Covered Entity Details

DSH180044U PIKEVILLE MEDICAL CENTER, INC. (Active) - information as of 5/6/2025 12:03:45 AM

Main Details

Name

PIKEVILLE MEDICAL CENTER, INC.

Subdivision Name

PIKEVILLE MEDICAL CENTER URGENT CAR - Family Practice

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH180044U

Medicare Provider Number

180044

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

12/2/2021

Participating Start Date

1/1/2022

Participating Approval Date

12/8/2021

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Pikeville Medical Center
MICHELLE HAGY, CFO
(606) 430-3519

Primary Contact

Pikeville Medical Center inc.
Marcus Conley, Assistant Chief Financial Officer
(606) 430-3509

Addresses

Street Address

238 CASSIDY BLVD
PIKEVILLE, KY 41501-1426

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
KY	01012251	1285621623
WV	0001441000	1285621623
VA	009810391,1285621623	1285621623
OH	0107477	1285621623

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
DSH180044A	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	Pikeville Medical Center, Inc. Leonard Lawson Cancer Center	172 South Mayo Trail	Pikeville	KY	Terminated
DSH180044B	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC / Infusion Center	172 SOUTH MAYO TRAIL	PIKEVILLE	KY	Terminated
DSH180044C	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE SLEEP LAB	911 Bypass Road	PIKEVILLE	KY	Active
DSH180044D	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	WHITESBURG SLEEP LAB	60 MAIN STREET	WHITESBURG	KY	Terminated
DSH180044E	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC - Pain Management	911 Bypass Road	PIKEVILLE	KY	Terminated
DSH180044F	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER - Clinic Harold	246 KY RT 979	HAROLD	KY	Terminated
DSH180044G	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC - Family Practice	184 S MAYO TRAIL	PIKEVILLE	KY	Active
DSH180044H	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC - Bariatric Center	1098 SOUTH MAYO TRAIL SUITE 103	PIKEVILLE	KY	Terminated
DSH180044J	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC - Clinic Whitesburg	107 Medical Plaza Lane	WHITESBURG	KY	Active
DSH180044K	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC - Clinic Prestonsburg	311 N ARNOLD AVE	PRESTONSBURG	KY	Active
DSH180044L	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC - Clinic Shelby Valley	6800 US 23	PIKEVILLE	KY	Terminated
DSH180044M	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	MARTIN CLINIC - Primary Care Services	263 KY ROUTE 122	MARTIN	KY	Terminated
DSH180044N	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC - Pikeville Medical Center Plastic Surgery	911 Bypass Road	PIKEVILLE	KY	Active
DSH180044P	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC - Pikeville Medical Center Prestonsburg Primary & Urgent Care Clinic	723 SOUTH LAKE DRIVE	PRESTONSBURG	KY	Active
DSH180044Q	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC - Pikeville Medical Center South Williamson	285 SOUTHSIDE MALL RD	SOUTH WILLIAMSON	KY	Active
DSH180044R	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER PRIMARY CA - Building B - Primary Care	911 BYPASS RD	PIKEVILLE	KY	Terminated
DSH180044S	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER URGENT CAR - Women & Children Services	238 CASSIDY BLVD	PIKEVILLE	KY	Active
DSH180044T	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER URGENT CAR - Primary Care Services	238 CASSIDY BLVD	PIKEVILLE	KY	Active
DSH180044U	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER URGENT CAR - Family Practice	238 CASSIDY BLVD	PIKEVILLE	KY	Active
DSH180044V	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER PLASTIC & - Pikeville Medical Center Aesthetic	911 BYPASS RD	PIKEVILLE	KY	Active
DSH180044W	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL DIAGNOSTIC CENTER - PET Scanning	911 BYPASS RD	PIKEVILLE	KY	Active
DSH180044X	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER INC - Nephrology	184 S MAYO TRAIL	PIKEVILLE	KY	Active
DSH180044Y	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	PIKEVILLE MEDICAL CENTER Bariatric Practice - Bariatrics	911 Bypass Road	Pikeville	KY	Active
