Covered Entity Details

DSH150023E UNION HOSPITAL INC. (Active) - information as of 5/24/2025 12:36:35 AM

Main Details

Name

UNION HOSPITAL INC.

Subdivision Name

Chemotherapy Infusion Services Union - Chemotherapy Infusion Services Union

Type

Disproportionate Share Hospital

Rural

340B ID

DSH150023E

Medicare Provider Number

150023

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

12/21/2021

Participating Start Date

12/28/2021

Participating Approval Date

12/28/2021

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Union Hospital, Inc
James Schrader, Chief Strategy and Bus Dev Officer
(812) 238-7249

Primary Contact

Union Health System
Tammie Brown, System Director of Finance
(812) 238-4939

Addresses

Street Address

1711 N 6 1/2 Street
Suite 201
Terre Haute, IN 47804

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participated starting 7/1/2019, terminated 8/3/2021. Reinstated 12/28/2021.	12/28/2021

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
IN	100270020	1619975331
IL	350876396001	1619975331

Shipping Addresses

Shipping Address 1

Chemotherapy Infusion Services Union - Chemotherapy Infusion Services Union
1606 North 7th Street
Attn: Pharmacy
Terre Haute, IN 47804

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
DSH150023A	Child	DSH	UNION HOSPITAL INC.	WVSC - WVSC - Outpatient Surgery Center	1421 North 7th Street	Terre Haute	IN	Active
DSH150023B	Child	DSH	UNION HOSPITAL INC.	Union Hospital Radiation Therapy - Union Hospital Radiation Therapy outpatient	1711 North 6 1/2 Street	Terre Haute	IN	Active
DSH150023C	Child	DSH	UNION HOSPITAL INC.	Chemotherapy services at PMG, Suite T - Chemotherpay services at PMG, Suite T	2723 south 7th street	Terre Haute	IN	Active
DSH150023D	Child	DSH	UNION HOSPITAL INC.	Union Hospital Rheumatology - Union Hospital Rheumatology outpatient	1711 North 6 1/2 Street Suite 302	Terre Haute	IN	Active
DSH150023E	Child	DSH	UNION HOSPITAL INC.	Chemotherapy Infusion Services Union - Chemotherapy Infusion Services Union	1711 N 6 1/2 Street	Terre Haute	IN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Nealon, Matthew CFO Union Health System 8122387951	Schrader, James Chief Strategy and Bus Dev Officer Union Hospital, Inc 8122387249	3/18/2025 8:18 AM
Contacts	Primary Contact	Update	Change Request	Brown, Tammie Director of Finance Union Hospital, Inc. 8122384939	Brown, Tammie System Director of Finance Union Health System 8122384939	12/19/2024 12:39 PM
Contacts	Authorizing Official	Update	Change Request	Nealon, Matt Vice President CFO Union Hospital, Inc 8122387606	Nealon, Matthew CFO Union Health System 8122387951	10/7/2024 9:40 AM
Details	Last Recertification Date	Update	Recertification	8/14/2023 2:11:40 PM	8/12/2024 9:42:38 AM	8/12/2024 9:42 AM
Details	Last Recertification Date	Update	Recertification	8/30/2022 7:39:03 AM	8/14/2023 2:11:40 PM	8/14/2023 2:11 PM
Details	Last Recertification Date	Update	Recertification		8/30/2022 7:39:03 AM	8/30/2022 7:39 AM
Details	Comments Public	Insert	OPA Edit		Participated starting 7/1/2019, terminated 8/3/2021. Reinstated 12/28/2021.	12/28/2021 2:44 PM
Details	State	Update	OPA Edit	Approved	Active	12/28/2021 2:33 PM
Dates	Start Date	Update	OPA Edit	1/1/2022 12:00:00 AM	12/28/2021 12:00:00 AM	12/28/2021 2:33 PM
Contacts	Signed By	Update	Reinstatement	HUTSON, WAYNE EXECUTIVE VICE PRESIDENT & CFO Union Hospital, Inc. 8122387601	Nealon, Matt Vice President CFO Union Hospital, Inc 8122387606	12/28/2021 2:26 PM
Details	Last Recertification Date	Update	Reinstatement	8/20/2020 3:44:34 PM		12/28/2021 2:26 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	8/3/2021 12:00:00 AM		12/28/2021 2:26 PM
Dates	Participating Approval Date	Update	Reinstatement	6/3/2019 7:00:55 AM	12/28/2021 2:26:25 PM	12/28/2021 2:26 PM
Details	State	Update	Reinstatement	Terminated	Approved	12/28/2021 2:26 PM
Dates	Registration Date	Update	Reinstatement	4/1/2019 2:58:34 PM	12/21/2021 10:58:44 AM	12/28/2021 2:26 PM
Dates	Signed By Date	Update	Reinstatement	4/1/2019 4:14:18 PM	12/21/2021 11:12:40 AM	12/28/2021 2:26 PM
Dates	Start Date	Update	Reinstatement	7/1/2019 12:00:00 AM	1/1/2022 12:00:00 AM	12/28/2021 2:26 PM
Terminations	Termination Comments	Update	Reinstatement	Terminating immediately, COVID-19 related CE immediate start date given, 8/3/2021, to new 340B ID RRC150023-00		12/28/2021 2:26 PM
Terminations	Termination Date	Update	Reinstatement	8/3/2021 12:00:00 AM		12/28/2021 2:26 PM
Terminations	Termination Effective Date	Update	Reinstatement	8/3/2021 12:00:00 AM		12/28/2021 2:26 PM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		12/28/2021 2:26 PM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Edit Termination Info	10/1/2021 12:00:00 AM	8/3/2021 12:00:00 AM	8/3/2021 5:44 PM
Details	State	Update	OPA Edit Termination Info	To Be Terminated	Terminated	8/3/2021 5:44 PM
