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Program Integrity: FY23 Audit Results

Updated 11/29/24. 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 162 audits.
Entity Sort descending 340B ID State OPA Findings Sanction Corrective Action Status
Adventist Bolingbrook Hospital DSH140304 IL

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Authorizing Official phone number.

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

Repayment to manufacturers

CAP implemented

Audit closure date: October 18, 2023

Adventist Glenoaks Hospital DSH140292 IL

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Authorizing Official phone number.

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

Repayment to manufacturers

CAP implemented

Audit closure date: October 18, 2023

AIDS Arms Inc. dba Prism Health North Texas HV01710A TX

No adverse findings

None

N/A

Audit closure date: August 21, 2023

Arkansas Children's Hospital PED043300-00 AR

No adverse findings

None

N/A

Audit closure date: February 9, 2023

Ashland Health Center CAH171304-00 KS

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

None

CAP implemented

Audit closure date: October 16, 2023

Aspirus Ontonagon Hospital CAH231309-00 MI

No adverse findings

None

N/A

Audit closure date: June 30, 2023

Aspirus Stanley Hospitals & Clinics, Inc. CAH521311-00 WI

No adverse findings

None

N/A

Audit closure date: April 27, 2023

Aultman Hospital RRC360084-00 OH

Incorrect 340B OPAIS record - Incorrect entries in 340B OPAIS for Primary Contact for offsite outpatient facilities; Failed to remove a duplicate registration of a contract pharmacy from 340B OPAIS.

None

CAP implemented

Audit closure date: March 14, 2024

Avera Granite Falls CAH241343-00 MN

No adverse findings

None

N/A

Audit closure date: March 29, 2023

Baptist Health - Fort Smith DSH040055 AR

Incorrect 340B OPAIS record - Ineligible offsite outpatient facility registered on 340B OPAIS; Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

Termination of ineligible offsite outpatient facility from the 340B Program.*

CAP approved

Baptist Health Medical Center - Stuttgart DSH040072 AR

Incorrect 340B OPAIS record - Failed to remove contract pharmacies from 340B OPAIS that did not have a written contract in place.

Termination of contract pharmacies from 340B Program*

CAP implemented

Audit closure date: June 21, 2024.

Barnes Kasson County Hospital CAH391309-00 PA

No adverse findings

None

N/A

Audit closure date: February 9, 2023

Bath County Community Hospital, Inc. CAH491300-00 VA

No adverse findings

None

N/A

Audit closure date: January 26, 2023

Callaway Hospital District dba Callaway Hospital District CAH281335-00 NE

No adverse findings

None

N/A

Audit closure date: April 26, 2023

Camarena Health CH093210 CA

Incorrect 340B OPAIS record - Failed to remove closed grant associated sites from 340B OPAIS; Failed to remove a duplicate registration of a contract pharmacy from 340B OPAIS.

Termination of grant associated sites from 340B Program*

CAP implemented

Audit closure date: March 12, 2024

CAN Community Health, Inc. - FWB STD32547 FL

No adverse findings

None

N/A

Audit closure date: November 21, 2023

Cape Fear Valley Medical Center DSH340028 NC

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

None

CAP implemented

State Medicaid has since determined duplicate discounts did not occur.

Audit closure date: March 7, 2024

Carilion Giles Community Hospital CAH491302-00 VA

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

None

CAP implemented

State Medicaid has since determined duplicate discounts did not occur.

Audit closure date: May 20, 2024

Carilion Rockbridge Community Hospital CAH491304-00 VA

Incorrect 340B OPAIS record - Failed to remove a contract pharmacy from 340B OPAIS that did not have a written contract in place.

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

Termination of contract pharmacy from 340B Program*

Repayment to manufacturers

CAP implemented

State Medicaid has since determined duplicate discounts did not occur.

Audit closure date: November 13, 2023

Carson Tahoe Regional Healthcare
Contact Information

340B Coordinator
1600 Medical Parkway
Carson City, NV 89703
702-249-2353
Gary.horne@carsontahoe.org

SCH290019, DSH290019 NV

Covered outpatient drugs obtained through a Group Purchasing Organization prior to November 2022.

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for hospital classification; Offsite outpatient facilities were not listed in 340B OPAIS; Failed to remove a duplicate registration of a contract pharmacy from 340B OPAIS.

Duplicate Discounts - Entitys contract pharmacy was billing Medicaid without notification to HRSA.

