Covered Entity Details

SCH140210-00 HARRISBURG MEDICAL CENTER INC. (Active) - information as of 4/29/2025 11:54:05 PM

Main Details

Name

HARRISBURG MEDICAL CENTER INC.

Subdivision Name

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH140210-00

Medicare Provider Number

140210

Additional Details

Current Program Status

Active

Registration Date

10/9/2024

Participating Start Date

1/1/2025

Participating Approval Date

11/13/2024

Last Recertification Date

Contacts

Authorizing Official

SIH
Warren Ladner, CFO
(618) 457-5200 Ext: 67130

Primary Contact

Southern Illinois Healthcare - Carbondale, IL
Katelyn Morgan, 340B Coordinator
(618) 457-5200 Ext: 67205

Addresses

Street Address

100 DR WARREN TUTTLE DRIVE
HARRISBURG, IL 62946

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participated starting 3/15/22; Terminated 10/1/2023; Reinstated 1/1/2025.	11/12/2024

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
IL	237426289001,237426289401	1073580130,1396878658

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	BECKS LONG TERM CARE PHARMACY INC.	1413 LOCUST ST		ELDORADO	IL	62930-1629	07/11/2017	03/15/2022	10/01/2023	10/01/2023
Contract Detail	KENTUCKY CENTRAL FILL FACILITY, L-010	5594 SHEPHERDSVILLE ROAD		LOUISVILLE	KY	40228-1012	07/13/2017	03/15/2022	10/09/2022	10/25/2022
Contract Detail	KROGER PHARMACY	1704 WEST DEYOUNG STREET		MARION	IL	62959	07/16/2020	03/15/2022	03/20/2023	04/12/2023
Contract Detail	KROGER PHARMACY	1609 SOUTH PARK AVENUE		HERRIN	IL	62948	07/16/2020	03/15/2022	03/20/2023	04/12/2023
Contract Detail	Kroger Pharmacy	Jeffersonville Central Fill Facility	301 Logistics Ave Suite 200	Jeffersonville	IN	47130	10/18/2022	01/01/2023	03/20/2023	04/12/2023
Contract Detail	KROGER PHARMACY #L-642	601 NORTH COMMERCIAL STREET		HARRISBURG	IL	62946	07/13/2017	03/15/2022	03/20/2023	04/12/2023
Contract Detail	KROGER PHARMACY L-714	501 NORTH GIANT CITY ROAD		CARBONDALE	IL	62902	07/13/2017	10/01/2017	04/01/2019	04/03/2019
Contract Detail	MEDICINE SHOPPE #2127	PRN PHARMACIES LTD	254 N LINCOLN BLVD E	SHAWNEETOWN	IL	62984-3261	01/11/2023	04/01/2023	10/01/2023	10/01/2023
Contract Detail	MEDICINE SHOPPE #2171	PRN PHARMACIES, LTD	1101 US HIGHWAY 45 N	ELDORADO	IL	62930-3768	01/11/2023	04/01/2023	10/01/2023	10/01/2023
Contract Detail	MEDICINE SHOPPE RIDGWAY	PRN PHARMACIES LTD	101 E MAIN ST	RIDGWAY	IL	62979	07/11/2017	03/15/2022	10/01/2023	10/01/2023
Contract Detail	PRN PHARMACIES LTD	DBA MEDICINE SHOPPE #0503	304 S COMMERCIAL ST	HARRISBURG	IL	62946	07/11/2017	03/15/2022	10/01/2023	10/01/2023
Contract Detail	PRN PHARMACIES LTD	DBA MEDICINE SHOPPE #0503	304 S COMMERCIAL ST	HARRISBURG	IL	62946	04/11/2025	07/01/2025		04/11/2025
Contract Detail	THE MEDICINE SHOPPE	1315 W MAIN ST		MARION	IL	62959	07/11/2017	03/15/2022	10/01/2023	10/01/2023
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/11/2017	03/15/2022	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-0196	1450 EAST MAIN		CARBONDALE	IL	62901	07/11/2017	10/01/2017	04/01/2019	04/03/2019
Contract Detail	WAL-MART PHARMACY 10-0196	1450 EAST MAIN		CARBONDALE	IL	62901	10/18/2022	01/01/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-0216	2802 OUTER ROAD DRIVE		MARION	IL	62959	04/03/2019	03/15/2022	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-0233	300 LEIGH AVENUE		ANNA	IL	62906	10/18/2022	01/01/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-0237	710 SOUTH COMMERCIAL		HARRISBURG	IL	62946	07/11/2017	03/15/2022	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-0252	215 GRANT WAY		DU QUOIN	IL	62832	10/18/2022	01/01/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-0262	919 GIACONE DR		BENTON	IL	62812	07/11/2017	10/01/2017	04/01/2019	04/03/2019
