Covered Entity Details

CAH151330-10 ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL (Active) - information as of 4/28/2025 1:44:21 AM

Main Details

Name

ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL

Subdivision Name

ADAMS COUNTY MEMORIAL HOSPITAL - Adams Medical Group -- High Street

Type

Critical Access Hospital

Rural

340B ID

CAH151330-10

Medicare Provider Number

151330

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/6/2021

Participating Start Date

1/1/2022

Participating Approval Date

10/21/2021

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Adams Memorial Hospital
Scott Smith, Executive Director
(260) 724-2145 Ext: 11002

Primary Contact

Adams Memorial Hospital
Dane Wheeler, CFO
(260) 724-2145

Addresses

Street Address

955 HIGH ST STE 1
ADAMS MEDICAL GROUP- HIGH STREET
DECATUR, IN 46733-2361

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
CAH151330-01	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	OUTPATIENT BEHAVIOR HEALTH	200 NORTH HOSPITAL CIRCLE DRIVE	DECATUR	IN	Terminated
CAH151330-02	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	NEUROLOGY	1100 Mercer Ave	DECATUR	IN	Active
CAH151330-03	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	ORTHOPEDICS	1100 Mercer Ave	Decatur	IN	Active
CAH151330-04	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	GENERAL SURGERY	1100 Mercer Ave	Decatur	IN	Active
CAH151330-06	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	Decatur FAMILY MEDICINE	1100 Mercer Ave	DECATUR	IN	Active
CAH151330-07	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	ADAMS COUNTY MEMORIAL HOSPITAL - Monroe Family Medicine	205 TOWER DR	MONROE	IN	Active
CAH151330-08	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	ADAMS COUNTY MEMORIAL HOSPITAL - Stat Care	1401 N 13th Street	DECATUR	IN	Active
CAH151330-09	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	ADAMS COUNTY MEMORIAL HOSPITAL - Woodcrest Family Medicine	1300 MERCER AVE	DECATUR	IN	Active
CAH151330-10	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	ADAMS COUNTY MEMORIAL HOSPITAL - Adams Medical Group -- High Street	955 HIGH ST STE 1	DECATUR	IN	Active
CAH151330-11	Child	CAH	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	Adams Medical Group -- Berne - Adams Medical Group -- Berne	1521 W. Main St.	Berne	IN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Group Change Request	CURRIE, TONY DIR OF PHARMACY Adams Memorial 2607242145-12604	Wheeler, Dane CFO Adams Memorial Hospital 2607242145	4/14/2025 6:28 AM
Details	Last Recertification Date	Update	Recertification	8/24/2023 2:24:05 PM	8/19/2024 11:29:31 AM	8/19/2024 11:29 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 12:41:54 PM	8/24/2023 2:24:05 PM	8/24/2023 2:24 PM
Details	Last Recertification Date	Update	Recertification		8/29/2022 12:41:54 PM	8/29/2022 12:41 PM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Smith, Scott Executive Director Adams Memorial Hospital 2607242145-11002	10/21/2021 10:23 AM
Details	340B ID	Update	New Registration		CAH151330-10	10/21/2021 10:23 AM
Details	Entity Name	Update	New Registration	ADAMS MEMORIAL HOSPITAL	ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL	10/21/2021 10:23 AM
Details	Entity Subname	Update	New Registration	ADAMS COUNTY MEMORIAL HOSPITAL	ADAMS COUNTY MEMORIAL HOSPITAL - Adams Medical Group -- High Street	10/21/2021 10:23 AM
Dates	Participating Approval Date	Update	New Registration		10/21/2021 10:23:00 AM	10/21/2021 10:23 AM
Details	State	Update	New Registration	Pending	Approved	10/21/2021 10:23 AM
Dates	Signed By Date	Update	New Registration		10/15/2021 2:10:32 PM	10/21/2021 10:23 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	10/21/2021 10:23 AM
Addresses	Main Address	Insert	New Registration		955 HIGH ST STE 1 ADAMS MEDICAL GROUP- HIGH STREET DECATUR, IN 46733-2361	10/6/2021 2:38 PM
Contacts	Primary Contact	Insert	New Registration		CURRIE, TONY DIR OF PHARMACY Adams Memorial 2607242145-12604	10/6/2021 2:38 PM
Contacts	Authorizing Official	Insert	New Registration		Smith, Scott Executive Director Adams Memorial Hospital 2607242145-11002	10/6/2021 2:38 PM
Details	Assistance Received From Date	Insert	New Registration			10/6/2021 2:38 PM
Details	Assistance Received To Date	Insert	New Registration			10/6/2021 2:38 PM
Details	Last Recertification Date	Insert	New Registration			10/6/2021 2:38 PM
Details	Grant Number	Insert	New Registration			10/6/2021 2:38 PM
Details	340B ID	Insert	New Registration			10/6/2021 2:38 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/6/2021 2:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/6/2021 2:38 PM
Details	Medicare Provider Number	Insert	New Registration		151330	10/6/2021 2:38 PM
Details	Entity Name	Insert	New Registration		ADAMS MEMORIAL HOSPITAL	10/6/2021 2:38 PM
Details	NOFO Number	Insert	New Registration			10/6/2021 2:38 PM
Details	Program Code	Insert	New Registration		CAH	10/6/2021 2:38 PM
Details	Entity Subname	Insert	New Registration		ADAMS COUNTY MEMORIAL HOSPITAL	10/6/2021 2:38 PM
Dates	Participating Approval Date	Insert	New Registration			10/6/2021 2:38 PM
Details	State	Insert	New Registration		Pending	10/6/2021 2:38 PM
Dates	Registration Date	Insert	New Registration		10/6/2021 2:38:02 PM	10/6/2021 2:38 PM
Dates	Signed By Date	Insert	New Registration			10/6/2021 2:38 PM
Dates	Start Date	Insert	New Registration			10/6/2021 2:38 PM
Terminations	Termination Comments	Insert	New Registration			10/6/2021 2:38 PM
Terminations	Termination Date	Insert	New Registration			10/6/2021 2:38 PM
Terminations	Termination Effective Date	Insert	New Registration			10/6/2021 2:38 PM
Terminations	Termination Reason	Insert	New Registration			10/6/2021 2:38 PM