Repayment to manufacturers

CAP implemented

Audit closure date: August 16, 2024

Castro County Health District dba Plains Memorial Hospital
Contact Information

Chief Financial Officer / Chief Operating Officer
310 W. Halsell St.
Dimmitt, TX 79027
Laura.case@cchdonline.com
806-647-8751

CAH451350-00 TX

Diversion - 340B drugs dispensed at contract pharmacy for prescriptions written at ineligible sites.

Repayment to manufacturers

CAP approved

Cedar County Memorial Hospital
Contact Information

Chief Financial Officer
1401 S. Park Street
El Dorado Springs, MO 64744
417-876-3097
carla.gilbert@cedarcomem.com

CAH261323-00 MO

Duplicate Discounts - Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

Repayment to manufacturers

CAP implemented

Audit closure date: October 29, 2024

Central Vermont Medical Center SCH470001-00 VT

No adverse findings

None

N/A

Audit closure date: October 27, 2023

Centura St. Anthony North Hospital DSH060104 CO

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

None

CAP approved

Chadron Community Hospital and Health Services CAH281341-00 NE

No adverse findings

None

N/A

Audit closure date: September 11, 2023

Chase County Community Hospital CAH281351-00 NE

No adverse findings

None

N/A

Audit closure date: June 20, 2023

Chattanooga C.A.R.E.S. dba Cempa Community Care FQHCLA404 TN

No adverse findings

None

N/A

Audit closure date: September 13, 2023

Citizens Medical Center Inc. CAH171362 KS

Incorrect 340B OPAIS record - Incorrect entries in 340B OPAIS for Medicare Cost Report filing date.

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

None

CAP approved

Cleveland Clinic Hospital RRC360180-00 OH

Incorrect 340B OPAIS record - Ineligible offsite outpatient facility registered on 340B OPAIS.

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

Termination of ineligible offsite outpatient facilites*

CAP implemented

Audit closure date: July 19, 2024

Clinch Memorial Hospital CAH111308-00 GA

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

None

CAP implemented

Audit closure date: September 17, 2024

Community Care Resources, Inc. STD32714 FL

No adverse findings

None

N/A

Audit closure date: June 9, 2023

Community Health Clinic Inc. CHC11358-00 PA

No adverse findings

None

N/A

Audit closure date: January 26, 2023

Community Health Programs, Incorporated
Contact Information

Senior Director Compliance and Risk Management
Community Health Programs
444 Stockbridge Road
Great Barrington, MA 01230 214-960-9767 pciotti@chpberkshires.org

CH01384B MA

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

Repayment to manufacturers

CAP approved

Community Health Service, Inc. CH050320 MN

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for address for grant associated site; Failed to remove duplicate registrations from 340B OPAIS for a grant associated site.

None

CAP implemented

Audit closure date: August 21, 2024

Community Medical Center
Contact Information

340B TPA Program Specialist
MC 24-06
100 N. Academy Ave
Danville, PA 17822
570-951-2223
jryost@geisinger.edu

DSH390001 PA

Duplicate Discounts - Inaccurate or incomplete information on the HRSA Medicaid Exclusion File; Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

Repayment to manufacturers

CAP implemented

Audit closure date: September 27, 2024

Connecticut Children's Medical Center PED073300-00 CT

No adverse findings

None

N/A

Audit closure date: July 27, 2023

Dawson Area Hospital District dba Johnson Memorial Health Services CAH241314-00 MN

No adverse findings

None

N/A

Audit closure date: January 30, 2023

Dayton Children's Hospital PED363306-00 OH

Incorrect 340B OPAIS record - Ineligible offsite outpatient facilities registered on 340B OPAIS.

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

Termination of ineligible offsite outpatient facilities*

CAP implemented

Audit closure date: June 24, 2024

Deaconess Henderson Hospital DSH180056 KY

No adverse findings

None

N/A

Audit closure date: July 27, 2023

Dekalb Medical Center, Inc. - dba Emory Decatur Hospital DSH110076 GA

Incorrect 340B OPAIS record - Incorrect entries in 340B OPAIS for Medicare Cost Report filing date, cost reporting period, control type, and disproportionate share percentage.

