Covered Entity Details

CAH281364-06 Beatrice Community Hospital (Terminated) - information as of 5/6/2025 11:00:21 PM

Main Details

Name

Beatrice Community Hospital

Subdivision Name

Community Medical Center

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH281364-06

Medicare Provider Number

281364

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/12/2019

Participating Start Date

7/1/2019

Participating Approval Date

4/18/2019

Last Recertification Date

8/20/2019

Termination Date
Termination Reason

7/1/2020
Outpatient facility moved within the 4 walls of the parent hospital

Contacts

Authorizing Official

Beatrice Community Hospital and Health Center, Inc.
Chad E Jurgens, CFO
(402) 223-7224

Primary Contact

Beatrice Community Hospital & Health Center
KRIS SHUBERT, Director of Pharmacy
(402) 223-7324

Addresses

Street Address

1123 N 10th Street
Beatrice, NE 68310

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
CAH281364-01	Child	CAH	Beatrice Community Hospital	Wymore Medical Clinic	116 E H St	Wymore	NE	Active
CAH281364-02	Child	CAH	Beatrice Community Hospital	Beatrice Womens Clinic	4800 Hospital Parkway	Beatrice	NE	Terminated
CAH281364-03	Child	CAH	Beatrice Community Hospital	Gage County Medical Center	1101 N. 10th Street	Beatrice	NE	Terminated
CAH281364-04	Child	CAH	Beatrice Community Hospital	Beatrice Medical Center	805 West Court	Beatrice	NE	Terminated
CAH281364-05	Child	CAH	Beatrice Community Hospital	Beatrice Internal Medicine	4800 Hospital Parkway	Beatrice	NE	Terminated
CAH281364-06	Child	CAH	Beatrice Community Hospital	Community Medical Center	1123 N 10th Street	Beatrice	NE	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		4/24/2020 12:00:00 AM	4/30/2020 8:12 AM
Details	State	Update	Termination Request	Active	To Be Terminated	4/30/2020 8:12 AM
Terminations	Termination Comments	Update	Termination Request		Community Medical Center 281364-06 has been moved within the four walls of the parent hospital, and has been integrated with Beatrice Internal Medicine 281364-05, effective 4/27/2020.	4/30/2020 8:12 AM
Terminations	Termination Date	Update	Termination Request		7/1/2020 12:00:00 AM	4/30/2020 8:12 AM
Terminations	Termination Effective Date	Update	Termination Request		4/27/2020 12:00:00 AM	4/30/2020 8:12 AM
Terminations	Termination Reason	Update	Termination Request		Outpatient facility moved within the 4 walls of the parent hospital	4/30/2020 8:12 AM
Contacts	Authorizing Official	Update	AO Change Request	Haraldson, Rick CEO Beatrice Community Hospital and Health Center 4022283344	Jurgens, Chad E CFO Beatrice Community Hospital and Health Center, Inc. 4022237224	1/2/2020 6:48 AM
Addresses	Main Address	Update	Change Request	1123 NORTH 10TH STREET bEATRICE, NE 68310	1123 N 10th Street Beatrice, NE 68310	8/26/2019 10:56 AM
Details	Entity Subname	Update	Change Request	COMMUNITY MEDICAL CENTER - RURAL HEALTH CLINIC	Community Medical Center	8/26/2019 10:56 AM
Details	Last Recertification Date	Update	Recertification		8/20/2019 9:56:16 AM	8/20/2019 9:56 AM
Contacts	Authorizing Official	Update	AO Change Request	Streeter, Alan CFO Beatrice Community Hospital and Health Center 4022237224	Haraldson, Rick CEO Beatrice Community Hospital and Health Center 4022283344	7/19/2019 1:02 PM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Streeter, Alan CFO Beatrice Community Hospital and Health Center 4022237224	4/18/2019 9:50 AM
Details	340B ID	Update	New Registration		CAH281364-06	4/18/2019 9:50 AM
Details	Entity Name	Update	New Registration	BEATRICE COMMUNITY HOSPITAL	Beatrice Community Hospital	4/18/2019 9:50 AM
Details	Entity Subname	Update	New Registration	COMMUNITY MEDICAL CENTER	COMMUNITY MEDICAL CENTER - RURAL HEALTH CLINIC	4/18/2019 9:50 AM
Dates	Participating Approval Date	Update	New Registration		4/18/2019 9:50:06 AM	4/18/2019 9:50 AM
Details	State	Update	New Registration	Pending	Approved	4/18/2019 9:50 AM
Dates	Signed By Date	Update	New Registration		4/12/2019 11:24:34 AM	4/18/2019 9:50 AM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	4/18/2019 9:50 AM
Contacts	Primary Contact	Insert	New Registration		SHUBERT, KRIS Director of Pharmacy Beatrice Community Hospital & Health Center 4022237324	4/12/2019 11:24 AM
Addresses	Main Address	Insert	New Registration		1123 NORTH 10TH STREET bEATRICE, NE 68310	4/12/2019 11:24 AM
Contacts	Authorizing Official	Insert	New Registration		Streeter, Alan CFO Beatrice Community Hospital and Health Center 4022237224	4/12/2019 11:24 AM
Details	Last Recertification Date	Insert	New Registration			4/12/2019 11:24 AM
Details	Grant Number	Insert	New Registration			4/12/2019 11:24 AM
Details	340B ID	Insert	New Registration			4/12/2019 11:24 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/12/2019 11:24 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/12/2019 11:24 AM
Details	Medicare Provider Number	Insert	New Registration		281364	4/12/2019 11:24 AM
Details	Entity Name	Insert	New Registration		BEATRICE COMMUNITY HOSPITAL	4/12/2019 11:24 AM
Details	Program Code	Insert	New Registration		CAH	4/12/2019 11:24 AM
Details	Entity Subname	Insert	New Registration		COMMUNITY MEDICAL CENTER	4/12/2019 11:24 AM
Dates	Participating Approval Date	Insert	New Registration			4/12/2019 11:24 AM
Details	State	Insert	New Registration		Pending	4/12/2019 11:24 AM
Dates	Registration Date	Insert	New Registration		4/12/2019 11:24:30 AM	4/12/2019 11:24 AM
Dates	Signed By Date	Insert	New Registration			4/12/2019 11:24 AM
Dates	Start Date	Insert	New Registration			4/12/2019 11:24 AM
Terminations	Termination Comments	Insert	New Registration			4/12/2019 11:24 AM
Terminations	Termination Date	Insert	New Registration			4/12/2019 11:24 AM
Terminations	Termination Effective Date	Insert	New Registration			4/12/2019 11:24 AM
Terminations	Termination Reason	Insert	New Registration			4/12/2019 11:24 AM