Covered Entity Details

DSH180029Q HAZARD ARH REGIONAL MEDICAL CENTER (Active) - information as of 5/20/2025 11:44:09 PM

Main Details

Name

HAZARD ARH REGIONAL MEDICAL CENTER

Subdivision Name

ARH Medical and Specialty Associates - Hazard - Infectious Disease

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH180029Q

Medicare Provider Number

180029

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/7/2018

Participating Start Date

1/1/2019

Participating Approval Date

10/19/2018

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

ARH
Maria Braman, Chief Medical Officer
(406) 465-8506

Primary Contact

Appalachian Regional Healthcare, Inc
Michael Herald, Associate Vice President of Pharmaceutical Services
(606) 438-1210

Addresses

Street Address

200 Medical Center Drive
Hazard, KY 41701

Billing Address

Hazard ARH Regional Medical Center – Accounts Payable
200 Hospital Drive
South Williamson, KY 41503

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	01014844,65901712,101484400,78900032,7100569790,7100538090,7100538430,7100066370,54022033	1447370960,1558431346,1609869916,1205400421,1407420698,1033426135,1073506184,1164947099,1225380389,1346515905,1730172057,1780728881

Shipping Addresses

Shipping Address 1

Hazard ARH Regional Medical Center
100 Medical Center Drive
Hazard, KY 41701

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
DSH180029A	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH MEDICAL MALL	210 BLACK GOLD BLVD	HAZARD	KY	Terminated
DSH180029AA	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Gastroenterology	200 Medical Center Drive	Hazard	KY	Active
DSH180029AB	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	JACKSON ARH SPECIALTY CLINIC - CARDIOLOGY	424 Jet Drive	Jackson	KY	Terminated
DSH180029AC	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	JACKSON ARH SPECIALTY CLINIC - Surgery	424 Jet Drive	Jackson	KY	Terminated
DSH180029AD	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	JACKSON ARH SPECIALTY CLINIC - UROLOGY	424 Jet Drive	Jackson	KY	Terminated
DSH180029AE	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH HAZARD CLINIC - PEDIATRICS	181 Roy Campbell Dr	Hazard	KY	Active
DSH180029AF	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Pain Management and Headache Medicine - RECOVERY CLINIC	101 Medical Center Drive	Hazard	KY	Active
DSH180029AG	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH HAZARD CLINIC - Family Practice	181 Roy Campbell Dr	Hazard	KY	Active
DSH180029AH	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Behavioral Health	200 Medical Center Drive	Hazard	KY	Active
DSH180029AJ	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH WOUND TREATMENT CENTER - WOUND CARE	200 Medical Center Drive	Hazard	KY	Active
DSH180029AK	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical Mall Family Specialty Clinic - Orthopedics	210 Black Gold Blvd	Hazard	KY	Active
DSH180029AL	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Hazard - Cardiology	200 Medical Center Drive	Hazard	KY	Active
DSH180029B	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Hazard Family Health Services - ONCOLOGY	110 Medical Center Drive	Hazard	KY	Active
DSH180029C	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH PSYCHIATRIC CENTER - HAZARD	102 MEDICAL CENTER DRIVE	HAZARD	KY	Active
DSH180029D	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical Mall Family Specialty Clinic - Physical Medicine and Rehabilitation	210 BLACK GOLD BLVD	HAZARD	KY	Active
DSH180029E	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH SPECIALTY ASSOCIATES HAZARD-MEDICAL	200 MEDICAL CENTER DRIVE	HAZARD	KY	Terminated
DSH180029F	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Surgical	200 MEDICAL CENTER DRIVE	HAZARD	KY	Active
DSH180029G	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	HAZARD FAMILY HEALTH CENTER / FAMILY HEALTH SERVICES	200 MEDICAL CENTER DRIVE	HAZARD	KY	Terminated
DSH180029H	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	HAZARD FAMILY HEALTH CENTER	110 MEDICAL CENTER DRIVE	HAZARD	KY	Terminated
DSH180029J	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical Mall Family Specialty Clinic - Dermatology	210 BLACK GOLD BLVD	HAZARD	KY	Active
DSH180029K	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical Mall Family Specialty Clinic - Bariatrics	210 BLACK GOLD BLVD	HAZARD	KY	Active
DSH180029L	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical Mall Family Specialty Clinic - Cardiology	210 BLACK GOLD BLVD	HAZARD	KY	Active
DSH180029M	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	JACKSON ARH SPECIALTY CLINIC - ONCOLOGY	424 Jet Drive	JACKSON	KY	Terminated
DSH180029N	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Pain Management and Headache Medicine	200 Medical Center Drive	Hazard	KY	Active
DSH180029P	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Specialty Associates - Hazard - Neurology	200 Medical Center Drive	Hazard	KY	Active
DSH180029Q	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates - Hazard - Infectious Disease	200 Medical Center Drive	Hazard	KY	Active
DSH180029R	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Hazard Clinic - Internal Medicine	181 Roy Campbell Dr	Hazard	KY	Active
DSH180029S	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Pulmonology	200 Medical Center Drive	Hazard	KY	Active
