Covered Entity Details

SCH450055-03 ROLLING PLAINS MEMORIAL HOSPITAL (Active) - information as of 6/9/2025 11:00:18 PM

Main Details

Name

ROLLING PLAINS MEMORIAL HOSPITAL

Subdivision Name

RPMH / Rural Health Clinic

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH450055-03

Medicare Provider Number

450055

Outpatient Facility Provider Number

673439

Additional Details

Current Program Status

Active

Registration Date

4/12/2017

Participating Start Date

7/1/2017

Participating Approval Date

5/3/2017

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

ROLLING PLAINS MEMORIAL HOSPITAL
RHONDA GUELKER, CFO
(325) 219-6238

Primary Contact

Rolling Plains Memorial Hospital
Brandon Staggs, Director of Pharmacy
(325) 219-6075

Addresses

Street Address

201 EAST ARIZONA
SWEETWATER, TX 79556-7120

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?
Yes

State	Medicaid Number	NPI Number
TX		1275581852

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
SCH450055-01	Child	SCH	ROLLING PLAINS MEMORIAL HOSPITAL	RPMH Medical Associates / Orthopedic Surgeon	301 Jenny George Lane Bldg B	Sweetwater	TX	Terminated
SCH450055-02	Child	SCH	ROLLING PLAINS MEMORIAL HOSPITAL	RPMH Medical Associates/Family Practice-Obstetrics	301 Jenny George Lane	Sweetwater	TX	Active
SCH450055-03	Child	SCH	ROLLING PLAINS MEMORIAL HOSPITAL	RPMH / Rural Health Clinic	201 EAST ARIZONA	SWEETWATER	TX	Active
SCH450055-04	Child	SCH	ROLLING PLAINS MEMORIAL HOSPITAL	RPMH MEDICAL ASSOCIATES FAMILY PRACTICE - FAMILY PRACTICE	301 JENNY GEORGE LANE	SWEETWATER	TX	Active
SCH450055-05	Child	SCH	ROLLING PLAINS MEMORIAL HOSPITAL	RPMH MEDICAL ASSOCIATES - OBGYN SERVICES	301 JENNY GEORGE LANE	SWEETWATER	TX	Active
SCH450055-06	Child	SCH	ROLLING PLAINS MEMORIAL HOSPITAL	RPMH MEDICAL ASSOCIATES - INTERNAL MEDICINE	301 JENNY GEORGE LANE	SWEETWATER	TX	Terminated
SCH450055-07	Child	SCH	ROLLING PLAINS MEMORIAL HOSPITAL	GENERAL SURGERY - SURGICAL SERVICES	301 JENNY GEORGE LANE	SWEETWATER	TX	Active
SCH450055-08	Child	SCH	ROLLING PLAINS MEMORIAL HOSPITAL	RPMH MEDICAL ASSOCIATES - PEDIATRIC - PEDIATRIC AND SPORTS MEDICINE	301 JENNY GEORGE LANE BLDG B	SWEETWATER	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/4/2023 11:52:00 AM	9/4/2024 11:32:13 AM	9/4/2024 11:32 AM
Details	Last Recertification Date	Update	Recertification	9/9/2022 4:12:29 PM	9/4/2023 11:52:00 AM	9/4/2023 11:52 AM
Contacts	Primary Contact	Update	Recertification	Staggs, Grady Lynn Pharmacy Director Rolling Plains Memorial Hospital 3252196075	Staggs, Brandon Director of Pharmacy Rolling Plains Memorial Hospital 3252196075	9/9/2022 4:12 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 3:21:11 PM	9/9/2022 4:12:29 PM	9/9/2022 4:12 PM
Details	Last Recertification Date	Update	Recertification	9/1/2020 2:51:38 PM	9/7/2021 3:21:11 PM	9/7/2021 3:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275581852	9/1/2020 2:51 PM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/1/2020 2:51 PM