None

CAP implemented

Audit closure date: August 22, 2024

Denver Health Medical Center DSH060011 CO

Inaccurate or incomplete information on the HRSA 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 12, 2024

East Tennessee Children's Hospital PED443303-00 TN

No adverse findings

None

N/A

Audit closure date: August 22, 2023

Erie Family Health Center, Inc. CH053210 IL

No adverse findings

None

N/A

Audit closure date: January 25, 2023

Family Health Service of Darke County Inc CH050640 OH

No adverse findings

None

N/A

Audit closure date: August 10, 2023

Fisher-Titus Medical Center RRC360065-00 OH

Incorrect 340B OPAIS record - Offsite outpatient facility was not listed in 340B OPAIS.

Duplicate Discounts - Entity billed Medicaid while not listed in on the HRSA Medicaid Exclusion File.

None

CAP implemented

State Medicaid has since determined duplicate discounts did not occur.

Audit closure date: May 20, 2024

Fort Hamilton Hospital DSH360132 OH

No adverse findings

None

N/A

Audit closure date: August 10, 2023

Franklin Medical Center
Contact Information

340B Program Coordinator
717-360-3291
2106 Loop Road
Winnsboro, LA 71295
ckehr@fmc-cares.com

DSH190140 LA

Diversion - 340B drugs dispensed to inpatients.

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

Repayment to manufacturers

CAP approved

Freeman Health System DSH260137 MO

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

None

CAP implemented

Audit closure date: August 12, 2024

Fulton County Health Center CAH361333-00 OH

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

None

CAP implemented

Audit closure date: October 31, 2023

Geisinger Jersey Shore Hospital CAH391300-00 PA

No adverse findings

None

N/A

Audit closure date: January 24, 2023

General John J. Pershing Memorial Hospital CAH261307-00 MO

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

None

CAP implemented

Audit closure date: May 6, 2024

Genesis Medical Center - Davenport DSH160033 IA

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Medicare Cost Report filing date and disproportionate share percentage.

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

None

CAP implemented

State Medicaid has since determined duplicate discounts did not occur.

Audit closure date: January 4, 2024

Gothenburg Memorial Hospital CAH281313-00 NE

No adverse findings

None

N/A

Audit closure date: February 8, 2023

Great Plains of Sabetha, Inc. dba Sabetha Community Hospital CAH171338-00 KS

Incorrect 340B OPAIS record - Incorrect entries in 340B OPAIS for Medicare Cost Report filing date and cost reporting period.

None

CAP implemented

Audit closure date: March 11, 2024

Greater Regional Medical Center CAH161365-00 IA

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

None

CAP implemented

Audit closure date: February 26, 2024

GRMC, Inc. dba Garrett Regional Medical Center DSH210017 MD

Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File. It was determined that duplicate discounts did not occur as a result of the finding.

None

CAP approved

HealthAlliance-Clinton Hospital
Contact Information

Director of Pharmacy
UMass Memorial Health HealthAlliance - Clinton Hospital
60 Hospital Road
Leominster, MA 01453
978-466-2535
rbautz@healthalliance.com

DSH220001 MA

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

Repayment to manufacturers

CAP implemented

Audit closure date: June 24, 2024

Heartland Regional Medical Center SCH260006-00 MO

Incorrect 340B OPAIS record - Utilized a contract pharmacy without a written contract in place and failed to register contract pharmacy in 340B OPAIS; Failed to remove terminated contract pharmacies from 340B OPAIS; Failed to remove contract pharmacies from 340B OPAIS that did not have a written contract in place; Failed to remove a duplicate registration of a contract pharmacy from 340B OPAIS .

Termination of contract pharmacies from 340B Program.*

CAP implemented

Audit closure date: June 25, 2024

Heywood Hospital
Contact Information

340B Director
242 Green Street
Gardner, MA 01440
978-630-6161
Lori.Doucette@heywood.org

DSH220095 MA

Covered outpatient drugs obtained through a Group Purchasing Organization.

Diversion - 340B drugs dispensed to inpatients.

Repayment to manufacturers

CAP approved

High Country Community Health CHC24142-00 NC

Incorrect 340B OPAIS record - Failed to remove duplicate registrations from 340B OPAIS for an offsite outpatient facility; Failed to remove contract pharmacies that did not have a written contract in place; Incorrect entry in 340B OPAIS for grant associated site name.

