Covered Entity Details

CAH261324-03 CASS REGIONAL MEDICAL CENTER (Active) - information as of 4/27/2025 11:36:55 PM

Main Details

Name

CASS REGIONAL MEDICAL CENTER

Subdivision Name

CASS REGIONAL MEDICAL CENTER - Rural Health Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH261324-03

Medicare Provider Number

261324

Outpatient Facility Provider Number

268515

Additional Details

Current Program Status

Active

Registration Date

6/12/2020

Participating Start Date

6/18/2020

Participating Approval Date

6/18/2020

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Cass Regional Medical Center
Ronnie Thompson, CFO
(816) 887-0661 Ext: 6610

Primary Contact

Cass Regional Medical Center
Kasandra K Blevins, Staff Accountant
(816) 887-0763

Addresses

Street Address

2820 E ROCK HAVEN RD STE 210
HARRISONVILLE MEDICAL CLINIC
HARRISONVILLE, MO 64701-4414

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
CAH261324-01	Child	CAH	CASS REGIONAL MEDICAL CENTER	CASS REGIONAL MEDICAL CENTER - Rural Health Clinic	305 E PACIFIC ST	KINGSVILLE	MO	Active
CAH261324-02	Child	CAH	CASS REGIONAL MEDICAL CENTER	CASS REGIONAL MEDICAL CENTER - Rural Health Clinic	709 E PINE ST	ARCHIE	MO	Active
CAH261324-03	Child	CAH	CASS REGIONAL MEDICAL CENTER	CASS REGIONAL MEDICAL CENTER - Rural Health Clinic	2820 E ROCK HAVEN RD STE 210	HARRISONVILLE	MO	Active
CAH261324-04	Child	CAH	CASS REGIONAL MEDICAL CENTER	CASS REGIONAL MEDICAL CENTER - Rural Health Clinic	1601 N STATE ROUTE 7	PLEASANT HILL	MO	Active
CAH261324-05	Child	CAH	CASS REGIONAL MEDICAL CENTER	CASS REGIONAL MEDICAL CENTER - Rural Health Clinic	101 OLD HWY 7 SUITE B	GARDEN CITY	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/28/2023 6:18:38 PM	8/21/2024 10:19:11 AM	8/21/2024 10:19 AM
Contacts	Authorizing Official	Update	AO Change Request	Lang, John Christopher CEO Cass Regional Medical Center 8163805888-6630	Thompson, Ronnie CFO Cass Regional Medical Center 8168870661-6610	10/16/2023 4:17 PM
Contacts	Primary Contact	Update	PC Change Request	Elloitt, Janie Business Office Manager Cass Regional Medical Center 8163805888-8100	Blevins, Kasandra K Staff Accountant Cass Regional Medical Center 8168870763	8/29/2023 7:46 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 10:57:42 AM	8/28/2023 6:18:38 PM	8/28/2023 6:18 PM
Contacts	Authorizing Official	Update	AO Change Request	PROBASCO, BRENT CFO Cass Regional Medical Center 8163805888-6610	Lang, John Christopher CEO Cass Regional Medical Center 8163805888-6630	8/15/2023 3:27 PM
Details	Last Recertification Date	Update	Recertification	8/20/2021 9:34:55 AM	8/29/2022 10:57:42 AM	8/29/2022 10:57 AM
Details	Last Recertification Date	Update	Recertification	8/26/2020 9:48:51 AM	8/20/2021 9:34:55 AM	8/20/2021 9:34 AM
Details	Last Recertification Date	Update	Recertification		8/26/2020 9:48:51 AM	8/26/2020 9:48 AM
Details	State	Update	OPA Edit	Approved	Active	6/18/2020 12:39 PM
Dates	Start Date	Update	OPA Edit	7/1/2020 12:00:00 AM	6/18/2020 12:00:00 AM	6/18/2020 12:39 PM
Contacts	Signed By	Insert	New Registration		PROBASCO, BRENT CFO Cass Regional Medical Center 8163805888-6610	6/18/2020 12:37 PM
Details	340B ID	Update	New Registration		CAH261324-03	6/18/2020 12:37 PM
Details	Entity Subname	Update	New Registration	CASS REGIONAL MEDICAL CENTER	CASS REGIONAL MEDICAL CENTER - Rural Health Clinic	6/18/2020 12:37 PM
Dates	Participating Approval Date	Update	New Registration		6/18/2020 12:37:09 PM	6/18/2020 12:37 PM
Details	State	Update	New Registration	Pending	Approved	6/18/2020 12:37 PM
Dates	Signed By Date	Update	New Registration		6/18/2020 10:42:56 AM	6/18/2020 12:37 PM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	6/18/2020 12:37 PM
Addresses	Main Address	Insert	New Registration		2820 E ROCK HAVEN RD STE 210 HARRISONVILLE MEDICAL CLINIC HARRISONVILLE, MO 64701-4414	6/12/2020 12:48 PM
Contacts	Authorizing Official	Insert	New Registration		PROBASCO, BRENT CFO Cass Regional Medical Center 8163805888-6610	6/12/2020 12:48 PM
Contacts	Primary Contact	Insert	New Registration		Elloitt, Janie Business Office Manager Cass Regional Medical Center 8163805888-8100	6/12/2020 12:48 PM
Details	Last Recertification Date	Insert	New Registration			6/12/2020 12:48 PM
Details	Grant Number	Insert	New Registration			6/12/2020 12:48 PM
Details	340B ID	Insert	New Registration			6/12/2020 12:48 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			6/12/2020 12:48 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			6/12/2020 12:48 PM
Details	Medicare Provider Number	Insert	New Registration		261324	6/12/2020 12:48 PM
Details	Entity Name	Insert	New Registration		CASS REGIONAL MEDICAL CENTER	6/12/2020 12:48 PM
Details	Program Code	Insert	New Registration		CAH	6/12/2020 12:48 PM
Details	Entity Subname	Insert	New Registration		CASS REGIONAL MEDICAL CENTER	6/12/2020 12:48 PM
Dates	Participating Approval Date	Insert	New Registration			6/12/2020 12:48 PM
Details	State	Insert	New Registration		Pending	6/12/2020 12:48 PM
Dates	Registration Date	Insert	New Registration		6/12/2020 12:48:15 PM	6/12/2020 12:48 PM
Dates	Signed By Date	Insert	New Registration			6/12/2020 12:48 PM
Dates	Start Date	Insert	New Registration			6/12/2020 12:48 PM
Terminations	Termination Comments	Insert	New Registration			6/12/2020 12:48 PM
Terminations	Termination Date	Insert	New Registration			6/12/2020 12:48 PM
Terminations	Termination Effective Date	Insert	New Registration			6/12/2020 12:48 PM
Terminations	Termination Reason	Insert	New Registration			6/12/2020 12:48 PM