Covered Entity Details

SCH020024-10 CENTRAL PENINSULA HOSPITAL (Active) - information as of 4/29/2025 11:57:01 PM

Main Details

Name

CENTRAL PENINSULA HOSPITAL

Subdivision Name

Central Peninsula Internal Medicine - Internal Medicine

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH020024-10

Medicare Provider Number

020024

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/13/2023

Participating Start Date

1/1/2024

Participating Approval Date

12/4/2023

Last Recertification Date

9/9/2024

Contacts

Authorizing Official

Central Peninsula Hospital
Shaun Patrick Keef, Chief Executive Officer
(907) 714-4719

Primary Contact

Central Peninsula Hospital
Amy Beth Kauffman, Pharmacy Director
(907) 714-4795

Addresses

Street Address

247 N. Fireweed Street, Suite A
Soldotna, AK 99669

Billing Address

Central Peninsula Hospital
250 Hospital Place
Soldotna, AK 99669

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

Shipping Address 1

Central Peninsula Hospital
250 Hospital Place
Soldotna, AK 99669

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
SCH020024-01	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Women's Health Clinic	108 E CORRAL AVE	SOLDOTNA	AK	Active
SCH020024-02	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Surgical Clinic	240 HOSPITAL PL	SOLDOTNA	AK	Active
SCH020024-03	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Foot and Ankle Clinic	240 HOSPITAL PL	SOLDOTNA	AK	Active
SCH020024-04	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Central Peninsula Urology	240 HOSPITAL PL	SOLDOTNA	AK	Active
SCH020024-05	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Infusion	240 HOSPITAL PL	SOLDOTNA	AK	Active
SCH020024-06	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Family Practice and Peds	245 N BINKLEY ST	SOLDOTNA	AK	Active
SCH020024-07	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Orthopedic	240 HOSPITAL PL	SOLDOTNA	AK	Active
SCH020024-08	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Kenai Family Practice	506 LAKE ST	KENAI	AK	Active
SCH020024-09	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Neurology	247 N. Fireweed Street, Suite B	SOLDOTNA	AK	Active
SCH020024-10	Child	SCH	CENTRAL PENINSULA HOSPITAL	Central Peninsula Internal Medicine - Internal Medicine	247 N. Fireweed Street, Suite A	Soldotna	AK	Active
SCH020024-11	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Surgery Center of Kenai - Surgery Center	100 Trading Bay Road	Kenai	AK	Active
SCH020024-12	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Kenai Urgent Care Clinic - Urgent Care	10128 Kenai Spur Highway	Kenai	AK	Terminated
SCH020024-13	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Kenai Spine - Orthopedic Spine Clinic	240 Hospital Place, Suite 104	Soldotna	AK	Active
SCH020024-14	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Serenity House Medical Clinic - Behavioral Health Medical Clinic	245 North Binkley Street	Soldotna	AK	Active
SCH020024-15	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Diabetes Clinic - Diabetes	209 N. Katmai Ave	Soldotna	AK	Active
SCH020024-16	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA HOSPITAL - Oncology	240 Hospital Place	Soldotna	AK	Active
SCH020024-17	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA MENTAL WELLNESS - Psychiatry and Psychology	291 N FIREWEED ST	SOLDOTNA	AK	Active
SCH020024-18	Child	SCH	CENTRAL PENINSULA HOSPITAL	CENTRAL PENINSULA GASTROENTEROLOGY - Gastroenterology	240 HOSPITAL PL	SOLDOTNA	AK	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Recertification	SANDERS, PHIL 340b Coordinator Central Peninsula Hospital 9077144795	Kauffman, Amy Beth Pharmacy Director Central Peninsula Hospital 9077144795	9/9/2024 7:24 AM
Details	Last Recertification Date	Update	Recertification		9/9/2024 7:24:55 AM	9/9/2024 7:24 AM
Addresses	Billing Address	Insert	Group Change Request		Central Peninsula Hospital 250 Hospital Place Soldotna, AK 99669	3/18/2024 3:38 PM
Addresses	Shipping Address	Insert	Group Change Request		Central Peninsula Hospital 250 Hospital Place Soldotna, AK 99669	3/18/2024 3:38 PM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Keef, Shaun Patrick Chief Executive Officer Central Peninsula Hospital 9077144719	12/4/2023 2:01 PM
Details	340B ID	Update	New Registration		SCH020024-10	12/4/2023 2:01 PM
Details	Entity Name	Update	New Registration	CENTRAL PENINSULA GENERAL HOSPITAL	CENTRAL PENINSULA HOSPITAL	12/4/2023 2:01 PM
Details	Entity Subname	Update	New Registration	Central Peninsula Internal Medicine	Central Peninsula Internal Medicine - Internal Medicine	12/4/2023 2:01 PM
Dates	Participating Approval Date	Update	New Registration		12/4/2023 2:01:26 PM	12/4/2023 2:01 PM
Details	State	Update	New Registration	Pending	Approved	12/4/2023 2:01 PM
Dates	Signed By Date	Update	New Registration		10/18/2023 5:59:32 PM	12/4/2023 2:01 PM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	12/4/2023 2:01 PM
Addresses	Main Address	Insert	New Registration		247 N. Fireweed Street, Suite A Soldotna, AK 99669	10/13/2023 9:45 PM
Contacts	Primary Contact	Insert	New Registration		SANDERS, PHIL 340b Coordinator Central Peninsula Hospital 9077144795	10/13/2023 9:45 PM
Contacts	Authorizing Official	Insert	New Registration		Keef, Shaun Patrick Chief Executive Officer Central Peninsula Hospital 9077144719	10/13/2023 9:45 PM
Details	Assistance Received From Date	Insert	New Registration			10/13/2023 9:45 PM
Details	Assistance Received To Date	Insert	New Registration			10/13/2023 9:45 PM
Details	Last Recertification Date	Insert	New Registration			10/13/2023 9:45 PM
Details	Grant Number	Insert	New Registration			10/13/2023 9:45 PM
Details	340B ID	Insert	New Registration			10/13/2023 9:45 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/13/2023 9:45 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/13/2023 9:45 PM
Details	Medicare Provider Number	Insert	New Registration		020024	10/13/2023 9:45 PM
Details	Entity Name	Insert	New Registration		CENTRAL PENINSULA GENERAL HOSPITAL	10/13/2023 9:45 PM
Details	NOFO Number	Insert	New Registration			10/13/2023 9:45 PM
Details	Program Code	Insert	New Registration		SCH	10/13/2023 9:45 PM
Details	Entity Subname	Insert	New Registration		Central Peninsula Internal Medicine	10/13/2023 9:45 PM
Dates	Participating Approval Date	Insert	New Registration			10/13/2023 9:45 PM
Details	State	Insert	New Registration		Pending	10/13/2023 9:45 PM
Dates	Registration Date	Insert	New Registration		10/13/2023 9:45:38 PM	10/13/2023 9:45 PM
Dates	Signed By Date	Insert	New Registration			10/13/2023 9:45 PM
Dates	Start Date	Insert	New Registration			10/13/2023 9:45 PM
Terminations	Termination Comments	Insert	New Registration			10/13/2023 9:45 PM
Terminations	Termination Date	Insert	New Registration			10/13/2023 9:45 PM
Terminations	Termination Effective Date	Insert	New Registration			10/13/2023 9:45 PM
Terminations	Termination Reason	Insert	New Registration			10/13/2023 9:45 PM