Covered Entity Details

DSH370214 LINDSAY MUNICIPAL HOSPITAL AUTHORITY (Active) - information as of 6/26/2025 12:23:50 AM

Main Details

Name

LINDSAY MUNICIPAL HOSPITAL AUTHORITY

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH370214

Medicare Provider Number

370214

Additional Details

Current Program Status

Active

Registration Date

7/5/2023

Participating Start Date

10/1/2023

Participating Approval Date

7/20/2023

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Lindsay Municipal Hospital Authority
Jeff W Walraven, CEO
(405) 756-1404 Ext: 226

Primary Contact

Lindsay Municipal Hospital
Tandy Warren, Program Manager
(405) 756-1404 Ext: 224

Addresses

Street Address

1305 W Cherokee St
LINDSAY, OK 73052

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participated starting 10/1/2017, terminated 1/1/2018. Reinstated 10/1/2023.	07/19/2023

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
Contract Detail	TABOR DRUG	225 S MAIN ST		LINDSAY	OK	73052-5633	07/20/2023	10/01/2023			10/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Change Request	100818200B (OK)		6/3/2025 8:53 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1144268723 (OK)		6/3/2025 8:53 AM
Addresses	Main Address	Update	Change Request	HIGHWAY #19 WEST LINDSAY, OK 73052	1305 W Cherokee St LINDSAY, OK 73052	4/8/2025 9:02 AM
Contacts	Primary Contact	Update	Change Request	Hazelrigg, Kyle Project Manager Lindsay Municipal Hospital 9184976358	Warren, Tandy Program Manager Lindsay Municipal Hospital 4057561404-224	4/3/2025 9:07 AM
Contacts	Authorizing Official	Update	Change Request	Walraven, Jeff CEO Lindsay Municipal Hospital Authority 4057561404-226	Walraven, Jeff W CEO Lindsay Municipal Hospital Authority 4057561404-226	9/3/2024 4:50 PM
Contacts	Signed By	Update	Change Request	Walraven, Jeff CEO Lindsay Municipal Hospital Authority 4057561404-226	Walraven, Jeff W CEO Lindsay Municipal Hospital Authority 4057561404-226	9/3/2024 4:50 PM
Details	Last Recertification Date	Update	Recertification		9/3/2024 12:51:44 PM	9/3/2024 12:51 PM
Details	State	Update		Approved	Active	10/1/2023 12:01 AM
Medicaid Billing	NPI: Number	Delete	Reinstatement	1144268723 ( )		7/20/2023 10:02 AM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1144268723	7/20/2023 10:02 AM
Medicaid Billing	NPI: State	Insert	Reinstatement		OK	7/20/2023 10:02 AM
Contacts	Primary Contact	Update	Reinstatement	Ayers, Candace Medical Records Supervisor Lindsay Municipal Hospital Authority 4057561404-242	Hazelrigg, Kyle Project Manager Lindsay Municipal Hospital 9184976358	7/20/2023 10:02 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	1/1/2018 12:00:00 AM		7/20/2023 10:02 AM
Dates	Participating Approval Date	Update	Reinstatement	7/20/2017 12:00:00 AM	7/20/2023 10:02:57 AM	7/20/2023 10:02 AM
Details	State	Update	Reinstatement	Terminated	Approved	7/20/2023 10:02 AM
Dates	Registration Date	Update	Reinstatement	7/12/2017 12:00:00 AM	7/5/2023 12:40:20 PM	7/20/2023 10:02 AM
Dates	Signed By Date	Update	Reinstatement	7/12/2017 12:00:00 AM	7/10/2023 9:40:26 AM	7/20/2023 10:02 AM
Dates	Start Date	Update	Reinstatement	10/1/2017 12:00:00 AM	10/1/2023 12:00:00 AM	7/20/2023 10:02 AM
Terminations	Termination Date	Update	Reinstatement	1/1/2018 12:00:00 AM		7/20/2023 10:02 AM
Terminations	Termination Effective Date	Update	Reinstatement	1/1/2018 12:00:00 AM		7/20/2023 10:02 AM