Details	Last Recertification Date	Update	Recertification	8/27/2019 3:50:19 PM	9/1/2020 2:51:38 PM	9/1/2020 2:51 PM
Details	Last Recertification Date	Update	Recertification	8/31/2018 1:05:49 AM	8/27/2019 3:50:19 PM	8/27/2019 3:50 PM
Details	Last Recertification Date	Update	Recertification	11/10/2017 3:21:45 PM	8/31/2018 1:05:49 AM	8/31/2018 1:05 AM
Details	Last Recertification Date	Update	Recertification		11/10/2017 3:21:45 PM	11/10/2017 3:21 PM
Contacts	Primary Contact	Update	Change Request	GUELKER, RHONDA CFO 3252196238	Staggs, Grady Lynn Pharmacy Director Rolling Plains Memorial Hospital 3252196075	10/13/2017 5:41 PM
Contacts	Authorizing Official	Update		GUELKER, RHONDA CFO 3252196238	GUELKER, RHONDA CFO ROLLING PLAINS MEMORIAL HOSPITAL 3252196238	10/5/2017 5:52 PM
Contacts	Signed By	Update		GUELKER, RHONDA CFO 3252196238	GUELKER, RHONDA CFO ROLLING PLAINS MEMORIAL HOSPITAL 3252196238	10/5/2017 5:52 PM
Addresses	Main Address	Insert			201 EAST ARIZONA SWEETWATER, TX 79556-7120	5/3/2017 2:05 PM
Contacts	Authorizing Official	Insert			GUELKER, RHONDA CFO 3252196238	5/3/2017 2:05 PM
Contacts	Primary Contact	Insert			GUELKER, RHONDA CFO 3252196238	5/3/2017 2:05 PM
Contacts	Signed By	Insert			GUELKER, RHONDA CFO 3252196238	5/3/2017 2:05 PM
Dates	Participating Approval Date	Update			5/3/2017 12:00:00 AM	5/3/2017 2:05 PM
Details	State	Update		Pending	Active	5/3/2017 2:05 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	5/3/2017 2:05 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_76646	SCH450055-03	5/3/2017 7:51 AM
Details	Entity Subname	Update		ROLLING PLAINS MEMORIAL HOSPITAL / RPMH Rural Health Clinic	RPMH / Rural Health Clinic	5/3/2017 7:51 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_76646	4/12/2017 11:30 AM
Details	Last Recertification Date	Insert				4/12/2017 11:30 AM
Details	Grant Number	Insert				4/12/2017 11:30 AM
Details	340B ID	Insert				4/12/2017 11:30 AM
Details	Is Authorizing Official EHB Data	Insert				4/12/2017 11:30 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/12/2017 11:30 AM
Details	Medicare Provider Number	Insert			450055	4/12/2017 11:30 AM
Details	Entity Name	Insert			ROLLING PLAINS MEMORIAL HOSPITAL	4/12/2017 11:30 AM
Details	Program Code	Insert			SCH	4/12/2017 11:30 AM
Details	Entity Subname	Insert			ROLLING PLAINS MEMORIAL HOSPITAL / RPMH Rural Health Clinic	4/12/2017 11:30 AM
Dates	Participating Approval Date	Insert				4/12/2017 11:30 AM
Details	State	Insert			Pending	4/12/2017 11:30 AM
Dates	Registration Date	Insert			4/12/2017 12:00:00 AM	4/12/2017 11:30 AM
Dates	Signed By Date	Insert			4/12/2017 12:00:00 AM	4/12/2017 11:30 AM
Dates	Start Date	Insert				4/12/2017 11:30 AM
Terminations	Termination Comments	Insert				4/12/2017 11:30 AM
Terminations	Termination Date	Insert				4/12/2017 11:30 AM
Terminations	Termination Effective Date	Insert				4/12/2017 11:30 AM
Terminations	Termination Reason	Insert				4/12/2017 11:30 AM