DSH180029T	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Specialty Associates - Hazard - Oncology	200 Medical Center Drive	Hazard	KY	Terminated
DSH180029U	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Hazard Clinic - Primary Care Clinic	181 Roy Campbell Dr	Hazard	KY	Active
DSH180029V	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Nephrology	200 Medical Center	Hazard	KY	Active
DSH180029W	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Specialty Associates - Hazard - ENT Clinic	200 Medical Center Drive	Hazard	KY	Terminated
DSH180029X	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Orthopedics	200 Medical Center Drive	Hazard	KY	Active
DSH180029Y	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	ARH Medical and Specialty Associates – Hazard - Urology	200 Medical Center Drive	Hazard	KY	Active
DSH180029Z	Child	DSH	HAZARD ARH REGIONAL MEDICAL CENTER	JACKSON ARH SPECIALTY CLINIC - Physical Medicine and Rehabilitation	424 Jet Drive	Jackson	KY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 2:36:56 PM	9/3/2024 11:32:12 AM	9/3/2024 11:32 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 11:11:17 AM	8/14/2023 2:36:56 PM	8/14/2023 2:36 PM
Contacts	Authorizing Official	Update	Change Request	Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262511	Braman, Maria Chief Medical Officer ARH 4064658506	5/25/2023 11:09 AM
Contacts	Primary Contact	Update	Profile Change Request	Herald, Michael Interim CEO of Pharmaceutical Services Appalachian Regional Healthcare, Inc 6064381210	Herald, Michael Associate Vice President of Pharmaceutical Services Appalachian Regional Healthcare, Inc 6064381210	2/15/2023 3:07 PM
Contacts	Primary Contact	Update	Group Change Request	Akers, Jeffrey CEO of Pharmaceutical Services Appalachian Regional Healthcare 6066162296	Herald, Michael Interim CEO of Pharmaceutical Services Appalachian Regional Healthcare, Inc 6064381210	9/13/2022 2:22 PM
Details	Last Recertification Date	Update	Recertification	9/9/2021 10:53:19 AM	8/26/2022 11:11:17 AM	8/26/2022 11:11 AM
Contacts	Primary Contact	Update	Profile Change Request	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6066162296	Akers, Jeffrey CEO of Pharmaceutical Services Appalachian Regional Healthcare 6066162296	2/8/2022 7:53 PM
Contacts	Authorizing Official	Update	Profile Change Request	Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262468	Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262511	1/28/2022 9:09 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1356327571 (KY)		1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1215180260 (KY)		1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1942792536 (KY)		1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1932606159 (KY)		1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1033426135	1/17/2022 12:02 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1073506184	1/17/2022 12:02 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1164947099	1/17/2022 12:02 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1225380389	1/17/2022 12:02 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1346515905	1/17/2022 12:02 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1730172057	1/17/2022 12:02 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1780728881	1/17/2022 12:02 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	1/17/2022 12:02 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1407420698	1/7/2022 3:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		KY	1/7/2022 3:47 PM
Addresses	Main Address	Update	Change Request	200 Medical Center Drive Suite 2-O Hazard, KY 41701	200 Medical Center Drive Hazard, KY 41701	11/2/2021 10:56 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1205400421	11/2/2021 10:56 AM
Medicaid Billing	NPI: State	Insert	Change Request		KY	11/2/2021 10:56 AM
Details	Entity Subname	Update	Change Request	ARH Specialty Associates - Hazard - Infectious Disease	ARH Medical and Specialty Associates - Hazard - Infectious Disease	11/2/2021 10:56 AM
Details	Last Recertification Date	Update	Recertification	8/31/2020 12:05:58 PM	9/9/2021 10:53:19 AM	9/9/2021 10:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		7100538090	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		KY	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		7100538430	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		KY	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		7100066370	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		KY	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		54022033	6/30/2021 5:08 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		KY	6/30/2021 5:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1356327571	6/30/2021 4:36 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	6/30/2021 4:36 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1215180260	6/30/2021 4:36 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	6/30/2021 4:36 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1942792536	6/30/2021 4:36 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	6/30/2021 4:36 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1932606159	6/30/2021 4:36 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	6/30/2021 4:36 PM
