Covered Entity Details

CAH041331-05 OZARKS COMMUNITY HOSPITAL OF GRAVETT (Active) - information as of 4/25/2025 8:34:29 PM

Main Details

Name

OZARKS COMMUNITY HOSPITAL OF GRAVETT

Subdivision Name

SGOH ACQUISITION INC - OCH GOODMAN FAMILY CLINIC

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH041331-05

Medicare Provider Number

041331

Outpatient Facility Provider Number

268745

Additional Details

Current Program Status

Active

Registration Date

1/5/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/10/2022

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

OZARKS COMMUNITY HOSPITAL
PAUL GREGORY TAYLOR, CEO
(417) 837-2012

Primary Contact

OZARKS COMMUNITY HOSPITAL
LINDA JANE REID, MEDICAL STAFF DIRECTOR
(417) 837-4004

Addresses

Street Address

912B STATE HIGHWAY 59
OCH GOODMAN FAMILY CLINIC
GOODMAN, MO 64843-8252

Billing Address

SGOH ACQUISITION, INC.
1101 JACKSON ST SW
GRAVETTE, AR 72736-9121

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

Shipping Address 1

SGOH ACQUISITION, INC.
1101 JACKSON ST SW
GRAVETTE, AR 72736-9121

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
CAH041331-01	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION, INC. - OCH LAWRENCE COUNTY CLINIC	108 S HICKORY ST	MOUNT VERNON	MO	Active
CAH041331-02	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION, INC. - OCH SPARTA CLINIC	155 VILLAGE DR	SPARTA	MO	Active
CAH041331-03	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION, INC. - OCH ANDERSON RURAL HEALTH CLINIC	104 E MAIN ST	ANDERSON	MO	Active
CAH041331-04	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION, INC. - OCH WEBSTER COUNTY CLINIC	101 S MAIN ST	ROGERSVILLE	MO	Active
CAH041331-05	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION INC - OCH GOODMAN FAMILY CLINIC	912B STATE HIGHWAY 59	GOODMAN	MO	Active
CAH041331-06	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION, INC. - OCH WELLPOINTE FAMILY MEDICAL CLINIC	543 W HUBBLE DR	MARSHFIELD	MO	Active
CAH041331-07	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION, INC. - OCH NEWTON COUNTY CLINIC	1355 ROCKETDYNE RD	NEOSHO	MO	Active
CAH041331-08	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION, INC. - OCH SOUTHWEST CITY COMMUNITY CLINIC	109 N BROADWAY ST	SOUTH WEST CITY	MO	Active
CAH041331-09	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION, INC. - OCH PINEVILLE MEDICAL CLINIC	5265 S BUSINESS HIGHWAY 71	PINEVILLE	MO	Active
CAH041331-10	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION, INC. - OCH JASPER COUNTY CLINIC-CARTHAGE CAMPUS	327 E AIRPORT DR	CARTHAGE	MO	Active
CAH041331-11	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION, INC. - OCH MCDONALD COUNTY CLINIC	125 MAIN ST	NOEL	MO	Active
CAH041331-12	Child	CAH	OZARKS COMMUNITY HOSPITAL OF GRAVETT	SGOH ACQUISITION INC - OCH BENTON COUNTY CLINIC	102 RUSSELL RD	ROGERS	AR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 4:49:31 PM	8/12/2024 5:28:52 PM	8/12/2024 5:28 PM
Details	Last Recertification Date	Update	Recertification	8/25/2022 10:19:29 AM	8/14/2023 4:49:31 PM	8/14/2023 4:49 PM
Details	Last Recertification Date	Update	Recertification		8/25/2022 10:19:29 AM	8/25/2022 10:19 AM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		TAYLOR, PAUL GREGORY CEO OZARKS COMMUNITY HOSPITAL 4178372012	1/10/2022 9:46 AM
Details	340B ID	Update	New Registration		CAH041331-05	1/10/2022 9:46 AM
Details	Entity Subname	Update	New Registration	SGOH ACQUISITION INC	SGOH ACQUISITION INC - OCH GOODMAN FAMILY CLINIC	1/10/2022 9:46 AM
Dates	Participating Approval Date	Update	New Registration		1/10/2022 9:46:10 AM	1/10/2022 9:46 AM
Details	State	Update	New Registration	Pending	Approved	1/10/2022 9:46 AM
Dates	Signed By Date	Update	New Registration		1/5/2022 4:42:07 PM	1/10/2022 9:46 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/10/2022 9:46 AM
Addresses	Main Address	Insert	New Registration		912B STATE HIGHWAY 59 OCH GOODMAN FAMILY CLINIC GOODMAN, MO 64843-8252	1/5/2022 2:58 PM
Addresses	Billing Address	Insert	New Registration		SGOH ACQUISITION, INC. 1101 JACKSON ST SW GRAVETTE, AR 72736-9121	1/5/2022 2:58 PM
Addresses	Shipping Address	Insert	New Registration		SGOH ACQUISITION, INC. 1101 JACKSON ST SW GRAVETTE, AR 72736-9121	1/5/2022 2:58 PM
Contacts	Primary Contact	Insert	New Registration		REID, LINDA JANE MEDICAL STAFF DIRECTOR OZARKS COMMUNITY HOSPITAL 4178374004	1/5/2022 2:58 PM
Contacts	Authorizing Official	Insert	New Registration		TAYLOR, PAUL GREGORY CEO OZARKS COMMUNITY HOSPITAL 4178372012	1/5/2022 2:58 PM
Details	Assistance Received From Date	Insert	New Registration			1/5/2022 2:58 PM
Details	Assistance Received To Date	Insert	New Registration			1/5/2022 2:58 PM
Details	Last Recertification Date	Insert	New Registration			1/5/2022 2:58 PM
Details	Grant Number	Insert	New Registration			1/5/2022 2:58 PM
Details	340B ID	Insert	New Registration			1/5/2022 2:58 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/5/2022 2:58 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/5/2022 2:58 PM
Details	Medicare Provider Number	Insert	New Registration		041331	1/5/2022 2:58 PM
Details	Entity Name	Insert	New Registration		OZARKS COMMUNITY HOSPITAL OF GRAVETT	1/5/2022 2:58 PM
Details	NOFO Number	Insert	New Registration			1/5/2022 2:58 PM
Details	Program Code	Insert	New Registration		CAH	1/5/2022 2:58 PM
Details	Entity Subname	Insert	New Registration		SGOH ACQUISITION INC	1/5/2022 2:58 PM
Dates	Participating Approval Date	Insert	New Registration			1/5/2022 2:58 PM
Details	State	Insert	New Registration		Pending	1/5/2022 2:58 PM
Dates	Registration Date	Insert	New Registration		1/5/2022 2:58:55 PM	1/5/2022 2:58 PM
Dates	Signed By Date	Insert	New Registration			1/5/2022 2:58 PM
Dates	Start Date	Insert	New Registration			1/5/2022 2:58 PM
Terminations	Termination Comments	Insert	New Registration			1/5/2022 2:58 PM
Terminations	Termination Date	Insert	New Registration			1/5/2022 2:58 PM
Terminations	Termination Effective Date	Insert	New Registration			1/5/2022 2:58 PM
Terminations	Termination Reason	Insert	New Registration			1/5/2022 2:58 PM