Covered Entity Details

SCH180038-16 OWENSBORO HEALTH INC (Terminated) - information as of 5/17/2025 10:54:04 PM

Main Details

Name

OWENSBORO HEALTH INC

Subdivision Name

Owensboro Health Outpatient Imaging - CT Healthpark - CT

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH180038-16

Medicare Provider Number

180038

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/16/2018

Participating Start Date

10/1/2018

Participating Approval Date

8/30/2018

Last Recertification Date

9/4/2022

Termination Date
Termination Reason

10/1/2023
Change of covered entity type

Contacts

Authorizing Official

Owensboro Health Regional Hospital - Owensboro, KY
Russ Ranallo, Chief Financial Officer
(270) 685-7180

Primary Contact

Owensboro Health Regional Hospital
Jason Collins, Director of Pharmacy
(270) 417-6711

Addresses

Street Address

1006 Ford Ave
Owensboro, KY 42301

Billing Address

Owensboro Health Regional Hospital
PO Box 20007
Owensboro, KY 42304

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
KY	1022441	1285613612

Shipping Addresses

Shipping Address 1

Owensboro Health Regional Hospital
1201 Pleasant Valley Road
Owensboro, KY 42303

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
SCH180038-01	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - BRECKENRIDGE MEDICAL PLAZA	1000 B BRECKENRIDGE	OWENSBORO	KY	Terminated
SCH180038-02	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - HEALTHPARK	1006 FORD AVE	OWENSBORO	KY	Terminated
SCH180038-03	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - THE SPRINGS	2200 E PARRISH AVE BLDG D	OWENSBORO	KY	Terminated
SCH180038-04	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Mitchell Memorial Cancer Center	1020 B BRECKENRIDGE	OWENSBORO	KY	Terminated
SCH180038-05	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Wound Center - Owensboro	1325 TRIPLETT STREET	OWENSBORO	KY	Terminated
SCH180038-06	Child	SCH	OWENSBORO HEALTH INC	Owensboro Heatlh Outpatient Imaging - Ultrasound Breckenridge - Ultrasound	1000 B Breckenridge	Owensboro	KY	Terminated
SCH180038-07	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - Ultrasound Springs - Ultrasound	2200 E Parrish Ave Bldg D	Owensboro	KY	Terminated
SCH180038-08	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - Ultrasound Healthpark - Ultrasound	1006 Ford Ave	Owensboro	KY	Terminated
SCH180038-09	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - Radiology Springs - Radiology	2200 E Parrish Ave Bldg D	Owensboro	KY	Terminated
SCH180038-10	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - Radiology Healthpark - Radiology	1006 Ford Ave	Owensboro	KY	Terminated
SCH180038-11	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - Radiology Breckenridge - Radiology	1000 B Breckenridge	Owensboro	KY	Terminated
SCH180038-12	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - Nuclear Medicine Springs - Nuclear Medicine	2200 E Parrish Ave Bldg D	Owensboro	KY	Terminated
SCH180038-13	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - MRI Springs - MRI	2200 E Parrish Ave Bldg D	Owensboro	KY	Terminated
SCH180038-14	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - MRI Breckenridge - MRI	1000 B Breckenridge	Owensboro	KY	Terminated
SCH180038-15	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - CT Springs - CT	2200 E Parrish Ave Bldg D	Owensboro	KY	Terminated
SCH180038-16	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - CT Healthpark - CT	1006 Ford Ave	Owensboro	KY	Terminated
SCH180038-17	Child	SCH	OWENSBORO HEALTH INC	Owensboro Health Outpatient Imaging - CT Breckenridge - CT	1000 B Breckenridge	Owensboro	KY	Terminated
SCH180038-18	Child	SCH	OWENSBORO HEALTH INC	Wound Care Beaver Dam - Owensboro Health Wound Center Beaver Dam	1307 N. Main St.	Beaver Dam	KY	Terminated
SCH180038-19	Child	SCH	OWENSBORO HEALTH INC	OWENSBORO HEALTH RADIATION THERAPY - Radiation Therapy	1020 BRECKENRIDGE ST	OWENSBORO	KY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		10/1/2023 12:00:00 AM	7/31/2023 8:33 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	7/31/2023 8:33 AM
Terminations	Termination Date	Update	Hospital Type Change Request		10/1/2023 12:00:00 AM	7/31/2023 8:33 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		10/1/2023 12:00:00 AM	7/31/2023 8:33 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	7/31/2023 8:33 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	200134380 (IN)		9/4/2022 2:13 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1285613612 (IN)		9/4/2022 2:13 PM
Details	Last Recertification Date	Update	Recertification	8/17/2021 11:28:21 AM	9/4/2022 2:13:39 PM	9/4/2022 2:13 PM
Contacts	Authorizing Official	Update	Profile Change Request	Ranallo, Russ VICE PRESIDENT, FINANCIAL SERVICES Owensboro Health Regional Hospital - Owensboro, KY 2706857180	Ranallo, Russ Chief Financial Officer Owensboro Health Regional Hospital - Owensboro, KY 2706857180	7/11/2022 4:16 PM
