Covered Entity Details

DSH180069Q TUG VALLEY ARH REGIONAL MEDICAL CENTER (Active) - information as of 5/29/2025 2:00:12 AM

Main Details

Name

TUG VALLEY ARH REGIONAL MEDICAL CENTER

Subdivision Name

ARH SPECIALTY ASSOCIATES TUG VALLEY - Endocrinology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH180069Q

Medicare Provider Number

180069

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/6/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/10/2022

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

ARH
Maria Braman, Chief Medical Officer
(406) 465-8506

Primary Contact

Appalachian Regional Healthcare, Inc
Michael Herald, Associate Vice President of Pharmaceutical Services
(606) 438-1210

Addresses

Street Address

306 Hospital Drive
Suite 203
South Williamson, KY 41503

Billing Address

Tug Valley ARH Regional Medical Center - Accounts Payable
200 Hospital Drive
South Williamson, KY 41503

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	7100371150,65920951,78901238,101565000,7100609860,01015650,7100542610,54020680	1144405101,1487762399,1649270257,1679658199,1710192950,1366900896,1467499046
WV	0001551000	1144405101,1487762399,1649270257,1679658199,1710192950,1366900896,1467499046

Shipping Addresses

Shipping Address 1

Tug Valley ARH Regional Medical Center
260 Hospital Drive
South Williamson, KY 41503