None

CAP implemented

Audit closure date: April 3, 2024

Highland Health Providers Corporation
Contact Information

Chief Financial Officer
Highland Health Providers
1487 N. High Street
Hillsboro, OH 45133
937-840-6617
mackley@hdh.org

CHC33657-00 OH

Duplicate Discounts - Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

Repayment to manufacturers

CAP implemented

Audit closure date: September 27, 2024

Hilltown Community Health Centers, Inc.
Contact Information

Chief Executive Officer Hilltown Community Health Centers, Inc. 58 Old North Rd Worthington, MA 01098
413-238-4116 mpurdy@hchcweb.org

CH010330 MA

Entity failed to maintain auditable medical records.

Repayment to manufacturers

CAP implemented

Audit closure date: September 23, 2024

Hood Memorial Hospital CAH191309-00 LA

No adverse findings

None

N/A

Audit closure date: May 19, 2023

Howard Brown Health Center
Contact Information

Chief Strategy and Business Development Officer
1025 W Sunnyside Ave, 3rd Floor, Chicago, IL 60640
anthonya@howardbrown.org
872-269-3505

CHC29004-00 IL

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

Repayment to manufacturers

CAP approved

Hudson Hospital, Inc. CAH521335-00 WI

No adverse findings

None

N/A

Audit closure date: August 21, 2023

Huntington Hospital DSH050438 CA

No adverse findings

None

N/A

Audit closure date: November 21, 2023

Hutchinson Health DSH240187 MN

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for control type.

None

CAP implemented

Audit closure date: August 26, 2024

Insight Hospital and Medical Center Chicago
Contact Information

Director of Pharmacy
312-567-2325
Florence.osisanya@insightchicago.com

DSH140158 IL

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for disproportionate share percentage; Failed to remove contract pharmacies from 340B OPAIS that did not have a written contract in place.

Diversion - 340B drugs dispensed at covered entity and a contract pharmacy, not supported by a medical record.

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

Termination of contract pharmacies from 340B Program*

Repayment to manufacturers

CAP implemented

Audit closure date: September 16, 2024

Iron County Hospital
Contact Information

Chief Financial Officer
Iron County Hospital dba Iron County Medical Center
301 N. Highway 21
PO Box 548
Pilot Knob, MO 63663
Kayla.chamberlain@icmedcenter.org

CAH261336-00 MO

Incorrect 340B OPAIS record - Failed to remove contract pharmacy from 340B OPAIS that did not have a written contract in place.

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

Termination of contract pharmacy from 340B Program*

Repayment to manufacturers

CAP approved

Jefferson Hospital
Contact Information

Chief Financial Officer
1067 Peachtree Street, Louisville, GA 30434
478-625-7000 ext. 1207
jharrison@jeffersonhosp.com

SCH110100-00 GA

Diversion - 340B drug dispensed to inpatient.

Repayment to manufacturers

CAP implemented

Audit closure date: October 29, 2024

Jessie Trice Community Health System, Inc. CH040330 FL

Incorrect 340B OPAIS record - Offsite outpatient facility was not listed in 340B OPAIS; Incorrect entries in 340B OPAIS for subdivision name for grant associated sites.

None

CAP implemented

Audit closure date: August 26, 2024

Kansas City Care Clinic CHC28966 MO

Incorrect 340B OPAIS record - Ineligible grant associated site registered on 340B OPAIS.

Termination of ineligible grant associated site from the 340B Program.*

CAP implemented

Audit closure date: February 26, 2024

Lane Regional Medical Center
Contact Information

Director of Pharmacy
225-658-4364
jamartin@lanermc.org

DSH190020 LA

Incorrect 340B OPAIS record - Failed to remove a contract pharmacy from 340B OPAIS that did not have a written contract in place.

Diversion - 340B drug dispensed to inpatient.

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

Termination of contract pharmacy from 340B Program*

Repayment to manufacturers

CAP approved

Lawrence County Hospital CAH251305-00 MS

No adverse findings

None

N/A

Audit closure date: April 20, 2023

Lehigh Valley Hospital - Hazleton
Contact Information

340B Program Manager
2024 Lehigh Street
Allentown, PA 18013
570-590-6093
claude.parnell@lvhn.org

DSH390185 PA

Covered outpatient drugs obtained through a Group Purchasing Organization prior to April 2023.