Terminations	Termination Comments	Update	OPA Edit Termination Info		Terminating immediately, COVID-19 related CE immediate start date given, 8/3/2021, to new 340B ID RRC150023-00	8/3/2021 5:44 PM
Terminations	Termination Date	Update	OPA Edit Termination Info	10/1/2021 12:00:00 AM	8/3/2021 12:00:00 AM	8/3/2021 5:44 PM
Terminations	Termination Effective Date	Update	OPA Edit Termination Info	10/1/2021 12:00:00 AM	8/3/2021 12:00:00 AM	8/3/2021 5:44 PM
Terminations	Termination Reason	Update	OPA Edit Termination Info	Change of covered entity type	DSH percentage below statutory minimum	8/3/2021 5:44 PM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		10/1/2021 12:00:00 AM	8/2/2021 10:17 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	8/2/2021 10:17 AM
Terminations	Termination Date	Update	Hospital Type Change Request		10/1/2021 12:00:00 AM	8/2/2021 10:17 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		10/1/2021 12:00:00 AM	8/2/2021 10:17 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	8/2/2021 10:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/8/2021 7:41 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100270020	3/8/2021 7:41 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	3/8/2021 7:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/8/2021 7:41 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		350876396001	3/8/2021 7:41 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	3/8/2021 7:41 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1619975331	3/8/2021 7:41 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	3/8/2021 7:41 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1619975331	3/8/2021 7:41 AM
Medicaid Billing	NPI: State	Insert	Change Request		IL	3/8/2021 7:41 AM
Details	Last Recertification Date	Update	Recertification	8/21/2019 4:17:08 PM	8/20/2020 3:44:34 PM	8/20/2020 3:44 PM
Addresses	Shipping Address	Insert	Change Request		Chemotherapy Infusion Services Union - Chemotherapy Infusion Services Union 1606 North 7th Street Attn: Pharmacy Terre Haute, IN 47804	7/27/2020 1:10 PM
Details	Last Recertification Date	Update	Recertification		8/21/2019 4:17:08 PM	8/21/2019 4:17 PM
Contacts	Authorizing Official	Update	Change Request	HUTSON, WAYNE EXECUTIVE VICE PRESIDENT & CFO Union Hospital, Inc. 8122387601	Nealon, Matt Vice President CFO Union Hospital, Inc 8122387606	7/1/2019 10:46 AM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		HUTSON, WAYNE EXECUTIVE VICE PRESIDENT & CFO Union Hospital, Inc. 8122387601	6/3/2019 7:00 AM
Details	340B ID	Update	New Registration		DSH150023E	6/3/2019 7:00 AM
Details	Entity Subname	Update	New Registration	Chemotherapy Infusion Services Union	Chemotherapy Infusion Services Union - Chemotherapy Infusion Services Union	6/3/2019 7:00 AM
Dates	Participating Approval Date	Update	New Registration		6/3/2019 7:00:55 AM	6/3/2019 7:00 AM
Details	State	Update	New Registration	Pending	Approved	6/3/2019 7:00 AM
Dates	Signed By Date	Update	New Registration		4/1/2019 4:14:18 PM	6/3/2019 7:00 AM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	6/3/2019 7:00 AM
Addresses	Main Address	Insert	New Registration		1711 N 6 1/2 Street Suite 201 Terre Haute, IN 47804	4/1/2019 2:58 PM
Contacts	Primary Contact	Insert	New Registration		Brown, Tammie Director of Finance Union Hospital, Inc. 8122384939	4/1/2019 2:58 PM
Contacts	Authorizing Official	Insert	New Registration		HUTSON, WAYNE EXECUTIVE VICE PRESIDENT & CFO Union Hospital, Inc. 8122387601	4/1/2019 2:58 PM
Details	Last Recertification Date	Insert	New Registration			4/1/2019 2:58 PM
Details	Grant Number	Insert	New Registration			4/1/2019 2:58 PM
Details	340B ID	Insert	New Registration			4/1/2019 2:58 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/1/2019 2:58 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/1/2019 2:58 PM
Details	Medicare Provider Number	Insert	New Registration		150023	4/1/2019 2:58 PM
Details	Entity Name	Insert	New Registration		UNION HOSPITAL INC.	4/1/2019 2:58 PM
Details	Program Code	Insert	New Registration		DSH	4/1/2019 2:58 PM
Details	Entity Subname	Insert	New Registration		Chemotherapy Infusion Services Union	4/1/2019 2:58 PM
Dates	Participating Approval Date	Insert	New Registration			4/1/2019 2:58 PM
Details	State	Insert	New Registration		Pending	4/1/2019 2:58 PM
Dates	Registration Date	Insert	New Registration		4/1/2019 2:58:34 PM	4/1/2019 2:58 PM
Dates	Signed By Date	Insert	New Registration			4/1/2019 2:58 PM
Dates	Start Date	Insert	New Registration			4/1/2019 2:58 PM
Terminations	Termination Comments	Insert	New Registration			4/1/2019 2:58 PM
Terminations	Termination Date	Insert	New Registration			4/1/2019 2:58 PM
Terminations	Termination Effective Date	Insert	New Registration			4/1/2019 2:58 PM
Terminations	Termination Reason	Insert	New Registration			4/1/2019 2:58 PM