Covered Entity Details

CAH181302-02 JAMES B HAGGIN MEMORIAL HOSPITAL (Terminated) - information as of 6/24/2025 3:09:30 AM

Main Details

Name

JAMES B HAGGIN MEMORIAL HOSPITAL

Subdivision Name

EPHRAIM MCDOWELLHAGGIN PRIMARY CARE - Ephraim McDowell Haggin Primary Care

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH181302-02

Medicare Provider Number

181302

Outpatient Facility Provider Number

188507

Additional Details

Current Program Status

Terminated

Registration Date

4/5/2019

Participating Start Date

7/1/2019

Participating Approval Date

4/18/2019

Last Recertification Date

8/30/2022

Termination Date
Termination Reason

10/1/2023
Site closure

Contacts

Authorizing Official

Fort Logan Hospital/James B. Haggin Hospital
Lynne Warner Lynn, Hospital Administrator
(859) 239-2329

Primary Contact

Ephraim McDowell Health
Megan N Curtis, 340B Program Coordinator
(859) 239-1727

Addresses

Street Address

470 LINDEN AVE
STE 5
HARRODSBURG, KY 40330-1871

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?
Yes

State	Medicaid Number	NPI Number
KY	7100557800	1396083325

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
CAH181302-01	Child	CAH	JAMES B HAGGIN MEMORIAL HOSPITAL	EPHRAIM MCDOWELL MERCER PEDIATRICS - Ephraim McDowell Mercer Pediatrics	466 LINDEN AVE	HARRODSBURG	KY	Active
CAH181302-02	Child	CAH	JAMES B HAGGIN MEMORIAL HOSPITAL	EPHRAIM MCDOWELLHAGGIN PRIMARY CARE - Ephraim McDowell Haggin Primary Care	470 LINDEN AVE	HARRODSBURG	KY	Terminated
CAH181302-03	Child	CAH	JAMES B HAGGIN MEMORIAL HOSPITAL	Ephraim McDowell Harrodsburg Family Medical Center - Ephraim McDowell Harrodsburg Family Medical Center	1509 Louisville Road	Harrodsburg	KY	Active
CAH181302-04	Child	CAH	JAMES B HAGGIN MEMORIAL HOSPITAL	Ephraim McDowell Springfield Family Medical Center - Ephraim McDowell Springfield Family Medical Center	280 Lincoln Drive	Springfield	KY	Active
CAH181302-05	Child	CAH	JAMES B HAGGIN MEMORIAL HOSPITAL	EPHRAIM MCDOWELL DEDMAN PRIMARY CAR - Ephraim McDowell Dedman Primary Care	466 LINDEN AVE	HARRODSBURG	KY	Active
CAH181302-06	Child	CAH	JAMES B HAGGIN MEMORIAL HOSPITAL	RURAL HEALTH CLINIC - EPHRAIM MCDOWELL WALK IN AND PRIMARY CARE	1541 LEBANON RD	DANVILLE	KY	Active
CAH181302-07	Child	CAH	JAMES B HAGGIN MEMORIAL HOSPITAL	RURAL HEALTH CLINIC - EPHRAIM MCDOWELL FAMILY AND INTERNAL MEDICINE	105 PONDER COURT	DANVILLE	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2023 12:01 AM
Contacts	Authorizing Official	Update	Change Request	Kinman, Amanda J. Chief Financial Officer Ephraim McDowell Health 8592392424	Lynn, Lynne Warner Hospital Administrator Fort Logan Hospital/James B. Haggin Hospital 8592392329	9/7/2023 1:20 PM
Contacts	Primary Contact	Update	Profile Change Request	Ballard, Megan N 340b Program Coordinator Ephraim McDowell Health 8592391727	Curtis, Megan N 340B Program Coordinator Ephraim McDowell Health 8592391727	9/7/2023 1:20 PM
Contacts	Signed By	Update	Change Request	Lynn, Lynne Warner Hospital Administrator James B Haggin Hospital 8592392329	Lynn, Lynne Warner Hospital Administrator Fort Logan Hospital/James B. Haggin Hospital 8592392329	9/7/2023 10:13 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/30/2021 12:00:00 AM	9/7/2023 9:28 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/7/2023 9:28 AM
Terminations	Termination Date	Update	Recertification		10/1/2023 12:00:00 AM	9/7/2023 9:28 AM
Terminations	Termination Effective Date	Update	Recertification		10/1/2021 12:00:00 AM	9/7/2023 9:28 AM
Terminations	Termination Reason	Update	Recertification		Site closure	9/7/2023 9:28 AM
Contacts	Authorizing Official	Update	Change Request	Lynn, Lynne Warner Hospital Administrator James B Haggin Hospital 8592392329	Kinman, Amanda J. Chief Financial Officer Ephraim McDowell Health 8592392424	10/19/2022 12:50 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 10:55:24 AM	8/30/2022 10:06:02 AM	8/30/2022 10:06 AM