Repayment to manufacturers

CAP implemented

Audit closure date: November 21, 2023

Lincoln Medical and Mental Health Center (NYCHHC) DSH330080 NY

No adverse findings

None

N/A

Audit closure date: September 13, 2023

Madison Memorial Hospital DSH130025 ID

Incorrect 340B OPAIS record - Failed to remove duplicate registrations from 340B OPAIS for an offsite outpatient facility.

Diversion - 340B drug dispensed to inpatient; 340B drugs dispensed at covered entity and at contract pharmacy, for prescriptions written at ineligible sites.

Repayment to manufacturers

Pending

Mantachie Rural Health Care Inc. CH043920 MS

Incorrect 340B OPAIS record - Failed to remove duplicate registrations of contract pharmacies from 340B OPAIS; Registered contract pharmacies that did not have a written contract in place.

Termination of contract pharmacies from 340B Program*

CAP approved

MCHS Eau Claire Hospital RRC520070-00 WI

Incorrect 340B OPAIS record - Incorrect entries in 340B OPAIS for address and for shipping address.

None

CAP implemented

Audit closure date: August 20, 2024

McKenzie Memorial Hospital CAH231314-00 MI

No adverse findings

None

N/A

Audit closure date: July 18, 2023

Memorial Hospital and Manor DSH110132 GA

Diversion - 340B drugs dispensed to inpatients.

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

Repayment to manufacturers

Pending

Mercy Harvard Hospital, Inc CAH141335-00 IL

No adverse findings

None

N/A

Audit closure date: June 20, 2023

Mercy Medical Center - Clinton Inc dba MercyOne Clinton Medical Center DSH160080 IA

Incorrect 340B OPAIS record - Incorrect entries in 340B OPAIS for control type and shipping address.

Diversion - 340B drug dispensed at contract pharmacy for prescription written at ineligible site.

Repayment to manufacturers

Pending

MercyOne Siouxland Medical Center
Contact Information

Director of Pharmacy
MercyOne Siouxland Medical Center
801 5th Street
Sioux City, IA 51101
Bieberb@mercyhealth.com

RRC160153-00 IA

Diversion - 340B drugs dispensed at contract pharmacies for prescriptions written at ineligible site.

Repayment to manufacturers

CAP approved

Methodist Hospital Levelland dba Covenant Hospital Levelland DSH450755 TX

Incorrect 340B OPAIS record - Entity improperly registered a distribution site as a contract pharmacy in 340B OPAIS.

Termination of contract pharmacy from 340B Program*

CAP implemented

Audit closure date: June 20, 2024

Metropolitan Hospital DSH230236 MI

Incorrect 340B OPAIS record - Failed to remove a duplicate registration of a contract pharmacy from 340B OPAIS.

Diversion - 340B drugs dispensed at contract pharmacies for prescriptions written at ineligible site.

Repayment to manufacturers

Pending

Midway Specialty Care Center, Inc. RWII34982 FL

No adverse findings

None

N/A

Audit closure date: August 1, 2024

Minnie Hamilton Health Care Center CH034190 WV

No adverse findings

None

N/A

Audit closure date: March 13, 2023

Mother Frances Hospital - Jacksonville CAH451319-00 TX

Incorrect 340B OPAIS record - Failed to remove contract pharmacy from 340B OPAIS that did not have a written contract in place; Contract pharmacy was not registered in 340B OPAIS.

Termination of contract pharmacy from 340B Program*

CAP approved

Muncy Valley Hospital CAH391301-00 PA

No adverse findings

None

N/A

Audit closure date: January 30, 2023

Murphy Medical Center dba Erlanger Western Carolina Hospital CAH341328-00 NC

Incorrect 340B OPAIS record - Failed to remove closed contract pharmacy from 340B OPAIS.

Termination of contract pharmacies from 340B Program*

CAP approved

MUSC Health Florence Medical Center DSH420091 SC

Incorrect 340B OPAIS record - Ineligible offsite outpatient facility registered on 340B OPAIS.

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

Termination of ineligible offsite outpatient facility from the 340B Program.*

CAP implemented

State Medicaid has since determined duplicate discounts did not occur.