Contract Detail	WAL-MART PHARMACY 10-0262	919 GIACONE DR		BENTON	IL	62812	10/18/2022	01/01/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-0302	6495 COUNTRY CLUB RD		MURPHYSBORO	IL	62966	04/12/2023	07/01/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-0431	3220 IRVING COBB DRIVE		PADUCAH	KY	42003	07/11/2017	10/01/2017	03/02/2018	03/05/2018
Contract Detail	WAL-MART PHARMACY 10-0596	1713 S. PARK AVE.		HERRIN	IL	62948	10/18/2022	01/01/2023	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-0833	1344 ILLINOIS HWY #1		CARMI	IL	62821	07/11/2017	03/15/2022	10/01/2023	10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/11/2017	03/15/2022	10/01/2023	10/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
SCH140210-01	Child	SCH	HARRISBURG MEDICAL CENTER INC.	Equality Family Practice	183 North Lane Street	Equality	IL	Terminated
SCH140210-02	Child	SCH	HARRISBURG MEDICAL CENTER INC.	Eldorado Primary Care	1007 US Highway 45 North	Eldorado	IL	Terminated
SCH140210-03	Child	SCH	HARRISBURG MEDICAL CENTER INC.	GALATIA PRIMARY CARE - General Health Care	124 E MAIN ST	GALATIA	IL	Terminated
SCH140210-04	Child	SCH	HARRISBURG MEDICAL CENTER INC.	HARRISBURG MEDICAL CENTER INC - HMC at Harrisburg - General Health Care	901 S COMMERCIAL ST	HARRISBURG	IL	Terminated
SCH140210-05	Child	SCH	HARRISBURG MEDICAL CENTER INC.	HARRISBURG MEDICAL CENTER INC - HMC at Marion - General Health Care	3106 OUTER DR	MARION	IL	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Patrick, Katelyn 340B Coordinator Southern Illinois Healthcare - Carbondale, IL 6184575200-67205	Morgan, Katelyn 340B Coordinator Southern Illinois Healthcare - Carbondale, IL 6184575200-67205	4/9/2025 2:55 PM
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Contacts	Signed By	Update	Reinstatement	Hayes, June CFO Harrisburg Medical Center, INc. 6182530141	Ladner, Warren CFO SIH 6184575200-67130	11/13/2024 7:23 AM
Contacts	Primary Contact	Update	Reinstatement	Sandusky, James Cody Pharmacy Manager SIH Harrisburg Medical Center 6182530263	Patrick, Katelyn 340B Coordinator Southern Illinois Healthcare - Carbondale, IL 6184575200-67205	11/13/2024 7:23 AM
Details	Last Recertification Date	Update	Reinstatement	8/31/2022 10:19:03 AM		11/13/2024 7:23 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	9/4/2023 12:00:00 AM		11/13/2024 7:23 AM
Dates	Participating Approval Date	Update	Reinstatement	4/20/2017 12:00:00 AM	11/13/2024 7:23:52 AM	11/13/2024 7:23 AM
Details	State	Update	Reinstatement	Terminated	Approved	11/13/2024 7:23 AM
Dates	Registration Date	Update	Reinstatement	4/13/2017 12:00:00 AM	10/9/2024 1:36:54 PM	11/13/2024 7:23 AM
Dates	Signed By Date	Update	Reinstatement	4/13/2017 12:00:00 AM	11/4/2024 5:32:43 PM	11/13/2024 7:23 AM
Dates	Start Date	Update	Reinstatement	3/15/2022 12:00:00 AM	1/1/2025 12:00:00 AM	11/13/2024 7:23 AM
Terminations	Termination Date	Update	Reinstatement	10/1/2023 12:00:00 AM		11/13/2024 7:23 AM
Terminations	Termination Effective Date	Update	Reinstatement	9/5/2023 12:00:00 AM		11/13/2024 7:23 AM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		11/13/2024 7:23 AM
