Covered Entity Details

DSH180079A HARRISON MEMORIAL HOSPITAL (Active) - information as of 6/9/2025 12:01:56 AM

Main Details

Name

HARRISON MEMORIAL HOSPITAL

Subdivision Name

HMH Primary Care - Primary Care

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH180079A

Medicare Provider Number

180079

Outpatient Facility Provider Number

188541

Additional Details

Current Program Status

Active

Registration Date

4/5/2022

Participating Start Date

7/1/2022

Participating Approval Date

4/11/2022

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Harrison Memorial Hospital
Kathy Tussey, Chief Executive Officer
(859) 234-2300 Ext: 3504

Primary Contact

Harrison Memorial Hospital
Brett Taylor Meade, Pharmacist
(859) 235-6210

Addresses

Street Address

439 East Pleasant Street
Cynthiana, KY 41031

Billing Address

Harrison Memorial Hospital
1210 KY HWY 36 E
Cynthiana, KY 41031

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	7100803820	1588237150

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
DSH180079A	Child	DSH	HARRISON MEMORIAL HOSPITAL	HMH Primary Care - Primary Care	439 East Pleasant Street	Cynthiana	KY	Active
DSH180079B	Child	DSH	HARRISON MEMORIAL HOSPITAL	HMH Primary Care Falmouth - Rural Health Clinic	1102 West Shelby Street	Falmouth	KY	Active
DSH180079C	Child	DSH	HARRISON MEMORIAL HOSPITAL	HMH Primary Care Carlisle - Rural Health Clinic	254 East Main Street	Carlisle	KY	Approved
DSH180079D	Child	DSH	HARRISON MEMORIAL HOSPITAL	HMH Primary Care South - Rural Health Clinic	809 US HWY 27S	CYNTHIANA	KY	Approved
DSH180079E	Child	DSH	HARRISON MEMORIAL HOSPITAL	HMH Primary Care Main - Rural Health Clinic	1210 KY-36	CYNTHIANA	KY	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 1:06:26 PM	8/14/2024 9:20:03 AM	8/14/2024 9:20 AM
Contacts	Authorizing Official	Update	AO Change Request	Toadvine, Stephen Chief Executive Officer Harrison Memorial Hospital 8592353503	Tussey, Kathy Chief Executive Officer Harrison Memorial Hospital 8592342300-3504	8/13/2024 2:40 PM
Details	Last Recertification Date	Update	Recertification	8/24/2022 4:06:27 PM	8/15/2023 1:06:26 PM	8/15/2023 1:06 PM
Details	Last Recertification Date	Update	Recertification		8/24/2022 4:06:27 PM	8/24/2022 4:06 PM
Details	State	Update		Approved	Active	7/1/2022 12:01 AM
Addresses	Main Address	Insert	New Registration		439 East Pleasant Street Cynthiana, KY 41031	4/11/2022 6:59 AM
Addresses	Billing Address	Insert	New Registration		Harrison Memorial Hospital 1210 KY HWY 36 E Cynthiana, KY 41031	4/11/2022 6:59 AM
Contacts	Signed By	Insert	New Registration		Toadvine, Stephen Chief Executive Officer Harrison Memorial Hospital 8592353503	4/11/2022 6:59 AM
Details	340B ID	Update	New Registration		DSH180079A	4/11/2022 6:59 AM
Details	Entity Subname	Update	New Registration	HMH DPA Primary Care	HMH Primary Care - Primary Care	4/11/2022 6:59 AM
Dates	Participating Approval Date	Update	New Registration		4/11/2022 6:59:35 AM	4/11/2022 6:59 AM
Details	State	Update	New Registration	Pending	Approved	4/11/2022 6:59 AM
Dates	Signed By Date	Update	New Registration		4/7/2022 3:52:33 PM	4/11/2022 6:59 AM
Dates	Start Date	Update	New Registration		7/1/2022 12:00:00 AM	4/11/2022 6:59 AM
Addresses	Main Address	Insert	New Registration		439 East Pleasant Street Cynthiana, KY 41031	4/5/2022 12:44 PM
Addresses	Billing Address	Insert	New Registration		Harrison Memorial Hospital 1210 KY HWY 36 E Cynthiana, KY 41031	4/5/2022 12:44 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/5/2022 12:44 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7100803820	4/5/2022 12:44 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	4/5/2022 12:44 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1588237150	4/5/2022 12:44 PM
Medicaid Billing	NPI: State	Insert	New Registration		KY	4/5/2022 12:44 PM
Contacts	Primary Contact	Insert	New Registration		Meade, Brett Taylor Pharmacist Harrison Memorial Hospital 8592356210	4/5/2022 12:44 PM
Contacts	Authorizing Official	Insert	New Registration		Toadvine, Stephen Chief Executive Officer Harrison Memorial Hospital 8592353503	4/5/2022 12:44 PM
Details	Assistance Received From Date	Insert	New Registration			4/5/2022 12:44 PM
Details	Assistance Received To Date	Insert	New Registration			4/5/2022 12:44 PM
Details	Last Recertification Date	Insert	New Registration			4/5/2022 12:44 PM
Details	Grant Number	Insert	New Registration			4/5/2022 12:44 PM
Details	340B ID	Insert	New Registration			4/5/2022 12:44 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/5/2022 12:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/5/2022 12:44 PM
Details	Medicare Provider Number	Insert	New Registration		180079	4/5/2022 12:44 PM
Details	Entity Name	Insert	New Registration		HARRISON MEMORIAL HOSPITAL	4/5/2022 12:44 PM
Details	NOFO Number	Insert	New Registration			4/5/2022 12:44 PM
Details	Program Code	Insert	New Registration		DSH	4/5/2022 12:44 PM
Details	Entity Subname	Insert	New Registration		HMH DPA Primary Care	4/5/2022 12:44 PM
Dates	Participating Approval Date	Insert	New Registration			4/5/2022 12:44 PM
Details	State	Insert	New Registration		Pending	4/5/2022 12:44 PM
Dates	Registration Date	Insert	New Registration		4/5/2022 12:44:25 PM	4/5/2022 12:44 PM
Dates	Signed By Date	Insert	New Registration			4/5/2022 12:44 PM
Dates	Start Date	Insert	New Registration			4/5/2022 12:44 PM
Terminations	Termination Comments	Insert	New Registration			4/5/2022 12:44 PM
Terminations	Termination Date	Insert	New Registration			4/5/2022 12:44 PM
Terminations	Termination Effective Date	Insert	New Registration			4/5/2022 12:44 PM
Terminations	Termination Reason	Insert	New Registration			4/5/2022 12:44 PM