/19/2024 10:46:17 AM	8/19/2024 10:46 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 11:17:12 AM	8/24/2023 11:21:20 AM	8/24/2023 11:21 AM
Details	Last Recertification Date	Update	Recertification	8/16/2021 3:38:10 PM	9/7/2022 11:17:12 AM	9/7/2022 11:17 AM
Details	Last Recertification Date	Update	Recertification	8/20/2020 10:14:51 AM	8/16/2021 3:38:10 PM	8/16/2021 3:38 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 3:43:18 PM	8/20/2020 10:14:51 AM	8/20/2020 10:14 AM
Details	Last Recertification Date	Update	Recertification	8/15/2018 11:05:31 AM	8/20/2019 3:43:18 PM	8/20/2019 3:43 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 10:18:22 AM	8/15/2018 11:05:31 AM	8/15/2018 11:05 AM
Contacts	Primary Contact	Insert	Recertification		burchfield, dawn lanae director of pharmacy ashley county medical center 8703641248	11/29/2017 10:18 AM
Details	Last Recertification Date	Update	Recertification		11/29/2017 10:18:22 AM	11/29/2017 10:18 AM
Contacts	Authorizing Official	Update		GILMORE, PHILLIP CHIEF EXECUTIVE OFFICER 8703644111-271	GILMORE, PHILLIP CHIEF EXECUTIVE OFFICER ashley county medcal center 8703644111-271	11/20/2017 10:58 AM
Contacts	Signed By	Update		GILMORE, PHILLIP CHIEF EXECUTIVE OFFICER 8703644111-271	GILMORE, PHILLIP CHIEF EXECUTIVE OFFICER ashley county medcal center 8703644111-271	11/20/2017 10:58 AM
Contacts	Authorizing Official	Insert			GILMORE, PHILLIP CHIEF EXECUTIVE OFFICER 8703644111-271	7/19/2017 10:29 AM
Contacts	Signed By	Insert			GILMORE, PHILLIP CHIEF EXECUTIVE OFFICER 8703644111-271	7/19/2017 10:29 AM
Addresses	Main Address	Insert			1003 FRED LAGRONE DRIVE ASHLEY HEALTH SERVICES CROSSETT, AR 71635-4546	4/20/2017 1:15 PM
Dates	Participating Approval Date	Update			4/20/2017 12:00:00 AM	4/20/2017 1:15 PM
Details	State	Update		Pending	Active	4/20/2017 1:15 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	4/20/2017 1:15 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_76533	CAH041323-01	4/19/2017 12:07 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_76533	4/11/2017 1:34 PM
Details	Last Recertification Date	Insert				4/11/2017 1:34 PM
Details	Grant Number	Insert				4/11/2017 1:34 PM
Details	340B ID	Insert				4/11/2017 1:34 PM
Details	Is Authorizing Official EHB Data	Insert				4/11/2017 1:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/11/2017 1:34 PM
Details	Medicare Provider Number	Insert			041323	4/11/2017 1:34 PM
Details	Entity Name	Insert			ASHLEY COUNTY MEDICAL CENTER	4/11/2017 1:34 PM
Details	Program Code	Insert			CAH	4/11/2017 1:34 PM
Details	Entity Subname	Insert			CROSSETT HEALTH FOUNDATION	4/11/2017 1:34 PM
Dates	Participating Approval Date	Insert				4/11/2017 1:34 PM
Details	State	Insert			Pending	4/11/2017 1:34 PM
Dates	Registration Date	Insert			4/11/2017 12:00:00 AM	4/11/2017 1:34 PM
Dates	Signed By Date	Insert			4/11/2017 12:00:00 AM	4/11/2017 1:34 PM
Dates	Start Date	Insert				4/11/2017 1:34 PM
Terminations	Termination Comments	Insert				4/11/2017 1:34 PM
Terminations	Termination Date	Insert				4/11/2017 1:34 PM
Terminations	Termination Effective Date	Insert				4/11/2017 1:34 PM
Terminations	Termination Reason	Insert				4/11/2017 1:34 PM