Covered Entity Details

CAH521322-03 GRANT REGIONAL HEALTH CENTER INC. (Active) - information as of 4/25/2025 6:34:32 PM

Main Details

Name

GRANT REGIONAL HEALTH CENTER INC.

Subdivision Name

GRANT REGIONAL HEALTH CENTER INC - Cassville RHC

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH521322-03

Medicare Provider Number

521322

Outpatient Facility Provider Number

528629

Additional Details

Current Program Status

Active

Registration Date

7/14/2022

Participating Start Date

10/1/2022

Participating Approval Date

7/27/2022

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Grant Regional Health Center
Joel Gehling, CFO
(608) 723-3202

Primary Contact

Grant Regional Health Center
Erin W Hornung, Pharmacist
(608) 723-3235

Addresses

Street Address

222 W AMELIA ST
CASSVILLE, WI 53806-9774

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
CAH521322-01	Child	CAH	GRANT REGIONAL HEALTH CENTER INC.	GRANT REGIONAL COMMUNITY CLINIC - Family Medicine with Multi Specialty Clinic practice	507S MONROE ST	LANCASTER	WI	Active
CAH521322-02	Child	CAH	GRANT REGIONAL HEALTH CENTER INC.	POTOSI TENNYSON MEDICAL CLINIC - Potosi RHC	114 US HIGHWAY 61 N	POTOSI	WI	Active
CAH521322-03	Child	CAH	GRANT REGIONAL HEALTH CENTER INC.	GRANT REGIONAL HEALTH CENTER INC - Cassville RHC	222 W AMELIA ST	CASSVILLE	WI	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 11:57:01 AM	8/14/2024 10:00:44 AM	8/14/2024 10:00 AM
Details	Last Recertification Date	Update	Recertification		8/15/2023 11:57:01 AM	8/15/2023 11:57 AM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Gehling, Joel CFO Grant Regional Health Center 6087233202	7/27/2022 8:42 AM
Details	340B ID	Update	New Registration		CAH521322-03	7/27/2022 8:42 AM
Details	Entity Subname	Update	New Registration	GRANT REGIONAL HEALTH CENTER INC	GRANT REGIONAL HEALTH CENTER INC - Cassville RHC	7/27/2022 8:42 AM
Dates	Participating Approval Date	Update	New Registration		7/27/2022 8:42:08 AM	7/27/2022 8:42 AM
Details	State	Update	New Registration	Pending	Approved	7/27/2022 8:42 AM
Dates	Signed By Date	Update	New Registration		7/25/2022 9:57:26 AM	7/27/2022 8:42 AM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	7/27/2022 8:42 AM
Addresses	Main Address	Insert	New Registration		222 W AMELIA ST CASSVILLE, WI 53806-9774	7/14/2022 12:11 PM
Contacts	Primary Contact	Insert	New Registration		Hornung, Erin W Pharmacist Grant Regional Health Center 6087233235	7/14/2022 12:11 PM
Contacts	Authorizing Official	Insert	New Registration		Gehling, Joel CFO Grant Regional Health Center 6087233202	7/14/2022 12:11 PM
Details	Assistance Received From Date	Insert	New Registration			7/14/2022 12:11 PM
Details	Assistance Received To Date	Insert	New Registration			7/14/2022 12:11 PM
Details	Last Recertification Date	Insert	New Registration			7/14/2022 12:11 PM
Details	Grant Number	Insert	New Registration			7/14/2022 12:11 PM
Details	340B ID	Insert	New Registration			7/14/2022 12:11 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/14/2022 12:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/14/2022 12:11 PM
Details	Medicare Provider Number	Insert	New Registration		521322	7/14/2022 12:11 PM
Details	Entity Name	Insert	New Registration		GRANT REGIONAL HEALTH CENTER INC.	7/14/2022 12:11 PM
Details	NOFO Number	Insert	New Registration			7/14/2022 12:11 PM
Details	Program Code	Insert	New Registration		CAH	7/14/2022 12:11 PM
Details	Entity Subname	Insert	New Registration		GRANT REGIONAL HEALTH CENTER INC	7/14/2022 12:11 PM
Dates	Participating Approval Date	Insert	New Registration			7/14/2022 12:11 PM
Details	State	Insert	New Registration		Pending	7/14/2022 12:11 PM
Dates	Registration Date	Insert	New Registration		7/14/2022 12:11:10 PM	7/14/2022 12:11 PM
Dates	Signed By Date	Insert	New Registration			7/14/2022 12:11 PM
Dates	Start Date	Insert	New Registration			7/14/2022 12:11 PM
Terminations	Termination Comments	Insert	New Registration			7/14/2022 12:11 PM
Terminations	Termination Date	Insert	New Registration			7/14/2022 12:11 PM
Terminations	Termination Effective Date	Insert	New Registration			7/14/2022 12:11 PM
Terminations	Termination Reason	Insert	New Registration			7/14/2022 12:11 PM