Covered Entity Details

CAH141300-03 THOMAS H BOYD CRITICAL ACC HOSPITAL (Active) - information as of 5/15/2025 2:00:18 AM

Main Details

Name

THOMAS H BOYD CRITICAL ACC HOSPITAL

Subdivision Name

Greene County Rural Health Clinic - Primary Care

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH141300-03

Medicare Provider Number

141300

Outpatient Facility Provider Number

143403

Additional Details

Current Program Status

Active

Registration Date

10/12/2018

Participating Start Date

1/1/2019

Participating Approval Date

11/21/2018

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Thomas H. Boyd Memorial Hospital
Stace D Holland, CEO
(217) 942-6946

Primary Contact

Thomas H. Boyd Memorial Hospital
Kathryn Garner, CFO
(217) 942-6946 Ext: 1303

Addresses

Street Address

727 Ninth Street
Carrollton, IL 62016

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?
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
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH141300-01	Child	CAH	THOMAS H BOYD CRITICAL ACC HOSPITAL	Boyd/Fillager - Primary Clinic	712 College	Greenfield	IL	Active
CAH141300-02	Child	CAH	THOMAS H BOYD CRITICAL ACC HOSPITAL	Rural Health Center of Roodhouse - Primary Care	132 West Lorton	Roodhouse	IL	Active
CAH141300-03	Child	CAH	THOMAS H BOYD CRITICAL ACC HOSPITAL	Greene County Rural Health Clinic - Primary Care	727 Ninth Street	Carrollton	IL	Active
CAH141300-04	Child	CAH	THOMAS H BOYD CRITICAL ACC HOSPITAL	Thomas H. Boyd Rural Health Clinic - Primary Care	803 5th Street	Carrollton	IL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Holland, Stace J CEO Thomas H. Boyd Memorial Hospital 2179426946	Holland, Stace D CEO Thomas H. Boyd Memorial Hospital 2179426946	8/28/2024 3:01 PM
Contacts	Authorizing Official	Update	Change Request	Dewitt, Donna CEO Thomas H. Boyd Memorial Hospital 2179426946-1201	Holland, Stace J CEO Thomas H. Boyd Memorial Hospital 2179426946	8/28/2024 11:58 AM
Details	Last Recertification Date	Update	Recertification	9/6/2023 12:00:04 PM	8/14/2024 10:13:01 AM	8/14/2024 10:13 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 9:47:49 AM	9/6/2023 12:00:04 PM	9/6/2023 12:00 PM
Contacts	Authorizing Official	Update	Change Request	Campbell, Deborah J CEO Thomas H. Boyd Memorial Hospital 2179426946	Dewitt, Donna CEO Thomas H. Boyd Memorial Hospital 2179426946-1201	5/21/2023 8:22 AM
Details	Last Recertification Date	Update	Recertification	8/20/2021 9:55:01 AM	8/26/2022 9:47:49 AM	8/26/2022 9:47 AM
Contacts	Primary Contact	Update	Recertification	Garner, Kathryne CFO Thomas H. Boyd Memorial Hospital 2179426946-1303	Garner, Kathryn CFO Thomas H. Boyd Memorial Hospital 2179426946-1303	8/26/2022 9:46 AM
Addresses	Main Address	Update	Change Request	116A North Main White Hall, IL 62016	727 Ninth Street Carrollton, IL 62016	11/1/2021 9:26 AM
Details	Last Recertification Date	Update	Recertification	9/11/2020 4:52:04 PM	8/20/2021 9:55:01 AM	8/20/2021 9:55 AM
Details	Last Recertification Date	Update	Recertification	8/19/2019 11:42:09 AM	9/11/2020 4:52:04 PM	9/11/2020 4:52 PM
Details	Last Recertification Date	Update	Recertification		8/19/2019 11:42:09 AM	8/19/2019 11:42 AM
Details	State	Update		Approved	Active	1/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Campbell, Deborah J CEO Thomas H. Boyd Memorial Hospital 2179426946	11/21/2018 8:27 AM
Details	340B ID	Update	New Registration		CAH141300-03	11/21/2018 8:27 AM
Details	Entity Subname	Update	New Registration	Greene County Rural Health Clinic	Greene County Rural Health Clinic - Primary Care	11/21/2018 8:27 AM
Dates	Participating Approval Date	Update	New Registration		11/21/2018 8:27:23 AM	11/21/2018 8:27 AM
Details	State	Update	New Registration	Pending	Approved	11/21/2018 8:27 AM
Dates	Signed By Date	Update	New Registration		10/12/2018 11:04:59 AM	11/21/2018 8:27 AM
Dates	Start Date	Update	New Registration		1/1/2019 12:00:00 AM	11/21/2018 8:27 AM
Addresses	Main Address	Insert	New Registration		116A North Main White Hall, IL 62016	10/12/2018 11:04 AM
Contacts	Authorizing Official	Insert	New Registration		Campbell, Deborah J CEO Thomas H. Boyd Memorial Hospital 2179426946	10/12/2018 11:04 AM
Contacts	Primary Contact	Insert	New Registration		Garner, Kathryne CFO Thomas H. Boyd Memorial Hospital 2179426946-1303	10/12/2018 11:04 AM
Details	Last Recertification Date	Insert	New Registration			10/12/2018 11:04 AM
Details	Grant Number	Insert	New Registration			10/12/2018 11:04 AM
Details	340B ID	Insert	New Registration			10/12/2018 11:04 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2018 11:04 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2018 11:04 AM
Details	Medicare Provider Number	Insert	New Registration		141300	10/12/2018 11:04 AM
Details	Entity Name	Insert	New Registration		THOMAS H BOYD CRITICAL ACC HOSPITAL	10/12/2018 11:04 AM
Details	Program Code	Insert	New Registration		CAH	10/12/2018 11:04 AM
Details	Entity Subname	Insert	New Registration		Greene County Rural Health Clinic	10/12/2018 11:04 AM
Dates	Participating Approval Date	Insert	New Registration			10/12/2018 11:04 AM
Details	State	Insert	New Registration		Pending	10/12/2018 11:04 AM
Dates	Registration Date	Insert	New Registration		10/12/2018 11:04:56 AM	10/12/2018 11:04 AM
Dates	Signed By Date	Insert	New Registration			10/12/2018 11:04 AM
Dates	Start Date	Insert	New Registration			10/12/2018 11:04 AM
Terminations	Termination Comments	Insert	New Registration			10/12/2018 11:04 AM
Terminations	Termination Date	Insert	New Registration			10/12/2018 11:04 AM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2018 11:04 AM
Terminations	Termination Reason	Insert	New Registration			10/12/2018 11:04 AM