Audit closure date: October 29, 2024

North Mississippi Primary Health Care, Inc. CH049100 MS

No adverse findings

None

N/A

Audit closure date: May 26, 2023

Northeast Community Clinic FQHCLA81C CA

No adverse findings

None

N/A

Audit closure date: March 4, 2024

Northern Rockies Medical Center dba Logan Health - Cut Bank CAH271337-00 MT

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

None

CAP implemented

Audit closure date: April 23, 2024

Northwest Medical Center Association, Inc. CAH261328-00 MO

No adverse findings

None

N/A

Audit closure date: March 14, 2023

Ohio County Hospital CAH181323-00 KY

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

None

CAP implemented

Audit closure date: October 2, 2024

OSF Heart of Mary Medical Center DSH140113 IL

No adverse findings

None

N/A

Audit closure date: August 2, 2024

Our Lady of Lourdes RMC DSH190102 LA

Duplicate Discounts - Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

None

CAP implemented

State Medicaid has since determined duplicate discounts did not occur.

Audit closure date: February 15, 2024

Planned Parenthood of the Pacific Southwest STD919112 CA

No adverse findings

None

N/A

Audit closure date: October 18, 2024

Planned Parenthood of the Rocky Mountains, Inc. STD80012 CO

No adverse findings

None

N/A

Audit closure date: June 12, 2023

Prairie du Chien Memorial Hospital Association Inc. CAH521330-00 WI

No adverse findings

None

N/A

Audit closure date: July 21, 2023

Presbyterian Hospital DSH320021 NM

Incorrect 340B OPAIS record - Offsite outpatient facilities were not registered in 340B OPAIS; Incorrect entry in 340B OPAIS for shipping address.

Duplicate Discounts - Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

Repayment to manufacturers

Pending

Providence Health and Services - Washington Providence Centralia DSH500019 WA

No adverse findings

None

N/A

Audit closure date: June 16, 2023

Providence Health System Southern California dba Providence Holy Cross Medical Center DSH050278 CA

No adverse findings

None

N/A

Audit closure date: January 31, 2023

Providence Kodiak Island Medical Center CAH021306-00 AK

No adverse findings

None

N/A

Audit closure date: July 17, 2023

Providence St. Peter Hospital RRC500024-00 WA

No adverse findings

None

N/A

Audit closure date: June 12, 2023

Queen's North Hawaii Community Hospital DSH120028 HI

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

Regional Medical Center of Central Alabama
Contact Information

Director of Pharmacy
29 LV Stabler Drive
Greenville, AL 36037
334-383-2269 salley.thompson@rmcca.com

SCH010150-00 AL

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for control type.

Duplicate Discounts - Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

Repayment to manufacturers

CAP approved

Ridgecrest Regional Hospital CAH051333-00 CA

No adverse findings

None

N/A

Audit closure date: February 27,2023

Ringgold County Hospital CAH161373-00 IA

No adverse findings

None

N/A

Audit closure date: February 8, 2023

Riverside Medical Center DSH140186 IL

No adverse findings

None

N/A

Audit closure date: June 26 2023

Rockcastle Hospital and Respiratory Care Center, Inc.
Contact Information

Director of Pharmacy
145 Newcomb Avenue
Mount Vernon, KY 40456
606-256-7738
m.fain@rhrcc.org

DSH180115 KY

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

Repayment to manufacturers

CAP implemented

Audit closure date: August 12, 2024

Rosebud Community Hospital, Inc. dba Rosebud Health Care Center CAH271327-00 MT

Incorrect 340B OPAIS record - Incorrect entries in 340B OPAIS for control type and hospital classification.

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 24, 2024

Roundup Memorial Healthcare CAH271346-00 MT

Incorrect 340B OPAIS record - Incorrect entries for in 340B OPAIS for control type and hospital classification.

None

CAP implemented

Audit closure date: March 20, 2024

Russell County Hospital
Contact Information

Chief Executive Officer
153 Dowell Road, Russell Springs, KY 42642
270-866-4141 x526
sthompson@russellcohospital.org

CAH181330-00 KY

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for control type; Offsite outpatient facility was not listed in 340B OPAIS.

Diversion - 340B drugs dispensed at a contract pharmacy, not supported by a medical record and prescribed by ineligible provider.

Repayment to manufacturers

CAP approved

Salem Health West Valley CAH381308-00 OR

Duplicate Discounts - Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

None

State Medicaid has since determined duplicate discounts did not occur.

