Covered Entity Details

CAH141320-04 HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital) (Active) - information as of 4/25/2025 12:00:55 AM

Main Details

Name

HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)

Subdivision Name

Paris EZ Care Clinic - EZ Care RHC

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH141320-04

Medicare Provider Number

141320

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/13/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/20/2020

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

Hospital & Medical Foundation of Paris, Inc.
Martin Donald Adams, Chief Financial Officer
(217) 466-4246

Primary Contact

Paris Community Hospital
Ryan Christopher Bonomo, Director of Pharmacy
(217) 465-4141 Ext: 4221

Addresses

Street Address

1 Phipps Ln
Paris, IL 61944

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
IL	370860281007	1760546782

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
CAH141320-01	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	PARIS CLINIC	727 EAST COURT STREET	PARIS	IL	Active
CAH141320-02	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC.	FAMILY MEDICAL CENTER-KANSAS	104 EAST BUENA VISTA	KANSAS	IL	Terminated
CAH141320-03	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	CHRISMAN CLINIC	112 W. MADISON	CHRISMAN	IL	Active
CAH141320-04	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	Paris EZ Care Clinic - EZ Care RHC	1 Phipps Ln	Paris	IL	Active
CAH141320-05	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	Marshall EZ Care Clinic - EZ Care- Marshall RHC	1602 N IL-1	Marshall	IL	Active
CAH141320-06	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	Oakland Clinic - Oakland RHC	5 S Walnut St	Oakland	IL	Active
CAH141320-07	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	Pain Management Clinic - Pain Management Clinic	15317 US Highway 150	Paris	IL	Approved
CAH141320-08	Child	CAH	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	HOSPITAL & MEDICAL FOUND INC - Sycamore Wellness	1378 S STATE ROAD 46	TERRE HAUTE	IN	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Smith, Oliver M. President & CEO Hospital & Medical Foundation of Paris, Inc. 2174654141-4218	Adams, Martin Donald Chief Financial Officer Hospital & Medical Foundation of Paris, Inc. 2174664246	1/17/2025 6:38 AM
Details	Last Recertification Date	Update	Recertification	8/21/2023 9:58:33 AM	8/22/2024 11:28:07 AM	8/22/2024 11:28 AM
Details	Entity Name	Update	Change Request	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC.	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC. (DBA Paris Community Hospital)	10/2/2023 12:39 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 11:00:50 AM	8/21/2023 9:58:33 AM	8/21/2023 9:58 AM
Details	Last Recertification Date	Update	Recertification	8/31/2021 2:08:58 PM	8/30/2022 11:00:50 AM	8/30/2022 11:00 AM
Details	Last Recertification Date	Update	Recertification	9/2/2020 3:06:24 PM	8/31/2021 2:08:58 PM	8/31/2021 2:08 PM
Contacts	Authorizing Official	Update	AO Change Request	Smith, Oliver M. CEO Hospital and Medical Foundation of Paris, Inc. 2174654141-218	Smith, Oliver M. President & CEO Hospital & Medical Foundation of Paris, Inc. 2174654141-4218	8/27/2021 8:08 AM
Medicaid Billing	NPI: State	Update	Recertification		IL	9/2/2020 3:06 PM
Details	Last Recertification Date	Update	Recertification		9/2/2020 3:06:24 PM	9/2/2020 3:06 PM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/29/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		370860281007	5/29/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/29/2020 3:09 PM
Contacts	Signed By	Insert	New Registration		Smith, Oliver M. CEO Hospital and Medical Foundation of Paris, Inc. 2174654141-218	4/20/2020 1:48 PM
Details	340B ID	Update	New Registration		CAH141320-04	4/20/2020 1:48 PM
Details	Entity Name	Update	New Registration	PARIS COMMUNITY HOSPITAL	HOSPITAL & MEDICAL FOUNDATION OF PARIS, INC.	4/20/2020 1:48 PM
Details	Entity Subname	Update	New Registration	Paris EZ Care Clinic	Paris EZ Care Clinic - EZ Care RHC	4/20/2020 1:48 PM
Dates	Participating Approval Date	Update	New Registration		4/20/2020 1:48:52 PM	4/20/2020 1:48 PM
Details	State	Update	New Registration	Pending	Approved	4/20/2020 1:48 PM
Dates	Signed By Date	Update	New Registration		4/14/2020 1:20:08 PM	4/20/2020 1:48 PM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/20/2020 1:48 PM
Addresses	Main Address	Insert	New Registration		1 Phipps Ln Paris, IL 61944	4/13/2020 11:35 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1760546782	4/13/2020 11:35 AM
Contacts	Authorizing Official	Insert	New Registration		Smith, Oliver M. CEO Hospital and Medical Foundation of Paris, Inc. 2174654141-218	4/13/2020 11:35 AM
Contacts	Primary Contact	Insert	New Registration		Bonomo, Ryan Christopher Director of Pharmacy Paris Community Hospital 2174654141-4221	4/13/2020 11:35 AM
Details	Last Recertification Date	Insert	New Registration			4/13/2020 11:35 AM
Details	Grant Number	Insert	New Registration			4/13/2020 11:35 AM
Details	340B ID	Insert	New Registration			4/13/2020 11:35 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/13/2020 11:35 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/13/2020 11:35 AM
Details	Medicare Provider Number	Insert	New Registration		141320	4/13/2020 11:35 AM
Details	Entity Name	Insert	New Registration		PARIS COMMUNITY HOSPITAL	4/13/2020 11:35 AM
Details	Program Code	Insert	New Registration		CAH	4/13/2020 11:35 AM
Details	Entity Subname	Insert	New Registration		Paris EZ Care Clinic	4/13/2020 11:35 AM
Dates	Participating Approval Date	Insert	New Registration			4/13/2020 11:35 AM
Details	State	Insert	New Registration		Pending	4/13/2020 11:35 AM
Dates	Registration Date	Insert	New Registration		4/13/2020 11:35:38 AM	4/13/2020 11:35 AM
Dates	Signed By Date	Insert	New Registration			4/13/2020 11:35 AM
Dates	Start Date	Insert	New Registration			4/13/2020 11:35 AM
Terminations	Termination Comments	Insert	New Registration			4/13/2020 11:35 AM
Terminations	Termination Date	Insert	New Registration			4/13/2020 11:35 AM
Terminations	Termination Effective Date	Insert	New Registration			4/13/2020 11:35 AM
Terminations	Termination Reason	Insert	New Registration			4/13/2020 11:35 AM