Details	Last Recertification Date	Update	Recertification	8/19/2020 9:17:46 AM	8/16/2021 10:55:24 AM	8/16/2021 10:55 AM
Medicaid Billing	NPI: State	Update	Recertification		KY	8/19/2020 9:17 AM
Details	Last Recertification Date	Update	Recertification	8/26/2019 9:28:25 AM	8/19/2020 9:17:46 AM	8/19/2020 9:17 AM
Contacts	Primary Contact	Update	Change Request	Haltom, Joan B System Director of Pharmacy Ephraim McDowell Health 8592391721	Ballard, Megan N 340b Program Coordinator Ephraim McDowell Health 8592391727	11/12/2019 6:17 AM
Details	Last Recertification Date	Update	Recertification		8/26/2019 9:28:25 AM	8/26/2019 9:28 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/8/2019 8:04 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7100557800	7/8/2019 8:04 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	7/8/2019 8:04 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1396083325	7/8/2019 8:04 PM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Medicaid Billing	Medicaid: Number	Delete	New Registration	01008044 (KY)		4/18/2019 2:18 PM
Medicaid Billing	NPI: Number	Delete	New Registration	1396083325 ( )		4/18/2019 2:18 PM
Contacts	Signed By	Insert	New Registration		Lynn, Lynne Warner Hospital Administrator James B Haggin Hospital 8592392329	4/18/2019 2:18 PM
Details	340B ID	Update	New Registration		CAH181302-02	4/18/2019 2:18 PM
Details	Entity Subname	Update	New Registration	EPHRAIM MCDOWELLHAGGIN PRIMARY CARE	EPHRAIM MCDOWELLHAGGIN PRIMARY CARE - Ephraim McDowell Haggin Primary Care	4/18/2019 2:18 PM
Dates	Participating Approval Date	Update	New Registration		4/18/2019 2:18:31 PM	4/18/2019 2:18 PM
Details	State	Update	New Registration	Pending	Approved	4/18/2019 2:18 PM
Dates	Signed By Date	Update	New Registration		4/8/2019 1:09:03 PM	4/18/2019 2:18 PM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	4/18/2019 2:18 PM
Addresses	Main Address	Insert	New Registration		470 LINDEN AVE STE 5 HARRODSBURG, KY 40330-1871	4/5/2019 3:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/5/2019 3:06 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01008044	4/5/2019 3:06 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	4/5/2019 3:06 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1396083325	4/5/2019 3:06 PM
Contacts	Primary Contact	Insert	New Registration		Haltom, Joan B System Director of Pharmacy Ephraim McDowell Health 8592391721	4/5/2019 3:06 PM
Contacts	Authorizing Official	Insert	New Registration		Lynn, Lynne Warner Hospital Administrator James B Haggin Hospital 8592392329	4/5/2019 3:06 PM
Details	Last Recertification Date	Insert	New Registration			4/5/2019 3:06 PM
Details	Grant Number	Insert	New Registration			4/5/2019 3:06 PM
Details	340B ID	Insert	New Registration			4/5/2019 3:06 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/5/2019 3:06 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/5/2019 3:06 PM
Details	Medicare Provider Number	Insert	New Registration		181302	4/5/2019 3:06 PM
Details	Entity Name	Insert	New Registration		JAMES B HAGGIN MEMORIAL HOSPITAL	4/5/2019 3:06 PM
Details	Program Code	Insert	New Registration		CAH	4/5/2019 3:06 PM
Details	Entity Subname	Insert	New Registration		EPHRAIM MCDOWELLHAGGIN PRIMARY CARE	4/5/2019 3:06 PM
Dates	Participating Approval Date	Insert	New Registration			4/5/2019 3:06 PM
Details	State	Insert	New Registration		Pending	4/5/2019 3:06 PM
Dates	Registration Date	Insert	New Registration		4/5/2019 3:06:47 PM	4/5/2019 3:06 PM
Dates	Signed By Date	Insert	New Registration			4/5/2019 3:06 PM
Dates	Start Date	Insert	New Registration			4/5/2019 3:06 PM
Terminations	Termination Comments	Insert	New Registration			4/5/2019 3:06 PM
Terminations	Termination Date	Insert	New Registration			4/5/2019 3:06 PM
Terminations	Termination Effective Date	Insert	New Registration			4/5/2019 3:06 PM
Terminations	Termination Reason	Insert	New Registration			4/5/2019 3:06 PM