Contacts	Authorizing Official	Update	Change Request	Thomas, Jeff Chief Financial Officer Owensboro Health, Inc. 2704174813	Ranallo, Russ VICE PRESIDENT, FINANCIAL SERVICES Owensboro Health Regional Hospital - Owensboro, KY 2706857180	6/21/2022 6:58 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 1:12:10 PM	8/17/2021 11:28:21 AM	8/17/2021 11:28 AM
Contacts	Authorizing Official	Update	Change Request	HACKBARTH, JOHN SENIOR VP & CFO Owensboro Health, Inc. 2704174813	Thomas, Jeff Chief Financial Officer Owensboro Health, Inc. 2704174813	8/4/2021 7:09 AM
Contacts	Primary Contact	Update	Change Request	Ranallo, Russ VICE PRESIDENT, FINANCIAL SERVICES Owensboro Health Regional Hospital - Owensboro, KY 2706857180	Collins, Jason Director of Pharmacy Owensboro Health Regional Hospital 2704176711	6/16/2021 7:54 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1285613612	9/3/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/3/2020 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285613612	9/3/2020 1:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/3/2020 1:12 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1285613612 ( )		9/3/2020 1:12 PM
Contacts	Primary Contact	Update	Recertification	Logsdon, Tammy Director of Reimbursement Owensboro Health, Inc 2706857182	Ranallo, Russ VICE PRESIDENT, FINANCIAL SERVICES Owensboro Health Regional Hospital - Owensboro, KY 2706857180	9/3/2020 1:12 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 4:29:32 PM	9/3/2020 1:12:10 PM	9/3/2020 1:12 PM
Details	Last Recertification Date	Update	Recertification		8/20/2019 4:29:32 PM	8/20/2019 4:29 PM
Details	State	Update		Approved	Active	10/1/2018 12:05 AM
Contacts	Signed By	Insert	New Registration		HACKBARTH, JOHN SENIOR VP & CFO Owensboro Health, Inc. 2704174813	8/30/2018 10:45 AM
Details	340B ID	Update	New Registration		SCH180038-16	8/30/2018 10:45 AM
Details	Entity Subname	Update	New Registration	Owensboro Health Outpatient Imaging - CT Healthpark	Owensboro Health Outpatient Imaging - CT Healthpark - CT	8/30/2018 10:45 AM
Dates	Participating Approval Date	Update	New Registration		8/30/2018 10:45:51 AM	8/30/2018 10:45 AM
Details	State	Update	New Registration	Pending	Approved	8/30/2018 10:45 AM
Dates	Signed By Date	Update	New Registration		7/16/2018 3:22:54 PM	8/30/2018 10:45 AM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	8/30/2018 10:45 AM
Addresses	Main Address	Insert	New Registration		1006 Ford Ave Owensboro, KY 42301	7/16/2018 1:24 PM
Addresses	Billing Address	Insert	New Registration		Owensboro Health Regional Hospital PO Box 20007 Owensboro, KY 42304	7/16/2018 1:24 PM
Addresses	Shipping Address	Insert	New Registration		Owensboro Health Regional Hospital 1201 Pleasant Valley Road Owensboro, KY 42303	7/16/2018 1:24 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/16/2018 1:24 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		200134380	7/16/2018 1:24 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IN	7/16/2018 1:24 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/16/2018 1:24 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1022441	7/16/2018 1:24 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	7/16/2018 1:24 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285613612	7/16/2018 1:24 PM
Contacts	Authorizing Official	Insert	New Registration		HACKBARTH, JOHN SENIOR VP & CFO Owensboro Health, Inc. 2704174813	7/16/2018 1:24 PM
Contacts	Primary Contact	Insert	New Registration		Logsdon, Tammy Director of Reimbursement Owensboro Health, Inc 2706857182	7/16/2018 1:24 PM
Details	Last Recertification Date	Insert	New Registration			7/16/2018 1:24 PM
Details	Grant Number	Insert	New Registration			7/16/2018 1:24 PM
Details	340B ID	Insert	New Registration			7/16/2018 1:24 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/16/2018 1:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/16/2018 1:24 PM
Details	Medicare Provider Number	Insert	New Registration		180038	7/16/2018 1:24 PM
Details	Entity Name	Insert	New Registration		OWENSBORO HEALTH INC	7/16/2018 1:24 PM
Details	Program Code	Insert	New Registration		SCH	7/16/2018 1:24 PM
Details	Entity Subname	Insert	New Registration		Owensboro Health Outpatient Imaging - CT Healthpark	7/16/2018 1:24 PM
Dates	Participating Approval Date	Insert	New Registration			7/16/2018 1:24 PM
Details	State	Insert	New Registration		Pending	7/16/2018 1:24 PM
Dates	Registration Date	Insert	New Registration		7/16/2018 1:24:37 PM	7/16/2018 1:24 PM
Dates	Signed By Date	Insert	New Registration			7/16/2018 1:24 PM
Dates	Start Date	Insert	New Registration			7/16/2018 1:24 PM
Terminations	Termination Comments	Insert	New Registration			7/16/2018 1:24 PM
Terminations	Termination Date	Insert	New Registration			7/16/2018 1:24 PM
Terminations	Termination Effective Date	Insert	New Registration			7/16/2018 1:24 PM
Terminations	Termination Reason	Insert	New Registration			7/16/2018 1:24 PM