Covered Entity Details

DSH440132B West Tennessee Healthcare Henry County Hospital (Terminated) - information as of 5/26/2025 12:56:04 AM

Main Details

Name

West Tennessee Healthcare Henry County Hospital

Subdivision Name

Henry County Medical Clinic Paris Henry County Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH440132B

Medicare Provider Number

440132

Outpatient Facility Provider Number

443469

Additional Details

Current Program Status

Terminated

Registration Date

10/7/2022

Participating Start Date

1/1/2023

Participating Approval Date

11/17/2022

Last Recertification Date

8/13/2024

Termination Date
Termination Reason

1/1/2025
Loss of qualifying hospital status

Contacts

Authorizing Official

Henry County Medical Center
John Robert Tucker, CEO
(731) 644-8478

Primary Contact

Henry County Medical Center
Paula Carter Bell, Director of Pharmacy
(731) 644-8579

Addresses

Street Address

305 Tyson Avenue
Paris, TN 38242

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
TN	044-0132,044S-132	1417043829,1497750244,1699861005

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
DSH440132A	Child	DSH	HENRY COUNTY MEDICAL CENTER	HENRY COUNTY MEDICAL CENTER SURGERY - HCMC SURGERY CENTER	1002 CONERSTONE DRIVE	PARIS	TN	Terminated
DSH440132B	Child	DSH	West Tennessee Healthcare Henry County Hospital	Henry County Medical Clinic Paris Henry County Clinic	305 Tyson Avenue	Paris	TN	Terminated
DSH440132C	Child	DSH	HENRY COUNTY MEDICAL CENTER	Eagle Creek - Eagle Creek	14201 US-79	Buchanan	TN	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/1/2024 12:00:00 AM	11/21/2024 9:26 AM
Details	State	Update	Termination Request	Active	To Be Terminated	11/21/2024 9:26 AM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	11/21/2024 9:26 AM
Terminations	Termination Effective Date	Update	Termination Request		11/19/2024 12:00:00 AM	11/21/2024 9:26 AM
Terminations	Termination Reason	Update	Termination Request		Loss of qualifying hospital status	11/21/2024 9:26 AM
Details	Entity Name	Update	Change Request	HENRY COUNTY MEDICAL CENTER	West Tennessee Healthcare Henry County Hospital	10/9/2024 3:04 PM
Details	Last Recertification Date	Update	Recertification	8/17/2023 10:51:06 AM	8/13/2024 10:31:46 AM	8/13/2024 10:31 AM
Addresses	Main Address	Update	Recertification	300 Hospital Circle 204 Paris, TN 38242	305 Tyson Avenue Paris, TN 38242	8/17/2023 10:51 AM
Details	Last Recertification Date	Update	Recertification		8/17/2023 10:51:06 AM	8/17/2023 10:51 AM
Details	Entity Subname	Update	Recertification	Medical Arts Clinic - Transitions Health and Paris Pulmonary	Henry County Medical Clinic Paris Henry County Clinic	8/17/2023 10:51 AM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Tucker, John Robert CEO Henry County Medical Center 7316448478	11/17/2022 10:24 AM
Details	340B ID	Update	New Registration		DSH440132B	11/17/2022 10:24 AM
Details	Entity Subname	Update	New Registration	Medical Arts Clinic	Medical Arts Clinic - Transitions Health and Paris Pulmonary	11/17/2022 10:24 AM
Dates	Participating Approval Date	Update	New Registration		11/17/2022 10:24:53 AM	11/17/2022 10:24 AM
Details	State	Update	New Registration	Pending	Approved	11/17/2022 10:24 AM
Dates	Signed By Date	Update	New Registration		10/10/2022 11:36:26 AM	11/17/2022 10:24 AM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	11/17/2022 10:24 AM
Addresses	Main Address	Insert	New Registration		300 Hospital Circle 204 Paris, TN 38242	10/7/2022 12:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/7/2022 12:39 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		044-0132	10/7/2022 12:39 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TN	10/7/2022 12:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/7/2022 12:39 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		044S-132	10/7/2022 12:39 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TN	10/7/2022 12:39 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1417043829	10/7/2022 12:39 PM
Medicaid Billing	NPI: State	Insert	New Registration		TN	10/7/2022 12:39 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1497750244	10/7/2022 12:39 PM
Medicaid Billing	NPI: State	Insert	New Registration		TN	10/7/2022 12:39 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1699861005	10/7/2022 12:39 PM
Medicaid Billing	NPI: State	Insert	New Registration		TN	10/7/2022 12:39 PM
Contacts	Primary Contact	Insert	New Registration		Bell, Paula Carter Director of Pharmacy Henry County Medical Center 7316448579	10/7/2022 12:39 PM
Contacts	Authorizing Official	Insert	New Registration		Tucker, John Robert CEO Henry County Medical Center 7316448478	10/7/2022 12:39 PM
Details	Assistance Received From Date	Insert	New Registration			10/7/2022 12:39 PM
Details	Assistance Received To Date	Insert	New Registration			10/7/2022 12:39 PM
Details	Last Recertification Date	Insert	New Registration			10/7/2022 12:39 PM
Details	Grant Number	Insert	New Registration			10/7/2022 12:39 PM
Details	340B ID	Insert	New Registration			10/7/2022 12:39 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/7/2022 12:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/7/2022 12:39 PM
Details	Medicare Provider Number	Insert	New Registration		440132	10/7/2022 12:39 PM
Details	Entity Name	Insert	New Registration		HENRY COUNTY MEDICAL CENTER	10/7/2022 12:39 PM
Details	NOFO Number	Insert	New Registration			10/7/2022 12:39 PM
Details	Program Code	Insert	New Registration		DSH	10/7/2022 12:39 PM
Details	Entity Subname	Insert	New Registration		Medical Arts Clinic	10/7/2022 12:39 PM
Dates	Participating Approval Date	Insert	New Registration			10/7/2022 12:39 PM
Details	State	Insert	New Registration		Pending	10/7/2022 12:39 PM
Dates	Registration Date	Insert	New Registration		10/7/2022 12:39:50 PM	10/7/2022 12:39 PM
Dates	Signed By Date	Insert	New Registration			10/7/2022 12:39 PM
Dates	Start Date	Insert	New Registration			10/7/2022 12:39 PM
Terminations	Termination Comments	Insert	New Registration			10/7/2022 12:39 PM
Terminations	Termination Date	Insert	New Registration			10/7/2022 12:39 PM
Terminations	Termination Effective Date	Insert	New Registration			10/7/2022 12:39 PM
Terminations	Termination Reason	Insert	New Registration			10/7/2022 12:39 PM