DSH180044Z	Child	DSH	PIKEVILLE MEDICAL CENTER, INC.	Pikeville Medical Center Urgent Care - Rheumatology Practice - Rheumatology	238 Cassidy Blvd	Pikeville	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 4:10:01 PM	8/13/2024 9:22:39 AM	8/13/2024 9:22 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/17/2023 8:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1285621623	8/17/2023 8:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	8/17/2023 8:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/15/2023 4:10 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0107477	8/15/2023 4:10 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	8/15/2023 4:10 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285621623	8/15/2023 4:10 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	8/15/2023 4:10 PM
Details	Last Recertification Date	Update	Recertification	8/25/2022 6:04:53 PM	8/15/2023 4:10:01 PM	8/15/2023 4:10 PM
Details	Last Recertification Date	Update	Recertification		8/25/2022 6:04:53 PM	8/25/2022 6:04 PM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		HAGY, MICHELLE CFO Pikeville Medical Center 6064303519	12/8/2021 12:45 PM
Details	340B ID	Update	New Registration		DSH180044U	12/8/2021 12:45 PM
Details	Entity Subname	Update	New Registration	PIKEVILLE MEDICAL CENTER URGENT CAR	PIKEVILLE MEDICAL CENTER URGENT CAR - Family Practice	12/8/2021 12:45 PM
Dates	Participating Approval Date	Update	New Registration		12/8/2021 12:45:20 PM	12/8/2021 12:45 PM
Details	State	Update	New Registration	Pending	Approved	12/8/2021 12:45 PM
Dates	Signed By Date	Update	New Registration		12/8/2021 10:52:11 AM	12/8/2021 12:45 PM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	12/8/2021 12:45 PM
Addresses	Main Address	Insert	New Registration		238 CASSIDY BLVD PIKEVILLE, KY 41501-1426	12/2/2021 11:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	12/2/2021 11:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01012251	12/2/2021 11:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	12/2/2021 11:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	12/2/2021 11:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0001441000	12/2/2021 11:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WV	12/2/2021 11:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	12/2/2021 11:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		009810391	12/2/2021 11:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		VA	12/2/2021 11:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285621623	12/2/2021 11:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		KY	12/2/2021 11:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285621623	12/2/2021 11:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		WV	12/2/2021 11:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285621623	12/2/2021 11:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		VA	12/2/2021 11:21 PM
Contacts	Primary Contact	Insert	New Registration		Conley, Marcus Assistant Chief Financial Officer Pikeville Medical Center inc. 6064303509	12/2/2021 11:21 PM
Contacts	Authorizing Official	Insert	New Registration		HAGY, MICHELLE CFO Pikeville Medical Center 6064303519	12/2/2021 11:21 PM
Details	Assistance Received From Date	Insert	New Registration			12/2/2021 11:21 PM
Details	Assistance Received To Date	Insert	New Registration			12/2/2021 11:21 PM
Details	Last Recertification Date	Insert	New Registration			12/2/2021 11:21 PM
Details	Grant Number	Insert	New Registration			12/2/2021 11:21 PM
Details	340B ID	Insert	New Registration			12/2/2021 11:21 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			12/2/2021 11:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			12/2/2021 11:21 PM
Details	Medicare Provider Number	Insert	New Registration		180044	12/2/2021 11:21 PM
Details	Entity Name	Insert	New Registration		PIKEVILLE MEDICAL CENTER, INC.	12/2/2021 11:21 PM
Details	NOFO Number	Insert	New Registration			12/2/2021 11:21 PM
Details	Program Code	Insert	New Registration		DSH	12/2/2021 11:21 PM
Details	Entity Subname	Insert	New Registration		PIKEVILLE MEDICAL CENTER URGENT CAR	12/2/2021 11:21 PM
Dates	Participating Approval Date	Insert	New Registration			12/2/2021 11:21 PM
Details	State	Insert	New Registration		Pending	12/2/2021 11:21 PM
Dates	Registration Date	Insert	New Registration		12/2/2021 11:21:43 PM	12/2/2021 11:21 PM
Dates	Signed By Date	Insert	New Registration			12/2/2021 11:21 PM
Dates	Start Date	Insert	New Registration			12/2/2021 11:21 PM
Terminations	Termination Comments	Insert	New Registration			12/2/2021 11:21 PM
Terminations	Termination Date	Insert	New Registration			12/2/2021 11:21 PM
Terminations	Termination Effective Date	Insert	New Registration			12/2/2021 11:21 PM
Terminations	Termination Reason	Insert	New Registration			12/2/2021 11:21 PM