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
DSH180069A	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH Women's and Family Health Center - Tug Valley	26901 US HIGHWAY 119 N	BELFRY	KY	Active
DSH180069B	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH SPECIALTY ASSOCIATES TUG VALLEY	306 HOSPITAL DRIVE	SOUTH WILLIAMSON	KY	Terminated
DSH180069C	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH CARDIOLOGY ASSOCIATES - TUG VALLEY	306 HOSPITAL DRIVE	SOUTH WILLIAMSON	KY	Active
DSH180069D	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	TUG VALLEY MEDICAL ASSOCIATES - INTERNAL MEDICINE	306 HOSPITAL DRIVE	SOUTH WILLIAMSON	KY	Active
DSH180069E	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH TUG VALLEY MEDICAL ASSOCIATES - PEDIATRICS	306 HOSPITAL DRIVE	SOUTH WILLIAMSON	KY	Active
DSH180069F	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	TUG VALLEY MEDICAL ASSOCIATES - SURGERY	306 HOSPITAL DRIVE	SOUTH WILLIAMSON	KY	Terminated
DSH180069G	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH SPECIALTY ASSOCIATES TUG VALLEY - ONCOLOGY	306 Hospital Drive	South Williamson	KY	Active
DSH180069H	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH WOMENS AND FAMILY HEALTHCARE TUG VALLEY - Internal Medicine	26901 US HIGHWAY 119 N	BELFRY	KY	Active
DSH180069J	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH SPECIALTY ASSOCIATES TUG VALLEY - SURGERY	306 Hospital Drive	South Williamson	KY	Active
DSH180069K	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH TUG VALLEY SPECIALTY ASSOCIATES - UROLOGY	306 Hospital Drive	South Williamson	KY	Terminated
DSH180069L	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH TUG VALLEY MEDICAL ASSOCIATES - PRIMARY CARE	306 Hospital Drive	South Williamson	KY	Terminated
DSH180069M	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH SPECIALTY ASSOCIATES TUG VALLEY - PULMONOLOGY	306 Hospital Drive	South Williamson	KY	Terminated
DSH180069N	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH SPECIALTY ASSOCIATES TUG VALLEY - NEUROLOGY	306 Hospital Drive	South Williamson	KY	Active
DSH180069P	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH SPECIALTY ASSOCIATES TUG VALLEY - Orthopedics	306 HOSPITAL DRIVE	South Williamson	KY	Active
DSH180069Q	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH SPECIALTY ASSOCIATES TUG VALLEY - Endocrinology	306 Hospital Drive	South Williamson	KY	Active
DSH180069R	Child	DSH	TUG VALLEY ARH REGIONAL MEDICAL CENTER	ARH Specialty Associates - Tug Valley - Internal Medicine	306 Hospital Drive	South Williamson	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 2:27:38 PM	9/3/2024 11:50:07 AM	9/3/2024 11:50 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 11:54:03 AM	8/14/2023 2:27:38 PM	8/14/2023 2:27 PM
Contacts	Authorizing Official	Update	Change Request	Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262511	Braman, Maria Chief Medical Officer ARH 4064658506	5/25/2023 11:05 AM
Contacts	Primary Contact	Update	Profile Change Request	Herald, Michael Interim CEO of Pharmaceutical Services Appalachian Regional Healthcare, Inc 6064381210	Herald, Michael Associate Vice President of Pharmaceutical Services Appalachian Regional Healthcare, Inc 6064381210	2/15/2023 3:07 PM
Contacts	Primary Contact	Update	Group Change Request	Akers, Jeffrey CEO of Pharmaceutical Services Appalachian Regional Healthcare 6066162296	Herald, Michael Interim CEO of Pharmaceutical Services Appalachian Regional Healthcare, Inc 6064381210	9/14/2022 6:50 AM
Details	Last Recertification Date	Update	Recertification		8/26/2022 11:54:03 AM	8/26/2022 11:54 AM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0046257 (OH)		2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1215913959 (KY)		2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1215913959 (WV)		2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1144405101 (OH)		2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1487762399 (OH)		2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1649270257 (OH)		2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1679658199 (OH)		2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1710192950 (OH)		2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1366900896 (OH)		2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1215913959 (OH)		2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1467499046	2/16/2022 9:02 AM
Medicaid Billing	NPI: State	Insert	Change Request		WV	2/16/2022 9:02 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1467499046	2/16/2022 9:02 AM
Medicaid Billing	NPI: State	Insert	Change Request		KY	2/16/2022 9:02 AM
Contacts	Primary Contact	Update	Profile Change Request	Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6066162296	Akers, Jeffrey CEO of Pharmaceutical Services Appalachian Regional Healthcare 6066162296	2/8/2022 7:53 PM
Contacts	Authorizing Official	Update	Profile Change Request	Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262468	Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262511	1/28/2022 9:09 AM
Contacts	Signed By	Update	Profile Change Request	Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262468	Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262511	1/28/2022 9:09 AM
Contacts	Signed By	Insert	New Registration		Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262468	1/10/2022 11:45 AM
Details	340B ID	Update	New Registration		DSH180069Q	1/10/2022 11:45 AM
Details	Entity Subname	Update	New Registration	ARH SPECIALTY ASSOCIATES TUG VALLEY	ARH SPECIALTY ASSOCIATES TUG VALLEY - Endocrinology	1/10/2022 11:45 AM
Dates	Participating Approval Date	Update	New Registration		1/10/2022 11:45:07 AM	1/10/2022 11:45 AM
Details	State	Update	New Registration	Pending	Approved	1/10/2022 11:45 AM
Dates	Signed By Date	Update	New Registration		1/7/2022 3:12:06 PM	1/10/2022 11:45 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/10/2022 11:45 AM
Addresses	Main Address	Insert	New Registration		306 Hospital Drive Suite 203 South Williamson, KY 41503	1/6/2022 9:06 AM
Addresses	Billing Address	Insert	New Registration		Tug Valley ARH Regional Medical Center - Accounts Payable 200 Hospital Drive South Williamson, KY 41503	1/6/2022 9:06 AM
Addresses	Shipping Address	Insert	New Registration		Tug Valley ARH Regional Medical Center 260 Hospital Drive South Williamson, KY 41503	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7100371150	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		65920951	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		78901238	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		101565000	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7100609860	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01015650	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7100542610	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		54020680	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0001551000	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		WV	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0046257	1/6/2022 9:06 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		OH	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1144405101	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1487762399	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1649270257	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1679658199	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1710192950	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1366900896	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1215913959	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		KY	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1144405101	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		WV	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1487762399	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		WV	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1649270257	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		WV	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1679658199	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		WV	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1710192950	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		WV	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1366900896	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		WV	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1215913959	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		WV	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1144405101	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1487762399	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1649270257	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1679658199	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1710192950	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1366900896	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/6/2022 9:06 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1215913959	1/6/2022 9:06 AM
Medicaid Billing	NPI: State	Insert	New Registration		OH	1/6/2022 9:06 AM
Contacts	Primary Contact	Insert	New Registration		Akers, Jeffrey System Director of Pharmacy Appalachian Regional Healthcare 6066162296	1/6/2022 9:06 AM
Contacts	Authorizing Official	Insert	New Registration		Harris, Hollie P President & CEO Appalachian Regional Healthcare, Inc 8592262468	1/6/2022 9:06 AM
Details	Assistance Received From Date	Insert	New Registration			1/6/2022 9:06 AM
Details	Assistance Received To Date	Insert	New Registration			1/6/2022 9:06 AM
Details	Last Recertification Date	Insert	New Registration			1/6/2022 9:06 AM
Details	Grant Number	Insert	New Registration			1/6/2022 9:06 AM
Details	340B ID	Insert	New Registration			1/6/2022 9:06 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/6/2022 9:06 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/6/2022 9:06 AM
Details	Medicare Provider Number	Insert	New Registration		180069	1/6/2022 9:06 AM
Details	Entity Name	Insert	New Registration		TUG VALLEY ARH REGIONAL MEDICAL CENTER	1/6/2022 9:06 AM
Details	NOFO Number	Insert	New Registration			1/6/2022 9:06 AM
Details	Program Code	Insert	New Registration		DSH	1/6/2022 9:06 AM
Details	Entity Subname	Insert	New Registration		ARH SPECIALTY ASSOCIATES TUG VALLEY	1/6/2022 9:06 AM
Dates	Participating Approval Date	Insert	New Registration			1/6/2022 9:06 AM
Details	State	Insert	New Registration		Pending	1/6/2022 9:06 AM
Dates	Registration Date	Insert	New Registration		1/6/2022 9:06:03 AM	1/6/2022 9:06 AM
Dates	Signed By Date	Insert	New Registration			1/6/2022 9:06 AM
Dates	Start Date	Insert	New Registration			1/6/2022 9:06 AM
Terminations	Termination Comments	Insert	New Registration			1/6/2022 9:06 AM
Terminations	Termination Date	Insert	New Registration			1/6/2022 9:06 AM
Terminations	Termination Effective Date	Insert	New Registration			1/6/2022 9:06 AM
Terminations	Termination Reason	Insert	New Registration			1/6/2022 9:06 AM