Details	Comments Public	Insert	Reinstatement		Participated starting 3/15/22; Terminated 10/1/2023; Reinstated 1/1/2025.	11/12/2024 11:29 AM
Contacts	Authorizing Official	Update	Profile Change Request	Ladner, Warren CFO SIH 6018701228-67130	Ladner, Warren CFO SIH 6184575200-67130	7/25/2024 12:07 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/4/2023 12:00:00 AM	9/8/2023 11:58 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/8/2023 11:58 AM
Terminations	Termination Date	Update	Recertification		10/1/2023 12:00:00 AM	9/8/2023 11:58 AM
Terminations	Termination Effective Date	Update	Recertification		9/5/2023 12:00:00 AM	9/8/2023 11:58 AM
Terminations	Termination Reason	Update	Recertification		DSH percentage below statutory minimum	9/8/2023 11:58 AM
Contacts	Authorizing Official	Update	Change Request	Lovett, Michelle Financial Analyst-340B/Pharmacy SIH 6184575200	Ladner, Warren CFO SIH 6018701228-67130	8/1/2023 5:25 PM
Contacts	Authorizing Official	Update	AO Change Request	Hayes, June HMC Director of Finance Harrisburg Medical Center 6182530141	Lovett, Michelle Financial Analyst-340B/Pharmacy SIH 6184575200	8/1/2023 11:16 AM
Contacts	Primary Contact	Update	Change Request	Sandusky, Cody Director of Pharmacy Harrisburg Medical Center, Inc. 6182530263	Sandusky, James Cody Pharmacy Manager SIH Harrisburg Medical Center 6182530263	12/6/2022 6:45 AM
Contacts	Authorizing Official	Update	Change Request	Hayes, June CFO Harrisburg Medical Center, INc. 6182530141	Hayes, June HMC Director of Finance Harrisburg Medical Center 6182530141	10/27/2022 10:30 AM
Details	Last Recertification Date	Update	Recertification	9/21/2020 7:05:46 AM	8/31/2022 10:19:03 AM	8/31/2022 10:19 AM
Dates	Last Date That 340B Drugs Purchased	Update	COVID-19 Reinstatement	1/26/2021 12:00:00 AM		4/15/2022 5:59 PM
Details	State	Update	COVID-19 Reinstatement	Terminated	Active	4/15/2022 5:59 PM
Dates	Start Date	Update	COVID-19 Reinstatement	7/1/2017 12:00:00 AM	3/15/2022 12:00:00 AM	4/15/2022 5:59 PM
Terminations	Termination Date	Update	COVID-19 Reinstatement	4/1/2021 12:00:00 AM		4/15/2022 5:59 PM
Terminations	Termination Effective Date	Update	COVID-19 Reinstatement	1/27/2021 12:00:00 AM		4/15/2022 5:59 PM
Terminations	Termination Reason	Update	COVID-19 Reinstatement	DSH percentage below statutory minimum		4/15/2022 5:59 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/26/2021 12:00:00 AM	1/29/2021 9:24 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/29/2021 9:24 AM
Terminations	Termination Date	Update	Termination Request		4/1/2021 12:00:00 AM	1/29/2021 9:24 AM
Terminations	Termination Effective Date	Update	Termination Request		1/27/2021 12:00:00 AM	1/29/2021 9:24 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	1/29/2021 9:24 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1073580130	9/21/2020 7:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/21/2020 7:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1396878658	9/21/2020 7:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/21/2020 7:05 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1073580130 ( )		9/21/2020 7:05 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1396878658 ( )		9/21/2020 7:05 AM
Details	Last Recertification Date	Update	Recertification	8/26/2019 3:12:35 PM	9/21/2020 7:05:46 AM	9/21/2020 7:05 AM
