Covered Entity Details

RRC010039-52 HUNTSVILLE HOSPITAL (Active) - information as of 5/6/2025 12:01:29 AM

Main Details

Name

HUNTSVILLE HOSPITAL

Subdivision Name

Blackwell Medical Tower - Radiation Oncology

Type

Rural Referral Center

Rural

Yes

340B ID

RRC010039-52

Medicare Provider Number

010039

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/9/2024

Participating Start Date

4/1/2024

Participating Approval Date

2/20/2024

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

Huntsville Hospital
Clinton Carter, CFO
(256) 265-8818

Primary Contact

Huntsville Hospital
Luona Wang, Business Manager of Pharmacy Services
(256) 265-6241

Addresses

Street Address

201 Sivley Rd SW
Suite 10
Huntsville, AL 35801

Billing Address

Huntsville Hospital
101 Sivley Rd SW
Huntsville, AL 35801

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
AL	HOS0039H	1447221056

Shipping Addresses

Shipping Address 1

Huntsville Hospital
101 Sivley Rd SW
Huntsville, AL 35801

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
RRC010039-01	Child	RRC	HUNTSVILLE HOSPITAL	Clinic for Breast Center - Breast Center	910 Adams St SE	Huntsville	AL	Active
RRC010039-02	Child	RRC	HUNTSVILLE HOSPITAL	Wound Center - Wound Care Clinic	2012 Whitesburg Dr SW	Huntsville	AL	Active
RRC010039-03	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - Pediatric ER	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-04	Child	RRC	HUNTSVILLE HOSPITAL	Madison - Labor & Delivery/Post Partum	8375 Hwy 72 W	Madison	AL	Active
RRC010039-05	Child	RRC	HUNTSVILLE HOSPITAL	Blackwell Medical Tower - Congestive Heart Failure	201 Sivley Rd SW	Huntsville	AL	Active
RRC010039-06	Child	RRC	HUNTSVILLE HOSPITAL	Governors Medical Tower - Surgery	201 Governors Dr SW	Huntsville	AL	Active
RRC010039-07	Child	RRC	HUNTSVILLE HOSPITAL	Outpatient Medical - CCI - (OPM-C)	3601 CCI Drive Northwest	Huntsville	AL	Active
RRC010039-08	Child	RRC	HUNTSVILLE HOSPITAL	Blackwell Medical Tower - Chemotherapy Infusion	201 Sivley Rd SW	Huntsville	AL	Active
RRC010039-09	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - Labor & Delivery	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-10	Child	RRC	HUNTSVILLE HOSPITAL	Governors Medical Tower - MRI	201 Governors Dr SW	Huntsville	AL	Active
RRC010039-11	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - Emergency Dept - OB	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-12	Child	RRC	HUNTSVILLE HOSPITAL	Blackwell Medical Tower - Outpatient Services (OPMA)	201 Sivley Rd SW	Huntsville	AL	Active
RRC010039-13	Child	RRC	HUNTSVILLE HOSPITAL	Governors Medical Tower - Pain Mgt. Center	201 Governors Dr SW	Huntsville	AL	Active
RRC010039-14	Child	RRC	HUNTSVILLE HOSPITAL	THE HEART CENTER - Nuclear/PET	930 FRANKLIN STREET SE	HUNTSVILLE	AL	Active
RRC010039-15	Child	RRC	HUNTSVILLE HOSPITAL	THE HEART CENTER - Vein Center	930 FRANKLIN STREET SE	HUNTSVILLE	AL	Active
RRC010039-16	Child	RRC	HUNTSVILLE HOSPITAL	THE HEART CENTER - CCTA (Coronary CT Scan)	930 FRANKLIN STREET SE	HUNTSVILLE	AL	Active
RRC010039-17	Child	RRC	HUNTSVILLE HOSPITAL	THE HEART CENTER - Echo/PV	930 FRANKLIN STREET SE	HUNTSVILLE	AL	Active
RRC010039-18	Child	RRC	HUNTSVILLE HOSPITAL	Madison - Imaging	8375 Hwy 72 W	Madison	AL	Active
RRC010039-19	Child	RRC	HUNTSVILLE HOSPITAL	Madison - PACU	8375 Hwy 72 W	Madison	AL	Active
RRC010039-20	Child	RRC	HUNTSVILLE HOSPITAL	Medical Mall - Imaging	1963 Memorial Pkwy SW	Huntsville	AL	Active
RRC010039-21	Child	RRC	HUNTSVILLE HOSPITAL	Madison - Endoscopy	8375 Hwy 72 W	Madison	AL	Terminated
RRC010039-22	Child	RRC	HUNTSVILLE HOSPITAL	Madison - Emergency Dept	8375 Hwy 72 W	Madison	AL	Active
RRC010039-23	Child	RRC	HUNTSVILLE HOSPITAL	THE HEART CENTER - Cath Lab	930 FRANKLIN STREET SE	HUNTSVILLE	AL	Active
RRC010039-24	Child	RRC	HUNTSVILLE HOSPITAL	Madison - Vein Center	8371 Hwy 72 W	Madison	AL	Active