CAP implemented

Audit closure date: October 3, 2024

San Juan Regional Medical Center
Contact Information

Director of Pharmacy
801 W. Maple Street
Farmington, NM 87401
505-609-2484
aabuffington@sjrmc.net

DSH320005 NM

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

Repayment to manufacturers

CAP approved

Satanta District Hospital CAH171324-00 KS

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

Duplicate Discounts - Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

Repayment to manufacturers

Pending

Scheurer Hospital CAH231310-00 MI

No adverse findings

None

N/A

Audit closure date: January 27, 2023

Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital CAH141333-00 IL

Incorrect 340B OPAIS record - Incorrect entries in 340B OPAIS for Medicare Cost Report filing date and cost reporting period.

None

CAP implemented

Audit closure date: March 11, 2024

Schuyler Hospital Inc. CAH331313-00 NY

Incorrect 340B OPAIS record - Incorrect entries in 340B OPAIS for Primary Contact; Failed to remove a contract pharmacy from 340B OPAIS that did not have a written contract in place.

Termination of contract pharmacy from 340B Program

CAP implemented

Audit closure date: November 8, 2023

Sebasticook Valley Health CAH201313 ME

No adverse findings

None

N/A

Audit closure date: March 13, 2023

Signature Health, Inc.
Contact Information

Chief Administrative Officer
7232 Justin Way
Mentor, OH 44060
440-578-8200 ext 10214
smajoras@shinc.org

CHC30718-00 OH

Incorrect 340B OPAIS record - Failed to remove a contract pharmacy from 340B OPAIS that did not have a written contract in place.

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

Repayment to manufacturers

CAP approved

Sleepy Eye Municipal Hospital
Contact Information

Pharmacy Manager
Sleepy Eye Medical Center
400 4th Ave NW
Sleepy Eye, MN 56085
507-794-8450
lfischer@semedicalcenter.org

CAH241327-00 MN

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

Repayment to manufacturers

CAP approved

South Central Missouri Community Health Center
Contact Information

Pharmacy Programs Manager/340B
1081 East 18th Street, Rolla, MO 65401
573-545-5934 abrooks@fourrivers.org

CHC26564-01 MO

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

Repayment to manufacturers

CAP implemented

Audit closure date: July 24, 2024

South Central Regional Medical Center DSH250058 MS

Diversion - 340B drugs dispensed at contract pharmacies for prescriptions written at ineligible site.

Repayment to manufacturers

Pending

Southwest Colorado Mental Center, Inc. CHC26510-00 CO

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Authorizing Official for parent site and offsite outpatient facilities.

Diversion - 340B drugs dispensed at contract pharmacies, for prescriptions written at ineligible sites.

Repayment to manufacturers

Pending

St. Bernard's Community Hospital dba Crossridge Community Hospital CAH041307-00 AR

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for control type; Failed to remove closed contract pharmacy from 340B OPAIS.

None

CAP implemented

Audit closure date: June 24, 2024

St. Elizabeth Boardman Health Ctr DSH360276 OH

Incorrect 340B OPAIS record - Offsite outpatient facilities were not listed in 340B OPAIS.

Duplicate Discounts - Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

None

CAP implemented

State Medicaid has since determined duplicate discounts did not occur.

Audit closure date: May 30, 2024

St. Elizabeth Community Hospital
Contact Information

340B Division Manager
2550 Sister Mary Columba
Red Bluff, CA 96080
ryan.pearcy@commonspirit.org

DSH050042 CA

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

Repayment to manufacturers

CAP approved

St. Luke's Hospital of Kansas City DSH260138 MO

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for name for offsite outpatient facility; Incorrect entries for address for offsite outpatient facilities.

Duplicate Discounts - Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

None

State Medicaid has since determined duplicate discounts did not occur.

CAP implemented

Audit closure date: July 16, 2024

St. Lukes Hospital CAH341322-00 NC

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for control type.

None

CAP implemented

Audit closure date: January 8, 2024

St. Lukes Regional Medical Center, Ltd. DSH130006 ID

No adverse findings

None

N/A

Audit closure date: July 21, 2023

St. Vincent Hospital of the Hospital Sisters of the Third Order of St. Francis DSH520075 WI

No adverse findings

None

N/A

Audit closure date: June 5, 2023

Staten Island University Hospital DSH330160 NY

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

Sutter Bay Hospitals, dba Eden Medical Center DSH050488 CA

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

None

CAP implemented

Audit closure date: October 3, 2024

Sutter Bay Hospitals, dba Sutter Santa Rosa Regional Hospital DSH050291 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 approved

Syringa Hospital District CAH131315-00 ID

Incorrect 340B OPAIS record - Incorrect entries in 340B OPAIS for Authorizing Official and Primary Contact.