Contacts	Authorizing Official	Update	Change Request	Grossman, Joseph PRESIDENT and CEO Appalachian Regional Healthcare 8592262450	Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262468	5/18/2021 3:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2020 12:05 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		101484400	8/31/2020 12:05 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		KY	8/31/2020 12:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2020 12:05 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		78900032	8/31/2020 12:05 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		KY	8/31/2020 12:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2020 12:05 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7100569790	8/31/2020 12:05 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		KY	8/31/2020 12:05 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1447370960	8/31/2020 12:05 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	8/31/2020 12:05 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1558431346	8/31/2020 12:05 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	8/31/2020 12:05 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1609869916	8/31/2020 12:05 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	8/31/2020 12:05 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1609869916 ( )		8/31/2020 12:05 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1558431346 ( )		8/31/2020 12:05 PM
Details	Last Recertification Date	Update	Recertification	9/4/2019 9:05:48 AM	8/31/2020 12:05:58 PM	8/31/2020 12:05 PM
Contacts	Primary Contact	Update	Profile Change Request	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6064396988	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6066162296	1/8/2020 11:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/4/2019 9:05 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		65901712	9/4/2019 9:05 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		KY	9/4/2019 9:05 AM
Details	Last Recertification Date	Update	Recertification		9/4/2019 9:05:48 AM	9/4/2019 9:05 AM
Details	State	Update		Approved	Active	1/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Grossman, Joseph PRESIDENT and CEO Appalachian Regional Healthcare 8592262450	10/19/2018 4:08 PM
Details	340B ID	Update	New Registration		DSH180029Q	10/19/2018 4:08 PM
Details	Entity Name	Update	New Registration	HAZARD ARH	HAZARD ARH REGIONAL MEDICAL CENTER	10/19/2018 4:08 PM
Details	Entity Subname	Update	New Registration	ARH Specialty Associates - Hazard	ARH Specialty Associates - Hazard - Infectious Disease	10/19/2018 4:08 PM
Dates	Participating Approval Date	Update	New Registration		10/19/2018 4:08:50 PM	10/19/2018 4:08 PM
Details	State	Update	New Registration	Pending	Approved	10/19/2018 4:08 PM
Dates	Signed By Date	Update	New Registration		10/12/2018 2:55:14 PM	10/19/2018 4:08 PM
Dates	Start Date	Update	New Registration		1/1/2019 12:00:00 AM	10/19/2018 4:08 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558431346	10/12/2018 6:54 PM
Addresses	Main Address	Insert	New Registration		200 Medical Center Drive Suite 2-O Hazard, KY 41701	10/7/2018 1:38 PM
Addresses	Billing Address	Insert	New Registration		Hazard ARH Regional Medical Center – Accounts Payable 200 Hospital Drive South Williamson, KY 41503	10/7/2018 1:38 PM
Addresses	Shipping Address	Insert	New Registration		Hazard ARH Regional Medical Center 100 Medical Center Drive Hazard, KY 41701	10/7/2018 1:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/7/2018 1:38 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01014844	10/7/2018 1:38 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	10/7/2018 1:38 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1609869916	10/7/2018 1:38 PM
Contacts	Primary Contact	Insert	New Registration		Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6064396988	10/7/2018 1:38 PM
Contacts	Authorizing Official	Insert	New Registration		Grossman, Joseph PRESIDENT and CEO Appalachian Regional Healthcare 8592262450	10/7/2018 1:38 PM
Details	Last Recertification Date	Insert	New Registration			10/7/2018 1:38 PM
Details	Grant Number	Insert	New Registration			10/7/2018 1:38 PM
Details	340B ID	Insert	New Registration			10/7/2018 1:38 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/7/2018 1:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/7/2018 1:38 PM
Details	Medicare Provider Number	Insert	New Registration		180029	10/7/2018 1:38 PM
Details	Entity Name	Insert	New Registration		HAZARD ARH	10/7/2018 1:38 PM
Details	Program Code	Insert	New Registration		DSH	10/7/2018 1:38 PM
Details	Entity Subname	Insert	New Registration		ARH Specialty Associates - Hazard	10/7/2018 1:38 PM
Dates	Participating Approval Date	Insert	New Registration			10/7/2018 1:38 PM
Details	State	Insert	New Registration		Pending	10/7/2018 1:38 PM
Dates	Registration Date	Insert	New Registration		10/7/2018 1:38:45 PM	10/7/2018 1:38 PM
Dates	Signed By Date	Insert	New Registration			10/7/2018 1:38 PM
Dates	Start Date	Insert	New Registration			10/7/2018 1:38 PM
Terminations	Termination Comments	Insert	New Registration			10/7/2018 1:38 PM
Terminations	Termination Date	Insert	New Registration			10/7/2018 1:38 PM
Terminations	Termination Effective Date	Insert	New Registration			10/7/2018 1:38 PM
Terminations	Termination Reason	Insert	New Registration			10/7/2018 1:38 PM