Covered Entity Details

CAH241351-01 CARRIS HEALTH-REDWOOD (Terminated) - information as of 6/2/2025 8:27:16 AM

Main Details

Name

CARRIS HEALTH-REDWOOD

Subdivision Name

CARRIS HEALTH - REDWOOD LLC - Rural Health Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH241351-01

Medicare Provider Number

241351

Outpatient Facility Provider Number

243489

Additional Details

Current Program Status

Terminated

Registration Date

1/11/2021

Participating Start Date

4/1/2021

Participating Approval Date

1/12/2021

Last Recertification Date

8/24/2023

Termination Date
Termination Reason

10/1/2024
Outpatient facility moved within the 4 walls of the parent hospital

Contacts

Authorizing Official

Carris Health Redwood
KIMBERLY RAE MAURER, Director of Finance
(507) 637-4500 Ext: 47315

Primary Contact

CentraCare Redwood
Carnita Allex, President
(507) 637-4500 Ext: 47301

Addresses

Street Address

101 CARING WAY
REDWOOD FALLS, MN 56283-2247

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
MN	1194206748	1194206748,1265914048,1396216412

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
CAH241351-01	Child	CAH	CARRIS HEALTH-REDWOOD	CARRIS HEALTH - REDWOOD LLC - Rural Health Clinic	101 CARING WAY	REDWOOD FALLS	MN	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		10/1/2024 12:00:00 AM	8/15/2024 7:14 AM
Details	State	Update	Recertification	Active	To Be Terminated	8/15/2024 7:14 AM
Terminations	Termination Comments	Update	Recertification		Moved into new facility (four walls of hospital) 2/20/21. Continues to be eligible for 340B, but was required to enter date above.	8/15/2024 7:14 AM
Terminations	Termination Date	Update	Recertification		10/1/2024 12:00:00 AM	8/15/2024 7:14 AM
Terminations	Termination Effective Date	Update	Recertification		10/1/2024 12:00:00 AM	8/15/2024 7:14 AM
Terminations	Termination Reason	Update	Recertification		Outpatient facility moved within the 4 walls of the parent hospital	8/15/2024 7:14 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1285116061 (MN)		12/12/2023 3:16 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 11:04:07 AM	8/24/2023 4:30:17 PM	8/24/2023 4:30 PM
Contacts	Authorizing Official	Update	Profile Change Request	MAURER, KIMBERLY RAE Director of Finance Carris Health Redwood 5076374667	MAURER, KIMBERLY RAE Director of Finance Carris Health Redwood 5076374500-47315	8/24/2023 3:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/31/2023 5:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1194206748	1/31/2023 5:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	1/31/2023 5:53 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1194206748	1/31/2023 5:53 PM
Medicaid Billing	NPI: State	Insert	Change Request		MN	1/31/2023 5:53 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1285116061	1/31/2023 5:53 PM
Medicaid Billing	NPI: State	Insert	Change Request		MN	1/31/2023 5:53 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1265914048	1/31/2023 5:53 PM
Medicaid Billing	NPI: State	Insert	Change Request		MN	1/31/2023 5:53 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1396216412	1/31/2023 5:53 PM
Medicaid Billing	NPI: State	Insert	Change Request		MN	1/31/2023 5:53 PM
Details	Last Recertification Date	Update	Recertification	8/19/2021 4:16:08 PM	8/30/2022 11:04:07 AM	8/30/2022 11:04 AM
Contacts	Primary Contact	Update	Change Request	Forby, Scott Pharmacy Director Carris Health Rice Memorial Hospital 3202314919	Allex, Carnita President CentraCare Redwood 5076374500-47301	7/11/2022 6:43 AM
Details	Last Recertification Date	Update	Recertification		8/19/2021 4:16:08 PM	8/19/2021 4:16 PM
Details	State	Update		Approved	Active	4/1/2021 12:01 AM
Contacts	Authorizing Official	Update	AO Change Request	Maurer, Kimberly Rae Director of Revenue & Finance Carris Health-Redwood 5076374667	MAURER, KIMBERLY RAE Director of Finance Carris Health Redwood 5076374667	3/1/2021 8:18 PM
Addresses	Main Address	Update	Change Request	1100 E BROADWAY ST REDWOOD FALLS, MN 56283-2247	101 CARING WAY REDWOOD FALLS, MN 56283-2247	2/23/2021 9:46 AM
Contacts	Signed By	Insert	New Registration		Maurer, Kimberly Rae Director of Revenue & Finance Carris Health-Redwood 5076374667	1/12/2021 8:52 AM
Details	340B ID	Update	New Registration		CAH241351-01	1/12/2021 8:52 AM
Details	Entity Name	Update	New Registration	REDWOOD AREA HOSPITAL	CARRIS HEALTH-REDWOOD	1/12/2021 8:52 AM
Details	Entity Subname	Update	New Registration	CARRIS HEALTH - REDWOOD LLC	CARRIS HEALTH - REDWOOD LLC - Rural Health Clinic	1/12/2021 8:52 AM
Dates	Participating Approval Date	Update	New Registration		1/12/2021 8:52:28 AM	1/12/2021 8:52 AM
Details	State	Update	New Registration	Pending	Approved	1/12/2021 8:52 AM
Dates	Signed By Date	Update	New Registration		1/11/2021 11:09:29 AM	1/12/2021 8:52 AM
Dates	Start Date	Update	New Registration		4/1/2021 12:00:00 AM	1/12/2021 8:52 AM
Addresses	Main Address	Insert	New Registration		1100 E BROADWAY ST REDWOOD FALLS, MN 56283-2247	1/11/2021 10:27 AM
Contacts	Primary Contact	Insert	New Registration		Forby, Scott Pharmacy Director Carris Health Rice Memorial Hospital 3202314919	1/11/2021 10:27 AM
Contacts	Authorizing Official	Insert	New Registration		Maurer, Kimberly Rae Director of Revenue & Finance Carris Health-Redwood 5076374667	1/11/2021 10:27 AM
Details	Assistance Received From Date	Insert	New Registration			1/11/2021 10:27 AM
Details	Assistance Received To Date	Insert	New Registration			1/11/2021 10:27 AM
Details	Last Recertification Date	Insert	New Registration			1/11/2021 10:27 AM
Details	Grant Number	Insert	New Registration			1/11/2021 10:27 AM
Details	340B ID	Insert	New Registration			1/11/2021 10:27 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/11/2021 10:27 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/11/2021 10:27 AM
Details	Medicare Provider Number	Insert	New Registration		241351	1/11/2021 10:27 AM
Details	Entity Name	Insert	New Registration		REDWOOD AREA HOSPITAL	1/11/2021 10:27 AM
Details	NOFO Number	Insert	New Registration			1/11/2021 10:27 AM
Details	Program Code	Insert	New Registration		CAH	1/11/2021 10:27 AM
Details	Entity Subname	Insert	New Registration		CARRIS HEALTH - REDWOOD LLC	1/11/2021 10:27 AM
Dates	Participating Approval Date	Insert	New Registration			1/11/2021 10:27 AM
Details	State	Insert	New Registration		Pending	1/11/2021 10:27 AM
Dates	Registration Date	Insert	New Registration		1/11/2021 10:27:15 AM	1/11/2021 10:27 AM
Dates	Signed By Date	Insert	New Registration			1/11/2021 10:27 AM
Dates	Start Date	Insert	New Registration			1/11/2021 10:27 AM
Terminations	Termination Comments	Insert	New Registration			1/11/2021 10:27 AM
Terminations	Termination Date	Insert	New Registration			1/11/2021 10:27 AM
Terminations	Termination Effective Date	Insert	New Registration			1/11/2021 10:27 AM
Terminations	Termination Reason	Insert	New Registration			1/11/2021 10:27 AM