Covered Entity Details

DSH010091D GROVE HILL MEMORIAL HOSPITAL (Active) - information as of 6/25/2025 12:51:48 AM

Main Details

Name

GROVE HILL MEMORIAL HOSPITAL

Subdivision Name

GROVE HILL PRIMARY CARE

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH010091D

Medicare Provider Number

010091

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/10/2020

Participating Start Date

4/1/2020

Participating Approval Date

2/4/2020

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Grove Hill Memorial Hospital
Kenneth Larrimore, COO
(251) 275-3191

Primary Contact

Grove Hill Memorial Hospital
Allen H Jordan, Pharmacy Manager
(251) 275-3191

Addresses

Street Address

297 S JACKSON ST
GROVE HILL, AL 36451-3231

Billing Address

GROVE HILL MEMORIAL HOSPITAL
PO BOX 915
GROVE HILL, AL 36451-0915

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
AL	540003429	1316997430

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
DSH010091B	Child	DSH	GROVE HILL MEMORIAL HOSPITAL	GROVE HILL HEALTHCARE	295-B SOUTH JACKSON ST	GROVE HILL	AL	Active
DSH010091C	Child	DSH	GROVE HILL MEMORIAL HOSPITAL	COFFEEVILLE MEDICAL CENTER	12 LONG AVE	COFFEEVILLE	AL	Terminated
DSH010091D	Child	DSH	GROVE HILL MEMORIAL HOSPITAL	GROVE HILL PRIMARY CARE	297 S JACKSON ST	GROVE HILL	AL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 2:27:09 PM	8/14/2024 4:26:21 PM	8/14/2024 4:26 PM
Details	Last Recertification Date	Update	Recertification	8/25/2022 10:54:16 AM	8/15/2023 2:27:09 PM	8/15/2023 2:27 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 8:56:25 AM	8/25/2022 10:54:16 AM	8/25/2022 10:54 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1386694487 (AL)		11/5/2021 10:42 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1316997430	11/5/2021 10:42 AM
Medicaid Billing	NPI: State	Insert	Change Request		AL	11/5/2021 10:42 AM
Details	Last Recertification Date	Update	Recertification	8/17/2020 10:53:05 AM	8/16/2021 8:56:25 AM	8/16/2021 8:56 AM
Medicaid Billing	NPI: State	Update	Recertification		AL	8/17/2020 10:53 AM
Details	Last Recertification Date	Update	Recertification		8/17/2020 10:53:05 AM	8/17/2020 10:53 AM
Details	Entity Subname	Update	Change Request	GROVE HILL HEALTHCARE #2 - Rural Health Clinic	GROVE HILL PRIMARY CARE	6/4/2020 8:13 AM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		Larrimore, Kenneth COO Grove Hill Memorial Hospital 2512753191	2/4/2020 1:12 PM
Details	340B ID	Update	New Registration		DSH010091D	2/4/2020 1:12 PM
Details	Entity Subname	Update	New Registration	GROVE HILL HEALTHCARE #2	GROVE HILL HEALTHCARE #2 - Rural Health Clinic	2/4/2020 1:12 PM
Dates	Participating Approval Date	Update	New Registration		2/4/2020 1:12:53 PM	2/4/2020 1:12 PM
Details	State	Update	New Registration	Pending	Approved	2/4/2020 1:12 PM
Dates	Signed By Date	Update	New Registration		1/10/2020 7:16:55 PM	2/4/2020 1:12 PM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	2/4/2020 1:12 PM
Addresses	Main Address	Insert	New Registration		297 S JACKSON ST GROVE HILL, AL 36451-3231	1/10/2020 2:43 PM
Addresses	Billing Address	Insert	New Registration		GROVE HILL MEMORIAL HOSPITAL PO BOX 915 GROVE HILL, AL 36451-0915	1/10/2020 2:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/10/2020 2:43 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		540003429	1/10/2020 2:43 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	1/10/2020 2:43 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1386694487	1/10/2020 2:43 PM
Contacts	Primary Contact	Insert	New Registration		Jordan, Allen H Pharmacy Manager Grove Hill Memorial Hospital 2512753191	1/10/2020 2:43 PM
Contacts	Authorizing Official	Insert	New Registration		Larrimore, Kenneth COO Grove Hill Memorial Hospital 2512753191	1/10/2020 2:43 PM
Details	Last Recertification Date	Insert	New Registration			1/10/2020 2:43 PM
Details	Grant Number	Insert	New Registration			1/10/2020 2:43 PM
Details	340B ID	Insert	New Registration			1/10/2020 2:43 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/10/2020 2:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/10/2020 2:43 PM
Details	Medicare Provider Number	Insert	New Registration		010091	1/10/2020 2:43 PM
Details	Entity Name	Insert	New Registration		GROVE HILL MEMORIAL HOSPITAL	1/10/2020 2:43 PM
Details	Program Code	Insert	New Registration		DSH	1/10/2020 2:43 PM
Details	Entity Subname	Insert	New Registration		GROVE HILL HEALTHCARE #2	1/10/2020 2:43 PM
Dates	Participating Approval Date	Insert	New Registration			1/10/2020 2:43 PM
Details	State	Insert	New Registration		Pending	1/10/2020 2:43 PM
Dates	Registration Date	Insert	New Registration		1/10/2020 2:43:14 PM	1/10/2020 2:43 PM
Dates	Signed By Date	Insert	New Registration			1/10/2020 2:43 PM
Dates	Start Date	Insert	New Registration			1/10/2020 2:43 PM
Terminations	Termination Comments	Insert	New Registration			1/10/2020 2:43 PM
Terminations	Termination Date	Insert	New Registration			1/10/2020 2:43 PM
Terminations	Termination Effective Date	Insert	New Registration			1/10/2020 2:43 PM
Terminations	Termination Reason	Insert	New Registration			1/10/2020 2:43 PM