Terminations	Termination Reason	Update	Reinstatement	Failure to recertify		7/20/2023 10:02 AM
Details	Comments Public	Insert	Reinstatement		Participated starting 10/1/2017, terminated 1/1/2018. Reinstated 10/1/2023.	7/19/2023 1:35 PM
Details	State	Update		To Be Terminated	Terminated	1/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		1/1/2018 12:00:00 AM	12/7/2017 11:30 AM
Details	State	Update	Recertification	Active	To Be Terminated	12/7/2017 11:30 AM
Terminations	Termination Date	Update	Recertification		1/1/2018 12:00:00 AM	12/7/2017 11:30 AM
Terminations	Termination Effective Date	Update	Recertification		1/1/2018 12:00:00 AM	12/7/2017 11:30 AM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	12/7/2017 11:30 AM
Contacts	Primary Contact	Update		Ayers, Candace Medical Records Supervisor 4057561404-242	Ayers, Candace Medical Records Supervisor Lindsay Municipal Hospital Authority 4057561404-242	10/20/2017 3:13 PM
Contacts	Authorizing Official	Update		Walraven, Jeff CEO 4057561404-226	Walraven, Jeff CEO Lindsay Municipal Hospital Authority 4057561404-226	10/20/2017 2:50 PM
Contacts	Signed By	Update		Walraven, Jeff CEO 4057561404-226	Walraven, Jeff CEO Lindsay Municipal Hospital Authority 4057561404-226	10/20/2017 2:50 PM
Addresses	Main Address	Insert			HIGHWAY #19 WEST LINDSAY, OK 73052	7/20/2017 3:29 PM
Contacts	Authorizing Official	Insert			Walraven, Jeff CEO 4057561404-226	7/20/2017 3:29 PM
Contacts	Signed By	Insert			Walraven, Jeff CEO 4057561404-226	7/20/2017 3:29 PM
Contacts	Primary Contact	Insert			Ayers, Candace Medical Records Supervisor 4057561404-242	7/20/2017 3:29 PM
Details	State	Update		Approved	Active	7/20/2017 3:29 PM
Dates	Participating Approval Date	Update			7/20/2017 12:00:00 AM	7/20/2017 3:29 PM
Details	State	Update		Pending	Approved	7/20/2017 3:29 PM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/20/2017 3:29 PM
Details	340B ID	Update		ONLINE_REG_78339	DSH370214	7/14/2017 1:30 PM
Details	340B ID	Update			ONLINE_REG_78339	7/12/2017 10:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/12/2017 10:54 AM
Medicaid Billing	Medicaid: Number	Insert			100818200B	7/12/2017 10:54 AM
Medicaid Billing	Medicaid: State	Insert			OK	7/12/2017 10:54 AM
Medicaid Billing	NPI: Number	Insert			1144268723	7/12/2017 10:54 AM
Details	Last Recertification Date	Insert				7/12/2017 10:54 AM
Details	Grant Number	Insert				7/12/2017 10:54 AM
Details	340B ID	Insert				7/12/2017 10:54 AM
Details	Is Authorizing Official EHB Data	Insert				7/12/2017 10:54 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/12/2017 10:54 AM
Details	Medicare Provider Number	Insert			370214	7/12/2017 10:54 AM
Details	Entity Name	Insert			LINDSAY MUNICIPAL HOSPITAL AUTHORITY	7/12/2017 10:54 AM
Details	Program Code	Insert			DSH	7/12/2017 10:54 AM
Details	Entity Subname	Insert				7/12/2017 10:54 AM
Dates	Participating Approval Date	Insert				7/12/2017 10:54 AM
Details	State	Insert			Pending	7/12/2017 10:54 AM
Dates	Registration Date	Insert			7/12/2017 12:00:00 AM	7/12/2017 10:54 AM
Dates	Signed By Date	Insert			7/12/2017 12:00:00 AM	7/12/2017 10:54 AM
Dates	Start Date	Insert				7/12/2017 10:54 AM
Terminations	Termination Comments	Insert				7/12/2017 10:54 AM
Terminations	Termination Date	Insert				7/12/2017 10:54 AM
Terminations	Termination Effective Date	Insert				7/12/2017 10:54 AM
Terminations	Termination Reason	Insert				7/12/2017 10:54 AM