RRC010039-25	Child	RRC	HUNTSVILLE HOSPITAL	Madison - Surgery	8375 Hwy 72 W	Madison	AL	Active
RRC010039-26	Child	RRC	HUNTSVILLE HOSPITAL	Governors Medical Tower - Operating Room	201 Governors Dr SW	Huntsville	AL	Active
RRC010039-27	Child	RRC	HUNTSVILLE HOSPITAL	St. Jude Clinic - St. Jude	910 Adams St SE	Huntsville	AL	Active
RRC010039-28	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - Sleep Lab/Center	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-29	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - Endoscopy	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-30	Child	RRC	HUNTSVILLE HOSPITAL	Madison - Ultrasound/Cardiovascular	8375 Hwy 72 W	Madison	AL	Active
RRC010039-31	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - Radiology	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-32	Child	RRC	HUNTSVILLE HOSPITAL	Medical Mall - Center For Lung Health	1963 Memorial Pkwy SW	Huntsville	AL	Active
RRC010039-33	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - MRI	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-34	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - PACU	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-35	Child	RRC	HUNTSVILLE HOSPITAL	Medical Mall - Diabetes Control Center	1963 Memorial Pkwy SW	Huntsville	AL	Active
RRC010039-36	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - Ultrasound	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-37	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - Operating Room	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-38	Child	RRC	HUNTSVILLE HOSPITAL	Women and Children - Outpatient Surgery	245 Governors Dr SE	Huntsville	AL	Active
RRC010039-39	Child	RRC	HUNTSVILLE HOSPITAL	Madison - Mammography	8375 Hwy 72 W	Madison	AL	Active
RRC010039-40	Child	RRC	HUNTSVILLE HOSPITAL	Ortho Spine Tower - Surgery 2	200 Sivley Rd SW	Huntsville	AL	Active
RRC010039-41	Child	RRC	HUNTSVILLE HOSPITAL	The Heart Center - Electrophysiology	930 Franklin St SE	Huntsville	AL	Active
RRC010039-42	Child	RRC	HUNTSVILLE HOSPITAL	The Heart Center - Madison Heart Center	1041 Balch Rd	Madison	AL	Active
RRC010039-43	Child	RRC	HUNTSVILLE HOSPITAL	Ortho Spine Tower - PACU 1	200 Sivley Rd SW	Huntsville	AL	Active
RRC010039-44	Child	RRC	HUNTSVILLE HOSPITAL	The Heart Center - Patient Care	930 Franklin St SE	Huntsville	AL	Active
RRC010039-45	Child	RRC	HUNTSVILLE HOSPITAL	Ortho Spine Tower - PreOp 2	200 Sivley Rd SW	Huntsville	AL	Active
RRC010039-46	Child	RRC	HUNTSVILLE HOSPITAL	Ortho Spine Tower - PACU 2	200 Sivley Rd SW	Huntsville	AL	Active
RRC010039-47	Child	RRC	HUNTSVILLE HOSPITAL	HH - Endo & Diabetes Clinic	201 Sivley Rd SW	Huntsville	AL	Active
RRC010039-48	Child	RRC	HUNTSVILLE HOSPITAL	Medical Mall - Non-Invasive Cardiology (EKG)	1963 Memorial Pkwy SW	Huntsville	AL	Active
RRC010039-49	Child	RRC	HUNTSVILLE HOSPITAL	Ortho Spine Tower - PreOp 1	200 Sivley Rd SW	Huntsville	AL	Active
RRC010039-50	Child	RRC	HUNTSVILLE HOSPITAL	Ortho Spine Tower - Surgery 1	200 Sivley Rd SW	Huntsville	AL	Active
RRC010039-51	Child	RRC	HUNTSVILLE HOSPITAL	The Heart Center - Cardiothoracic Surgeons	201 Sivley Rd SW	Huntsville	AL	Active
RRC010039-52	Child	RRC	HUNTSVILLE HOSPITAL	Blackwell Medical Tower - Radiation Oncology	201 Sivley Rd SW	Huntsville	AL	Active
RRC010039-53	Child	RRC	HUNTSVILLE HOSPITAL	HH - Ped Endo & Diabetes Clinic	920 Franklin St SE	Huntsville	AL	Active
RRC010039-54	Child	RRC	HUNTSVILLE HOSPITAL	THE HEART CENTER - Coumadin Clinic	930 FRANKLIN STREET SE	HUNTSVILLE	AL	Active
RRC010039-55	Child	RRC	HUNTSVILLE HOSPITAL	Spine and Neuro - Physical Therapy	201 Governors Dr SW	Huntsville	AL	Active
RRC010039-56	Child	RRC	HUNTSVILLE HOSPITAL	Medical Mall - Physical Therapy	1963 Memorial Pkwy SW	Huntsville	AL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Delete	Recertification	Huntsville Hospital 101 Sivley Road Huntsville, AL 35801		8/23/2024 9:39 AM
Addresses	Billing Address	Insert	Recertification		Huntsville Hospital 101 Sivley Rd SW Huntsville, AL 35801	8/23/2024 9:39 AM
Addresses	Shipping Address	Insert	Recertification		Huntsville Hospital 101 Sivley Rd SW Huntsville, AL 35801	8/23/2024 9:39 AM
Details	Last Recertification Date	Update	Recertification		8/23/2024 9:39:28 AM	8/23/2024 9:39 AM
Contacts	Primary Contact	Update	Group Change Request	Evereteze, Audreiana 340B Program Manager Huntsville Hospital 2562653274	Wang, Luona Business Manager of Pharmacy Services Huntsville Hospital 2562656241	7/30/2024 9:35 AM
Contacts	Primary Contact	Update	Group Change Request	Wang, Luona Business Manager of Pharmacy Services Huntsville Hospital 2562656241	Evereteze, Audreiana 340B Program Manager Huntsville Hospital 2562653274	4/9/2024 8:14 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Carter, Clinton CFO Huntsville Hospital 2562658818	2/20/2024 8:05 AM
Details	340B ID	Update	New Registration		RRC010039-52	2/20/2024 8:05 AM
Details	Entity Subname	Update	New Registration	Blackwell Medical Tower	Blackwell Medical Tower - Radiation Oncology	2/20/2024 8:05 AM
Dates	Participating Approval Date	Update	New Registration		2/20/2024 8:05:51 AM	2/20/2024 8:05 AM
Details	State	Update	New Registration	Pending	Approved	2/20/2024 8:05 AM
Dates	Signed By Date	Update	New Registration		1/11/2024 9:11:15 AM	2/20/2024 8:05 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	2/20/2024 8:05 AM
Addresses	Main Address	Insert	New Registration		201 Sivley Rd SW Suite 10 Huntsville, AL 35801	1/9/2024 12:21 PM
Addresses	Shipping Address	Insert	New Registration		Huntsville Hospital 101 Sivley Road Huntsville, AL 35801	1/9/2024 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 12:21 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HOS0039H	1/9/2024 12:21 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	1/9/2024 12:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1447221056	1/9/2024 12:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		AL	1/9/2024 12:21 PM
Contacts	Primary Contact	Insert	New Registration		Wang, Luona Business Manager of Pharmacy Services Huntsville Hospital 2562656241	1/9/2024 12:21 PM
Contacts	Authorizing Official	Insert	New Registration		Carter, Clinton CFO Huntsville Hospital 2562658818	1/9/2024 12:21 PM
Details	Assistance Received From Date	Insert	New Registration			1/9/2024 12:21 PM
Details	Assistance Received To Date	Insert	New Registration			1/9/2024 12:21 PM
Details	Last Recertification Date	Insert	New Registration			1/9/2024 12:21 PM
Details	Grant Number	Insert	New Registration			1/9/2024 12:21 PM
Details	340B ID	Insert	New Registration			1/9/2024 12:21 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/9/2024 12:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/9/2024 12:21 PM
Details	Medicare Provider Number	Insert	New Registration		010039	1/9/2024 12:21 PM
Details	Entity Name	Insert	New Registration		HUNTSVILLE HOSPITAL	1/9/2024 12:21 PM
Details	NOFO Number	Insert	New Registration			1/9/2024 12:21 PM
Details	Program Code	Insert	New Registration		RRC	1/9/2024 12:21 PM
Details	Entity Subname	Insert	New Registration		Blackwell Medical Tower	1/9/2024 12:21 PM
Dates	Participating Approval Date	Insert	New Registration			1/9/2024 12:21 PM
Details	State	Insert	New Registration		Pending	1/9/2024 12:21 PM
Dates	Registration Date	Insert	New Registration		1/9/2024 12:21:43 PM	1/9/2024 12:21 PM
Dates	Signed By Date	Insert	New Registration			1/9/2024 12:21 PM
Dates	Start Date	Insert	New Registration			1/9/2024 12:21 PM
Terminations	Termination Comments	Insert	New Registration			1/9/2024 12:21 PM
Terminations	Termination Date	Insert	New Registration			1/9/2024 12:21 PM
Terminations	Termination Effective Date	Insert	New Registration			1/9/2024 12:21 PM
Terminations	Termination Reason	Insert	New Registration			1/9/2024 12:21 PM