Covered Entity Details

CAH241323-02 Madelia Health (Active) - information as of 6/17/2025 11:38:54 PM

Main Details

Name

Madelia Health

Subdivision Name

MADELIA COM HOSPITAL INC - Family practice clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH241323-02

Medicare Provider Number

241323

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/13/2023

Participating Start Date

7/1/2023

Participating Approval Date

4/25/2023

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Madelia Health
David Frank Walz, CEO
(507) 642-3255

Primary Contact

Madelia Community Hospital & Clinic
JANE MALMSKOG, DIRECTOR OF PHARMACY
(507) 642-5257

Addresses

Street Address

401 N 4TH AVE E
MADELIA HEALTH - TRUMAN CLINIC
TRUMAN, MN 56088-1108

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
CAH241323-01	Child	CAH	Madelia Health	MADELIA COM HOSPITAL INC - Family practice clinic	200 E Prince St	LAKE CRYSTAL	MN	Active
CAH241323-02	Child	CAH	Madelia Health	MADELIA COM HOSPITAL INC - Family practice clinic	401 N 4TH AVE E	TRUMAN	MN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 11:38:29 PM	8/19/2024 10:47:51 AM	8/19/2024 10:47 AM
Details	Entity Name	Update	Change Request	MADELIA COMMUNITY HOSPITAL & CLINIC	Madelia Health	3/12/2024 1:39 PM
Details	Last Recertification Date	Update	Recertification		8/14/2023 11:38:29 PM	8/14/2023 11:38 PM
Details	State	Update		Approved	Active	7/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Walz, David Frank CEO Madelia Health 5076423255	4/25/2023 6:39 AM
Details	340B ID	Update	New Registration		CAH241323-02	4/25/2023 6:39 AM
Details	Entity Subname	Update	New Registration	MADELIA COM HOSPITAL INC	MADELIA COM HOSPITAL INC - Family practice clinic	4/25/2023 6:39 AM
Dates	Participating Approval Date	Update	New Registration		4/25/2023 6:39:12 AM	4/25/2023 6:39 AM
Details	State	Update	New Registration	Pending	Approved	4/25/2023 6:39 AM
Dates	Signed By Date	Update	New Registration		4/19/2023 3:18:17 PM	4/25/2023 6:39 AM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	4/25/2023 6:39 AM
Addresses	Main Address	Insert	New Registration		401 N 4TH AVE E MADELIA HEALTH - TRUMAN CLINIC TRUMAN, MN 56088-1108	4/13/2023 9:34 AM
Contacts	Primary Contact	Insert	New Registration		MALMSKOG, JANE DIRECTOR OF PHARMACY Madelia Community Hospital & Clinic 5076425257	4/13/2023 9:34 AM
Contacts	Authorizing Official	Insert	New Registration		Walz, David Frank CEO Madelia Health 5076423255	4/13/2023 9:34 AM
Details	Assistance Received From Date	Insert	New Registration			4/13/2023 9:34 AM
Details	Assistance Received To Date	Insert	New Registration			4/13/2023 9:34 AM
Details	Last Recertification Date	Insert	New Registration			4/13/2023 9:34 AM
Details	Grant Number	Insert	New Registration			4/13/2023 9:34 AM
Details	340B ID	Insert	New Registration			4/13/2023 9:34 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/13/2023 9:34 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/13/2023 9:34 AM
Details	Medicare Provider Number	Insert	New Registration		241323	4/13/2023 9:34 AM
Details	Entity Name	Insert	New Registration		MADELIA COMMUNITY HOSPITAL & CLINIC	4/13/2023 9:34 AM
Details	NOFO Number	Insert	New Registration			4/13/2023 9:34 AM
Details	Program Code	Insert	New Registration		CAH	4/13/2023 9:34 AM
Details	Entity Subname	Insert	New Registration		MADELIA COM HOSPITAL INC	4/13/2023 9:34 AM
Dates	Participating Approval Date	Insert	New Registration			4/13/2023 9:34 AM
Details	State	Insert	New Registration		Pending	4/13/2023 9:34 AM
Dates	Registration Date	Insert	New Registration		4/13/2023 9:34:37 AM	4/13/2023 9:34 AM
Dates	Signed By Date	Insert	New Registration			4/13/2023 9:34 AM
Dates	Start Date	Insert	New Registration			4/13/2023 9:34 AM
Terminations	Termination Comments	Insert	New Registration			4/13/2023 9:34 AM
Terminations	Termination Date	Insert	New Registration			4/13/2023 9:34 AM
Terminations	Termination Effective Date	Insert	New Registration			4/13/2023 9:34 AM
Terminations	Termination Reason	Insert	New Registration			4/13/2023 9:34 AM