None

CAP implemented

Audit closure date: June 6, 2024

Tarrant County Hospital District dba JPS Health Network DSH450039 TX

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

None

CAP approved

Taylorville Memorial Hospital CAH141339-00 IL

No adverse findings

None

N/A

Audit closure date:
July 10, 2023

Trego County Lemke Memorial Hospital CAH171355-00 KS

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for address for offsite outpatient facilities

None

CAP implemented

Audit closure date: March 11, 2024

Tri-County Memorial Hospital, Inc. CAH521316-00 WI

No adverse findings

None

N/A

Audit closure date: March 20, 2023

Trinity Health Shelby Hospital CAH231320-00 MI

No adverse findings

None

N/A

Audit closure date: June 9, 2023

Truman Medical Center, Incorporated dba University Health Lakewood Medical Center DSH260102 MO

Incorrect 340B OPAIS record - Failed to remove a duplicate registration of a contract pharmacy from 340B OPAIS.

None

CAP implemented

Audit closure date: May 20, 2024

Tyrone Hospital CAH391307-00 PA

No adverse findings

None

N/A

Audit closure date: September 28, 2023

UMass Memorial Health - Harrington Hospital, Inc.
Contact Information

Director of Pharmacy
UMass Memorial Health - Harrington
100 South Street
Southbridge, MA 01550
508-765-3110
kristie.reed@umassmemorial.org

DSH220019 MA

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

Repayment to manufacturers

CAP implemented

Audit closure date: July 16, 2024

University of Florida HV01312 FL

No adverse findings

None

N/A

Audit closure date: March 20, 2023

University of Miami Hospital and Clinics
Contact Information

AVP UHealth Pharmacy Services
1400 NW 12th Avenue, Suite 3023
Miami, FL 33136
305-689-5630
brivera@med.miami.edu

CAN100079-00 FL

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for EIN.

Diversion - 340B drugs dispensed to inpatients.

Repayment to manufacturers

CAP approved

University of Texas Medical Branch DSH450018 TX

Incorrect 340B OPAIS record - Offsite outpatient facilities were not listed in 340B OPAIS.

None

CAP implemented

Audit closure date: August 28, 2024

UPMC Magee-Womens Hospital DSH390114 PA

Entity billed Medicaid while not listed on the HRSA 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 27, 2024

USC Arcadia Hospital DSH050238 CA

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for control type and disproportionate share percentage.

None

CAP approved

Valley View Hospital Association DSH060075 CO

No adverse findings

None

N/A

Audit closure date: September 13, 2023

Wallowa County Health Care District DBA Wallowa Memorial Hospital CAH381306-00 OR

Incorrect 340B OPAIS record Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

None

CAP implemented

Audit closure date: October 22, 2024

Warren General Hospital DSH390146 PA

Duplicate Discounts - Entity billed Medicaid while not listed on the HRSA Medicaid Exclusion File.

None

State Medicaid has since determined duplicate discounts did not occur.

CAP implemented

Audit closure date: August 21, 2024

Washington University in St. Louis HV07849 MO

No adverse findings

None

N/A

Audit closure date: June 6, 2023

Washoe Barton Medical Clinic dba Carson Valley Health CAH291306-00 NV

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

None

CAP implemented

Audit closure date: June 10, 2024

Wayne Memorial Hospital DSH340010 NC

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for Medicare Cost Report filing date.

None

CAP implemented

Audit closure date: March 11, 2024

West Georgia Medical Center, Inc. DBA Wellstar West Georgia Medical Center DSH110016 GA

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for control type.

None

CAP implemented

Audit closure date: July 24, 2024

Whidbey General Hospital CAH501339-00 WA

Incorrect 340B OPAIS record - Incorrect entry in 340B OPAIS for entity address.

None

CAP implemented

Audit closure date: March 7, 2024

Winneshiek Medical Center CAH161371-00 IA

No adverse findings

None

N/A

Audit closure date: March 20, 2023

Yoakum Community Hospital
Contact Information

Chief Financial Officer
Yoakum Community Hospital
1200 Carl Ramert Drive
Yoakum, TX 77995
361-293-2321 x104
john.olivares@yoakumhospital.org

CAH451346-00 TX

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

Repayment to manufacturers

CAP approved

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

Date Last Reviewed: