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Program Integrity: FY20 Audit Results

Updated 1/15/21. The results chart includes audits where the findings have been finalized. Remaining audits are still under review. Information on Corrective Action Plans and Sanctions will be updated once approved by HRSA. HRSA recommends manufacturers do not contact audited entities regarding sanctions until a corrective action plan has been approved by HRSA and posted on this website.

Results posted for 191 audits.

Entity 340B ID State OPA Findings Sanction Corrective Action Status Entity Contact Information
Adventist Medical Center – Reedley DSH050192 CA Incorrect 340B OPAIS record – Ineligible sites registered on 340B OPAIS; Incorrect entry for address for offsite facility; Failed to remove a duplicate registration of a contract pharmacy.

Diversion – 340B drug dispensed at contract pharmacy, not supported by a medical record.

Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File.

Repayment to manufacturers CAP approved Director of Pharmacy
Adventist Medical Center Reedley
372 W. Cypress Ave, Reedley, CA  93654
559-537-2190  
AbukhaAF@ah.org
Alegent Health – Community Memorial Hospital DBA CHI Health Missouri Valley CAH161309-00 IA No adverse findings None N/A

Audit closure date: June 19, 2020

 
Alice Hyde Medical Center DSH330084 NY Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers CAP approved Director of Pharmacy
The University of Vermont Health Network
Alice Hyde Medical Center
133 Park Street
Malone, NY 12953-0729
mdufort@alicehyde.com
(518) 481-2404
Anthony L Jordan Health Corp CH022070 NY

Incorrect 340B OPAIS record – CE failed to terminate contract pharmacy carve-in arrangement.

Diversion – 340B drugs dispensed at contract pharmacies, not supported by a medical record.

Repayment to manufacturers CAP approved 340B Analyst
82 Holland St
Rochester NY, 14605-2131
585-423-5886
nadirahs@jordanhealth.org
Arnot Ogden Medical Center DSH330090 NY Incorrect 340B OPAIS record –  Failed to remove duplicate registrations for offsite outpatient facilities; Failed to remove duplicate registration for contract pharmacy; Incorrect entry for Authorizing Official phone number; Incorrect Primary Contact listed. None CAP implemented

Audit closure date: October 29, 2020

 
Ascension Seton DBA Ascension Seton Medical Center Austin DSH450056 TX

No adverse findings

None

N/A

Audit closure date: April 29, 2020

 
Atrium Health Lincoln DSH340145 NC No adverse findings None  N/A

Audit closure date: March 10, 2020

 
Atrium Health Union DSH340130 NC No adverse findings None N/A

Audit closure date: June 23, 2020

 
Banner Fort Collins Medical Center DSH060126 CO No adverse findings None N/A

Audit closure date: June 5, 2020

 
Baptist Memorial Hospital Memphis DSH440048 TN No adverse findings None N/A

Audit closure date: August 26, 2020

 
Barrio Comprehensive Family Health Care Center, Inc. CH062360 TX Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers CAP approved President and CEO
3066 East Commerce Street
San Antonio, 78220
210-233-7070
pnguyen@communicaresa.org
Beverly Hospital DSH220033 MA Incorrect 340B OPAIS record – Offsite outpatient facilities were not listed on the 340B OPAIS.

Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File.

None CAP approved

State Medicaid has since determined duplicate discounts did not occur.

 
Big Bend Cares STD323011 FL No adverse findings None N/A

Audit closure date: June 4, 2020

 
Birmingham AIDS Outreach, Inc. STD35233 AL Incorrect 340B OPAIS record - Incorrect entry for address. None CAP implemented

Audit closure date: June 18, 2020

 
Bliss Cares STD328062 FL Incorrect 340B OPAIS record - Ineligible sites registered on 340B OPAIS. Termination of ineligible offsite outpatient facilities from the 340B Program Pending  
Bon Secours Maryview Medical Center DSH490017 VA No adverse findings None N/A

Audit closure date: May 28, 2020

 
Botsford General Hospital d/b/a Beaumont Hospital – Farmington Hills DSH230151 MI No adverse findings None N/A

Audit closure date: March 25, 2020

 
Boys Town National Research Hospital PED283300-00 NE No adverse findings None N/A

Audit closure date: June 24, 2020

 
Braxton County Memorial Hospital CAH511308-00 WV No adverse findings None N/A

Audit closure date: June 19, 2020

 
Broaddus Hospital CAH511300-00 WV Incorrect 340B OPAIS record - Hospital classification on OPAIS was inconsistent with eligibility documents. None

CAP implemented

Audit closure date: December 14, 2020

 
Brockton Neighborhood Health Center, Inc. CH010700 MA No adverse findings None N/A

Audit closure date: April 17, 2020

 
Brookdale Hospital Medical Center DSH330233 NY No adverse findings None N/A

Audit closure date: May 15, 2020

 
Cabun Rural Health Services, Inc. CHC00342-00 AR Incorrect 340B OPAIS record – Incorrect entries for address, site ID, and name for offsite outpatient facilities;

Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Repayment to manufacturers CAP implemented

Audit closure date: December 15, 2020

Chief Executive Officer
melanies@cabun.org
402 South Lee Street
Hampton, AR 71744
870-798-4064
Cahaba Medical Care Foundation CHC24177-00 AL Diversion – 340B drugs dispensed at contract pharmacies, not supported by a medical record.

Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Repayment to manufacturers CAP approved CCO
405 Belcher St.
Centreville, AL 35042
kay.cox@cahabamedicalcare.com
205-277-2384
Calais Regional Hospital - Amended CAH201305-00 ME Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File. Repayment to manufacturers CAP approved

VP HR/Quality, Compliance Officer
24 Hospital Lane
Calais, ME 04619
207-454-9228
mary.barnett@calaishospital.org

CAN Community Health, Inc. – Daytona STD32114 FL No adverse findings None N/A

Audit closure date: May 19, 2020

 
Capital Health Med Center – Hopewell DSH310044 NJ No adverse findings None N/A

Audit closure date: July 16, 2020

 
Carle Hoopeston Regional Health Center CAH141316-00 IL No adverse findings None N/A

Audit closure date: March 24, 2020

 
Central Maine Medical Center RRC200024-00 ME Incorrect 340B OPAIS record – Ineligible site registered on 340B OPAIS; Registered contract pharmacies without written contract in place. Termination of ineligible offsite outpatient facility from the 340B Program*

Termination of contract pharmacies from 340B Program*

CAP implemented

Audit closure date: December 14, 2020

 
Central Mississippi Health Services, Inc. CH046080 MS No adverse findings None N/A

Audit closure date: June 3, 2020

 
Children’s Medical Center Plano PED453316-00 TX No adverse findings None N/A

Audit closure date: June 5, 2020

 
Choctaw Regional Medical Center CAH251334-00 MS No adverse findings None N/A

Audit closure date: April 30, 2020

 
Christ Community Health Services Augusta Inc. CHC24172-00 GA No adverse findings None N/A

Audit closure date: July 16, 2020

 
Clackamas, County of CH101310 OR No adverse findings None N/A

Audit closure date: August 7, 2020

 
Community Health Service Agency, Inc. of Hunt County, The CH060820 TX Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File. Repayment to manufacturers Pending  
Community Hospital Anderson DSH150113 IN No adverse findings None N/A

Audit closure date: August 6, 2020

 
Community Hospital of Indiana, Inc. DSH150169 IN No adverse findings None N/A

Audit closure date: July 14, 2020

 
Community Howard Regional Health DSH150007 IN No adverse findings None N/A

Audit closure date: July 8, 2020

 
County of Lane CH107920 OR Incorrect 340B OPAIS record – Failed to remove a duplicate registration of a contract pharmacy.

Diversion – 340B drug dispensed at contract pharmacy, not supported by a medical record.

Termination of contract pharmacy from 340B Program*

Repayment to manufacturers

CAP implemented

Audit closure date: October 28, 2020

Program Services Coordinator
151 West 7th Ave #520
Eugene, OR 97401
Juan.Rivera@lanecountyor.gov
541-731-4439
Deer Valley Medical Center RRC030092-00 AZ No adverse findings None N/A

Audit closure date: April 29, 2020

 
Dickinson County Healthcare System SCH230055-00 MI Incorrect 340B OPAIS record – Offsite outpatient facilities and a shipping address were not listed on the 340B OPAIS. None CAP implemented

Audit closure date: June 23, 2020

 
Driscoll Children’s Hospital PED453301-00 TX Incorrect 340B OPAIS record – Offsite outpatient facilities were not listed on the 340B OPAIS.

Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File.

Repayment to manufacturers CAP approved  
Eastern Iowa Health Center CH0718570 IA Inaccurate or incomplete information on the Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding. None CAP implemented

Audit closure date: December 14, 2020

 
Effingham Health System CAH111306-00 GA No adverse findings None N/A

Audit closure date: June 9, 2020

 
Einstein Medical Center Montgomery DSH390329 PA No adverse findings None N/A

Audit closure date: April 7, 2020

 
Episcopal Health Services, Inc. DSH330395 NY Diversion – 340B drugs dispensed at contract pharmacies, not supported by medical records.

Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File.

Repayment to manufacturers CAP  approved Director of Pharmacy
327 Beach 19th Street
Far Rockaway NY 11691
718-869-7180
kmuir@ehs.org
Espanola Hospital DSH320011 NM No adverse findings None N/A

Audit closure date: August 4, 2020

 
Faith Community Hospital SCH450241-00 TX No adverse findings None N/A

Audit closure date: June 1, 2020

 
Finger Lakes Migrant Health Care Project, Inc. CH028210 NY Incorrect 340B OPAIS record - Failed to remove closed contract pharmacy location registration.

Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Termination of contract pharmacy from 340B Program*

Repayment to manufacturers

CAP approved Chief Financial Officer
Finger Lakes Migrant Health Care Project, Inc
14 Maiden Lane
PO Box 423 Penn Yan, NY 14527
315-531-9102
annes@flchealth.org
Firelands Regional Medical Center DSH360025 OH Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers CAP approved Pharmacy Services Director
1111 Hayes Avenue
Sandusky, Ohio 44870
WallerD@Firelands.com
Gibson General Hospital CAH151319-00 IN No adverse findings None N/A

Audit closure date: July 24, 2020

 
Glendale Adventist Medical Center DSH050239 CA No adverse findings None N/A

Audit closure date: March 19, 2020

 
GraceMed Health Clinic, Inc. CHC08772-00 KS Incorrect 340B OPAIS record – Incorrect entry for address for offsite outpatient facility; Incorrect entries for authorizing official and primary contact; Failed to remove closed contract pharmacy locations registrations. None Pending  
Grande Ronde Hospital, Inc. CAH381321-00 OR Incorrect 340B OPAIS record – Incorrect entry for address for offsite outpatient facility. None CAP implemented

Audit closure date: July 9, 2020

 
Greene County General Hospital CAH151317-00 IN Duplicate Discounts - Entity was billing Medicaid contrary to information included on the Medicaid Exclusion File. None CAP implemented

State Medicaid has since determined duplicate discounts did not occur.

Audit closure date: October 27, 2020

 
Hardin Memorial Hospital DSH180012 KY Incorrect 340B OPAIS record – Incorrect entry for disproportionate share percentage.

Inaccurate or incomplete information on the Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding.

None CAP approved  
HealthAlliance Hospital Marys Avenue Campus DSH330224 NY No adverse findings None N/A

Audit closure date: February 19, 2020

 
Health Access Network CH015110 ME No adverse findings None N/A

Audit closure date: June 24, 2020

 
Heart of America Medical Center CAH351332-00 ND No adverse findings None N/A

Audit closure date: July 2, 2020

 
Henry District Hospital CAH141319-00 IL No adverse findings None N/A

Audit closure date: February 19, 2020

 
Highland Hospital of Rochester RRC330164-00 NY Inacurate or incomplete information on the Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding. None Pending  
Horizon Health Care, Inc. CH081030 SD

Incorrect 340B OPAIS record – Incorrect entry for address for offsite outpatient facility.

Duplicate Discounts – Entity was billing Medicaid contrary to information included on the Medicaid Exclusion File.

Repayment to manufacturers CAP approved Chief Financial Officer
P.O. Box 99
Howard, SD 57349
605-772-4525
werickson@horizonhealthcare.org
www.horizonhealthcare.org
Hospital & Medical Foundation of Paris, Inc. CAH141320-00 IL No adverse findings None N/A

Audit closure date: July 2, 2020

 
Hospital Authority of Miller County DBA Miller County Hospital CAH111305-00 GA No adverse findings None N/A

Audit closure date: June 16, 2020

 
Hospital of Central Connecticut, The DSH070035 CT Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. None CAP implemented

State Medicaid has since determined that duplicate discounts did not occur.

Audit closure date: October 14, 2020

 
IU Health Bloomington Hospital DSH150051 IN No adverse findings None N/A

Audit closure date: July 24, 2020

 
Iowa Methodist Medical Center DSH160082 IA No adverse findings None N/A

Audit closure date: July 30, 2020

 
Indiana University Health Ball Memorial Hospital, Inc. DSH150089 IN Diversion – 340B drug dispensed to inpatient. Repayment to manufacturers CAP approved Director - 340B Program
950 N. Meridian St., Ste 1200
Indianapolis, IN 46204
Lstewar1@iuhealth.org
317-962-3540
Inova Health Care Services dba Inova Juniper Program HV220311 VA Inaccurate or incomplete information on the Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding. None CAP implemented

Audit closure date: August 18, 2020

 
Jackson County Memorial Hospital SCH370022-00 OK No adverse findings None N/A

Audit closure date: May 29, 2020

 
Jackson Hospital and Clinic Inc. RRC010024-00 AL No adverse findings None N/A

Audit closure date: April 7, 2020

 
Jefferson Community Health Care Centers, Inc. CH0623760 LA Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File. Repayment to manufacturers CAP approved

Chief Operating Officer,
4028 US Hwy. 90
Avondale, LA 70072
wrose@inclusivcare.com
504-206-7738

Jefferson County Department of Health FP352129 AL Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers CAP approved Pharmacy Manager
Jefferson County Department of Health
1400 6th Ave. S
Birmingham, AL 35233
205-930-1987
Pharmacy.jcdh@jcdh.org
Jerold Phelps Community Hospital CAH051309-00 CA No adverse findings None N/A

Audit closure date: February 28, 2020

 
Jersey City Medical Center DSH310074 NJ No adverse findings None N/A

Audit closure date: April 9, 2020

 
Kemper CAH, Inc. d/b/a John C. Stennis Memorial Hospital CAH251335-00 MS No adverse findings None N/A

Audit closure date: May 29, 2020

 
Kiamichi Family Medical Center CH0611930 OK Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File. None CAP implemented

State Medicaid has since determined duplicate discounts did not occur.

Audit closure date: October 15, 2020

 
Klickitat County Public Hospital District #2 dba Skyline Hospital CAH501315-00 WA No adverse findings None N/A

Audit closure date: July 16, 2020

 
Lallie Kemp Regional Medical Center CAH191321-00 LA Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers CAP implemented

Audit closure date: December 15, 2020

Chief Financial Officer
52579 Highway 51 South
Independence, LA 70443
985-878-1350
Cthom5@lsuhsc.edu
Langlade Hospital Hotel Dieu of St. Joseph, of Antigo, WI CAH521350-00 WI No adverse findings None N/A

Audit closure date: August 10, 2020

 
Lee Memorial Health System dba Lee Memorial Hospital DSH100012 FL Incorrect 340B OPAIS record – Failed to remove duplicate registrations for offsite outpatient facilities.

Duplicate Discounts – Entity was billing Medicaid contrary to information included in the Medicaid Exclusion File.

Repayment to manufacturers CAP approved Pharmacy & 340B Compliance Officer
4211 Metro Parkway, 1st Floor
Fort Myers, FL 33916
Joseph.bitner@leememorial.org
239-343-8602
Lexington Regional Health Center CAH281361-00 NE No adverse findings None N/A

Audit closure date: August 21, 2020

 
Lincoln Medical Center DSH440102 TN No adverse findings None N/A

Audit closure date: March 9, 2020

 
Loma Linda University Children's Hospital DSH050778 CA No adverse findings None N/A

Audit closure date: March 18, 2020

 
Mahaska County Hospital CAH161379-00 IA No adverse findings None N/A

Audit closure date: June 30, 2020

 
Marin Community Clinic CH095380 CA Incorrect 340B OPAIS record – Offsite outpatient facility was not listed on the 340B OPAIS.

Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File.

Repayment to manufacturers CAP approved Compliance and Privacy
Officer
415-755-2509
9 Commercial Blvd, Suite 100
Novato, CA 94949
Marin General Hospital DSH050360 CA No adverse findings None N/A

Audit closure date: May 15, 2020

 
Mary Imogene Bassett Hospital SCH330136-00 NY Incorrect 340B OPAIS record – Incorrect entry for disproportionate share percentage. None

CAP implemented

Audit closure date: October 15, 2020

 
Massachusetts General Hospital DSH220071 MA No adverse findings None N/A

Audit closure date: April 22, 2020

 
Massena Hospital SCH330223-00 NY Diversion – 340B drug dispensed at contract pharmacy, not supported by a medical record. Repayment to manufacturers CAP approved Director of Pharmacy 
(315) 769-4216
1 Hospital Drive
Massena, NY 13662
emiller@massenahospital.org
McKee Medical Center DSH060030 CO No adverse findings None N/A

Audit closure date: June 4, 2020

 
McLaren Greater Lansing DSH230167 MI No adverse findings None N/A

Audit closure date: July 10, 200

 
Meadville Medical Center DSH390113 PA Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers Pending  
Memorial Hospital of South Bend, Inc. DSH150058 IN No adverse findings None N/A

Audit closure date: July 23, 2020

 
Memorial Medical Center CAH521323-00 WI Incorrect 340B OPAIS record - Failed to remove closed contract pharmacy location registration. None CAP implemented

Audit closure date: October 30, 2020

 
Mercy General Hospital DSH050017 CA No adverse findings None N/A

Audit closure date: July 16, 2020

 
Mercy Health Hackley Campus DSH230066 MI Incorrect 340B OPAIS record – Ineligible sites registered on 340B database; Failed to remove duplicate registration for offsite outpatient facility. Termination of ineligible offsite outpatient facility from the 340B Program* CAP approved  
Mercy Hospital Lebanon DSH260059 MO No adverse findings None N/A

Audit closure date: June 26, 2020

 
Mercy Hospital – St. Louis DSH260020 MO Inaccurate or incomplete information on the Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding. None CAP implemented

Audit closure date: August 18, 2020

 
Middlesboro ARH Hospital DSH180020 KY Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers CAP approved

System Director of Pharmacy
100 Airport Gardens Road, Hazard, KY 41701

606-437-1320
jakers@arh.org

MidMichigan Medical Center SCH230222-00 MI No adverse findings None N/A

Audit closure date: February 19, 2020

 
Midwest Medical Center CAH141302-00 IL No adverse findings None N/A

Audit closure date: April 3, 2020

 
Monmouth Medical Center Southern Campus DSH310084 NJ Incorrect 340B OPAIS record – Failed to remove a duplicate registration of a contract pharmacy. None CAP implemented

Audit closure date: July 13, 2020

 
Morton Plant North Bay Hospital DSH100063 FL No adverse findings None N/A

Audit closure date: May 20, 2020

 
Mount Carmel Health DSH360035 OH Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. None CAP approved

State Medicaid has since determined duplicate discounts did not occur.

 
Mountainlands Community Health Center, Inc CH083950 UT Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File.

Duplicate Discounts – Entity was billing Medicaid contrary to information included on the Medicaid Exclusion File.

Repayment to manufacturers CAP implemented

Audit closeout date: November 5, 2020

340B Coordinator
801-429-2000
mleavitt1@mchc.org
MRH Corp. DBA Northern Light Mayo Hospital CAH201309-00 ME No adverse findings None N/A

Audit closure date: August 6, 2020

 
Munson Healthcare Cadillac Hospital SCH230081-00 MI Incorrect 340B OPAIS record – Offsite outpatient facility was not listed on the 340B OPAIS. None CAP implemented

Audit closure date: July 29, 2020

 
Munson Healthcare Manistee Hospital SCH230303-00 MI No adverse findings None N/A

Audit closure date: June 5, 2020

 
Munson Medical Center SCH230097-00 MI Incorrect 340B OPAIS record – Incorrect entry for address for offsite outpatient facility. None CAP approved  
MyCareHealth Center CHC26572-00 MI Incorrect 340B OPAIS record – Incorrect entry for address for offsite outpatient facility. None CAP implemented

Audit closure date: August 20, 2020

 
Neighborhood Improvement Project, Inc. CH0438590 GA No adverse findings None N/A

Audit closure date:
September 8, 2020

 
Nemaha County Hospital CAH281324-00 NE No adverse findings None N/A

Audit closure date: June 18, 2020

 
Niagara Falls Memorial Medical Center DSH330065 NY Incorrect 340B OPAIS record – Incorrect entry for Primary Contact.

Diversion – 340B drug dispensed to inpatients

Repayment to manufacturers Pending  
Nicholas H. Noyes Memorial Hospital DSH330238 NY No adverse findings None N/A

Audit closure date: April 3, 2020

 
North Caddo Medical Center CAH191304-00 LA No adverse findings None N/A

Audit closure date: June 12, 2020

 
North Country Family Health Center, Inc. CHC24165-00 NY No adverse findings None N/A

Audit closure date: February 25, 2020

 
North Country Health System CAH471304-00 VT Duplicate Discounts – Entity was billing Medicaid contrary to information included on the Medicaid Exclusion File. Repayment to manufacturers Pending  
North Oaks Medical Center LLC DSH190015 LA Incorrect 340B OPAIS record – Offsite outpatient facilities were not listed on the 340B OPAIS;

Incorrect or incomplete information in the Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding.

None CAP implemented

Audit closure date: December 1, 2020

 
Northside Hospital Gwinnett DSH110087 GA Incorrect 340B OPAIS record - Incorrect entry for authorizing official. None

CAP implemented

Audit closure date: September 10, 2020

 
Oakwood Healthcare, Inc. dba Beaumont Hospital - Dearborn DSH230020 MI No adverse findings None

N/A

Audit closure date: October 5, 2020

 
Ochsner Bayou LLC CAH191324-00 LA No adverse findings None N/A

Audit closure date: April 2, 2020

 
Onslow Memorial Hospital SCH340042-00 NC Incorrect 340B OPAIS record – Incorrect entry for hospital control type. None CAP implemented

Audit closure date: July 29, 2020

 
Opelousas General Hospital DSH190017 LA Incorrect 340B OPAIS record – Incorrect entry for hospital control type; offsite outpatient facilities were not listed on the 340B OPAIS. None CAP approved  
Our Lady of Lourdes Memorial Hosp RRC330011-00 NY Incorrect 340B OPAIS record - Failed to remove a duplicate registration of a contract pharmacy. None CAP implemented

Audit closure date: October 30, 2020

 
Osborne County Memorial Hospital CAH171364-00 KS No adverse findings None N/A

Audit closure date: April 15, 2020

 
Pana Community Hospital CAH141341-00 IL No adverse findings None N/A

Audit closure date: July 16, 2020

 
PeaceHealth dba Peace Harbor Medical Center CAH381316-00 OR Incorrect 340B OPAIS record – Ineligible sites registered on 340B OPAIS. Termination of ineligible offsite outpatient facility from the 340B Program* CAP implemented

Audit closure date: August 12, 2020

 
Peoples Community Health Clinic, Inc. CH071410 IA No adverse findings None N/A

Audit closure date: September 15, 2020

 
Perkins County Health Services CAH281356-00 NE No adverse findings None N/A

Audit closure date: July 23, 2020

 
Philadelphia Fight CHC26634-00 PA Incorrect 340B OPAIS record – Failed to remove a duplicate registration of a contract pharmacy. None

CAP implemented

Audit closure date: September 10, 2020

 
Piedmont Newton Hospital, Inc. DSH110018 GA Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. None

CAP implemented

State Medicaid has since determined that duplicate discounts did not occur.

Audit closure date: September 30, 2020

 
Plains Regional Medical Center – Clovis DSH320022 NM Incorrect 340B OPAIS record – Failed to remove a duplicate registration of a contract pharmacy. None Pending  
Planned Parenthood Association of Utah STD841021 UT Duplicate Discounts – Entity was billing Medicaid contrary to information included on the Medicaid Exclusion File. Repayment to manufacturers CAP approved Chief Financial Officer
654 South 900 East,
Salt Lake City, UT 84102
801-532-1586
Lesley.bailey@ppau.org
Power County Hospital District CAH131304-00 ID No adverse findings None N/A

Audit closure date: March 5, 2020

 
Project Vida Health Center CH067960 TX Incorrect 340B OPAIS record – Failed to remove closed contract pharmacy location registration. None CAP implemented

Audit closure date: October 30, 2020

 
Premier Community Healthcare Group, Inc. CH045500 FL Incorrect 340B OPAIS record – Failed to remove a duplicate registration for offsite outpatient facility.

Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File.

Repayment to manufacturers CAP implemented

Audit closure date: December 1, 2020

Chief Executive Officer
PO Box 232
Dade City, FL 33526
352-518-2000
jresnick@hcnetwork.org
Preston Memorial Hospital CAH511312-00 WV No adverse findings None N/A

Audit closure date: June 15, 2020

 
Providence Health DBA Providence Seaside Hospital CAH381303-00 OR No adverse findings None N/A

Audit closure date: May 13, 2020

 
Providence Medford Medical Center DSH380075 OR Incorrect 340B OPAIS record – Offsite outpatient facility was not listed on the 340B OPAIS; Incorrect entry for address for an offsite outpatient facility. None CAP implemented

Audit closure date: October 21, 2020

 
Regional Health Rapid City Hospital DSH430077 SD No adverse findings None N/A

Audit closure date: May 15, 2020

 
Regional Health Services of Howard County CAH161328-00 IA No adverse findings None N/A

Audit closure date: June 23, 2020

 
Richmond University Medical Center DSH330028 NY Diversion – 340B drug dispensed at covered entity, not supported by a medical record. Repayment to manufacturer CAP approved 340B Manager
355 Bard Avenue
Inpatient Pharmacy Department
Staten Island, NY 10310
718-818-3272
zparnas@rumcsi.org
Riverside Shore Memorial Hospital DSH490037 VA No adverse findings None N/A

Audit closure date: April 21, 2020

 
Rowan Regional Hospital RRC340015-00 NC No adverse findings None N/A

Audit closure date: 
March 3, 2020

 
Saint Alphonsus Medical Center Nampa DSH130013 ID No adverse findings None N/A

Audit closure date: September 8, 2020

 
Saint Alphonsus Regional Medical Center DSH130007 ID No adverse findings None N/A

Audit closure date: June 12, 2020

 
San Francisco AIDS Foundation STD94114 CA No adverse findings None N/A

Audit closure date: April 17, 2020

 
Sanford Thief River Falls CAH241381-00 MN No adverse findings None N/A

Audit closure date: March 3, 2020

 
Santa Monica UCLAMC and Orthopaedic Hospital DSH050112 CA Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers CAP approved Director of Pharmacy
757 Westwood Plaza B531
Los Angeles, CA 90095
310-267-8500
kmenmuir@mednet.ucla.edu
Scotland Memorial Hospital DSH340008 NC Inaccurate or incomplete information on the Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding. None CAP implemented

Audit closure date: July 13, 2020

 
Seton Medical Center DSH050289 CA Incorrect 340B OPAIS record – Incorrect entry for disproportionate share percentage.

Inaccurate or incomplete information on the Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding.

None CAP implemented

Audit closure date: June 26, 2020

 
Sharp Chula Vista Medical Center DSH050222 CA No adverse findings None N/A

Audit closure date: April 28, 2020

 
Sheridan County Hospital CAH171347-00 KS No adverse findings None N/A

Audit closure date: March 17, 2020

 
Sioux Valley Memorial Hospital Association dba Cherokee Regional Medical Center CAH161362-00 IA No adverse findings None N/A

Audit closure date: June 24, 2020

 
Sonora Community Hospital dba Adventist Health Sonora DSH050335 CA Inaccurate or incomplete information on the Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding. None CAP implemented

Audit closure date: July 28, 2020

 
Southeast Mississippi Rural Health Initiative, Inc. CH045770 MS Duplicate Discounts – Entity was billing Medicaid contrary to information included on the Medicaid Exclusion File. Repayment to manufacturers CAP approved 340B Coordinator
Phone 601-544-4163 Ext 3908
64 Old Airport Road
Hattiesburg, MS 39401
lellis@semrhi.com
Southwestern Vermont Medical Center RRC470012-00 VT No adverse findings None N/A

Audit closure date: August 6, 2020

 
Southwest Mississippi Regional Medical Center DSH250097 MS No adverse findings None N/A

Audit closure date: June 11, 2020

 
Sparrow Clinton Hospital CAH231326-00 MI No adverse findings None N/A

Audit closure date: July 14, 2020

 
St. Anthony Regional Hospital SCH160005-00 IA No adverse findings None N/A

Audit closure date: June 17, 2020

 
St. Catherine Hospital SCH170023-00 KS No adverse findings None N/A

Audit closure date: July 23, 2020

 
St. Cloud Hospital DSH240036 MN Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers CAP implemented

Audit closure date: August 4, 2020

 
St. Jude Medical Center Fullerton DSH050168 CA No adverse findings None N/A

Audit closure date: March 5, 2020

 
St. Louis Children’s PED263301-00 MO Incorrect 340B OPAIS record - Offsite outpatient facilities were not listed on the 340B OPAIS.

Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File.

Repayment to manufacturers CAP approved Director of Pharmacy
St. Louis Children’s Hospital – 11E36
One Children’s Place
St. Louis, MO 63110
(314) 497-9450
melissa.heigham@bjc.org
St. Luke’s Methodist Hospital DSH160045 IA Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers Pending  
St. Mary’s Hospital, Centralia, Illinois RRC140034-00 IL No adverse findings None N/A

Audit closure date: June 11, 2020

 
Stacy McKay Health and Education Center CH0518280 IN

Diversion – 340B drug dispensed at covered entity, not supported by a medical record.

Duplicate Discounts – Entity was billing Medicaid contrary to information included on the Medicaid Exclusion File.

Repayment to manufacturers CAP approved Pharmacy Director
6050 Sterling Creek Rd.,
Portage, IN 46368
219-763-8112;
mwichlinski@northshorehealth.org
Stamford Hospital, The DSH070006 CT Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers CAP approved Pharmacy Business Manager
One Hospital Plaza
Stamford, CT 06902
PManirakiza@stamhealth.org
203-276-4232
Stokes Family Health Center FP270168 NC No adverse findings None N/A

Audit closure date: July 9, 2020

 
Tallahatchie General Hospital CAH251304-00 MS No adverse findings None N/A

Audit closure date: May 29, 2020

 
Trigg County Hospital Inc. CAH181304-00 KY No adverse findings None N/A

Audit closure date: April 14, 2020

 
Trinitas Regional Medical Center DSH310027 NJ Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers Pending  
Trinity Regional Medical Center SCH160016-00 IA No adverse findings None N/A

Audit closure date: June 11, 2020

 
University of Cincinnati Medical Center LLC DSH360003 OH No adverse findings None N/A

Audit closure date: July 23, 2020

 
UPMC Horizon Hospital DSH390178 PA Inaccurate or incomplete information on the Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding. None CAP implemented

Audit closure date: November 10, 2020

 
UPMC McKeesport DSH390002 PA Duplicate Discounts – Inaccurate or incomplete information on the Medicaid Exclusion File. Repayment to manufacturers Pending  
Upson County Hospital, Inc. SCH110002-00 GA No adverse findings None N/A

Audit closure date: May 12, 2020

 
Val Verde Regional Medical Center DSH450154 TX Incorrect 340B OPAIS record – Offsite outpatient facilities were not listed on the 340B OPAIS. None CAP approved  
Ventura County Medical Center DSH050159 CA Incorrect 340 OPAIS record – Offsite outpatient facilities were not listed on the 340B OPAIS. None CAP implemented

Audit closure date: November 19, 2020

 
Verde Valley Medical Center SCH030007-00 AZ Incorrect 340B OPAIS record – Failed to remove closed contract pharmacy location registration. None CAP implemented

Audit closure date: December 11, 2020

 
Walter Knox Memorial Hospital CAH131318-00 ID No adverse findings None N/A

Audit closure date: July 23, 2020

 
Weatherford Hospital Authority CAH371323-00 OK No adverse findings None N/A

Audit closure date: July 23, 2020

 
Weiser Valley Hospital District, dba Weiser Memorial Hospital CAH131307-00 ID No adverse findings None N/A

Audit closure date: August 4, 2020

 
Welia Health CAH241367-00 MN Duplicate Discounts – Entity was billing Medicaid contrary to information included on the Medicaid Exclusion File. Repayment to manufacturers CAP approved 340B Coordinator
ckordiak@welia.org
320-225-3999
WellStar Atlanta Medical Center DSH110115 GA No adverse findings None N/A

Audit closure date: August 4, 2020

 
Western Sierra Medical Clinic CH0921760 CA Incorrect 340B OPAIS record – Incorrect Authorizing Official listed; Incorrect Primary Contact listed; Failed to remove a duplicate registration of a contract pharmacy.

Diversion – 340B drug dispensed at contract pharmacy, not supported by a medical record.

Repayment to manufacturers CAP approved Senior Director of Operations
844 Old Tunnel Road
Grass Valley, CA 95945
530-273-4984 X102
francine@wsmcmed.org
Wickenburg Community Hospital Association Inc. CAH031300-00 AZ Incorrect 340B OPAIS record – Offsite outpatient facilities were not listed on the 340B OPAIS; Incorrect entry for address for an offsite outpatient facility;

Diversion – 340B drugs dispensed to inpatients

Repayment to manufacturers CAP approved Director of Pharmacy Services and 340B Program
520 Rose Lane
Wickenburg, AZ 85390
928-684-4380
William Beaumont Hospital DBA Beaumont Hospital - Grosse Pointe DSH230089 MI No adverse findings None N/A

Audit closure date: August 21, 2020

 
Willis Knighton Medical Center, Inc. DSH190111 LA No adverse findings None N/A

Audit closure date: June 11, 2020

 
Wyckoff Heights Medical Center DSH330221 NY Covered outpatient drugs obtained through a Group Purchasing Organization prior to October 2019;

Diversion – 340B drugs dispensed at contract pharmacy, not supported by medical records.

Repayment to manufacturers CAP approved Director of Pharmacy, Wyckoff Heights Medical Center
374 Stockholm Street
Brooklyn, NY 11237
718-963-7141
jrumore@wyckoffhospital.org

*Note: Covered entity self-terminated cited facilities prior to termination of facilities by OPA.

Date Last Reviewed:  January 2021