Contacts	Primary Contact	Update	Change Request	Hurley, David Director of Pharmacy Harrisburg Medical Center 6182530243	Sandusky, Cody Director of Pharmacy Harrisburg Medical Center, Inc. 6182530263	10/15/2019 9:20 AM
Details	Last Recertification Date	Update	Recertification	9/8/2018 1:06:48 PM	8/26/2019 3:12:35 PM	8/26/2019 3:12 PM
Details	Last Recertification Date	Update	Recertification	12/5/2017 3:41:05 PM	9/8/2018 1:06:48 PM	9/8/2018 1:06 PM
Details	Last Recertification Date	Update	Recertification		12/5/2017 3:41:05 PM	12/5/2017 3:41 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/28/2017 4:41 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		237426289401	9/28/2017 4:41 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	9/28/2017 4:41 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1396878658	9/28/2017 4:41 PM
Contacts	Authorizing Official	Update		Hayes, June CFO 6182530141	Hayes, June CFO Harrisburg Medical Center, INc. 6182530141	9/25/2017 6:14 PM
Contacts	Signed By	Update		Hayes, June CFO 6182530141	Hayes, June CFO Harrisburg Medical Center, INc. 6182530141	9/25/2017 6:14 PM
Contacts	Primary Contact	Update		Hurley, David Director of Pharmacy 6182530243	Hurley, David Director of Pharmacy Harrisburg Medical Center 6182530243	9/25/2017 5:19 PM
Contacts	Authorizing Official	Insert			Hayes, June CFO 6182530141	7/13/2017 2:43 PM
Contacts	Signed By	Insert			Hayes, June CFO 6182530141	7/13/2017 2:43 PM
Contacts	Primary Contact	Insert			Hurley, David Director of Pharmacy 6182530243	4/20/2017 10:19 AM
Addresses	Main Address	Insert			100 DR WARREN TUTTLE DRIVE HARRISBURG, IL 62946	4/20/2017 10:19 AM
Dates	Participating Approval Date	Update			4/20/2017 12:00:00 AM	4/20/2017 10:18 AM
Details	State	Update		Pending	Active	4/20/2017 10:18 AM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	4/20/2017 10:18 AM
Details	340B ID	Update		ONLINE_REG_76851	SCH140210-00	4/19/2017 7:59 AM
Details	340B ID	Update			ONLINE_REG_76851	4/13/2017 11:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/13/2017 11:57 AM
Medicaid Billing	Medicaid: Number	Insert			237426289001	4/13/2017 11:57 AM
Medicaid Billing	Medicaid: State	Insert			IL	4/13/2017 11:57 AM
Medicaid Billing	NPI: Number	Insert			1073580130	4/13/2017 11:57 AM
Details	Last Recertification Date	Insert				4/13/2017 11:57 AM
Details	Grant Number	Insert				4/13/2017 11:57 AM
Details	340B ID	Insert				4/13/2017 11:57 AM
Details	Is Authorizing Official EHB Data	Insert				4/13/2017 11:57 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/13/2017 11:57 AM
Details	Medicare Provider Number	Insert			140210	4/13/2017 11:57 AM
Details	Entity Name	Insert			HARRISBURG MEDICAL CENTER INC.	4/13/2017 11:57 AM
Details	Program Code	Insert			SCH	4/13/2017 11:57 AM
Details	Entity Subname	Insert				4/13/2017 11:57 AM
Dates	Participating Approval Date	Insert				4/13/2017 11:57 AM
Details	State	Insert			Pending	4/13/2017 11:57 AM
Dates	Registration Date	Insert			4/13/2017 12:00:00 AM	4/13/2017 11:57 AM
Dates	Signed By Date	Insert			4/13/2017 12:00:00 AM	4/13/2017 11:57 AM
Dates	Start Date	Insert				4/13/2017 11:57 AM
Terminations	Termination Comments	Insert				4/13/2017 11:57 AM
Terminations	Termination Date	Insert				4/13/2017 11:57 AM
Terminations	Termination Effective Date	Insert				4/13/2017 11:57 AM
Terminations	Termination Reason	Insert				4/13/2017 11:57 AM