| Contacts | Primary Contact | Update | Profile Change Request | Sturm, Benjamin
Director of Pharmacy & Optometry
Charles River Community Health
6178707448 | Sturm, Benjamin
Director of Pharmacy
Charles River Community Health
6178707448 | 4/9/2025 3:31 PM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2024 4:17:35 PM | 2/27/2025 3:49:13 PM | 2/27/2025 3:49 PM |
| Contacts | Authorizing Official | Update | Group Change Request | Browne, Elizabeth
CEO
Charles River Community Health
6172081511 | Mullaney, Matthew L.
Chief Executive Officer
Charles River Community Health
7814006221 | 1/21/2025 2:18 PM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2023 3:35:14 PM | 1/29/2024 4:17:35 PM | 1/29/2024 4:17 PM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2022 12:02:33 PM | 2/17/2023 3:35:14 PM | 2/17/2023 3:35 PM |
| Details | Last Recertification Date | Update | Recertification | 2/19/2021 9:01:14 AM | 2/4/2022 12:02:33 PM | 2/4/2022 12:02 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | MA | 2/19/2021 9:01 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | MA | 2/19/2021 9:01 AM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2020 10:07:54 AM | 2/19/2021 9:01:14 AM | 2/19/2021 9:01 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Browne, Elizabeth
Executive Director
Charles River Community Health
6172081511 | Browne, Elizabeth
CEO
Charles River Community Health
6172081511 | 2/5/2021 2:49 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Sturm, Benjamin
Assoc. Director of Pharmacy
Charles River Community Health
6178707448 | Sturm, Benjamin
Director of Pharmacy & Optometry
Charles River Community Health
6178707448 | 2/5/2021 12:39 PM |
| Medicaid Billing | Medicaid: Number | Update | Recertification | 1301446 | 110024306H | 1/29/2020 10:07 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2019 10:21:29 AM | 1/29/2020 10:07:54 AM | 1/29/2020 10:07 AM |
| Contacts | Primary Contact | Update | Change Request | Souza, James
CFO
Charles River Community Health
6178707280 | Sturm, Benjamin
Assoc. Director of Pharmacy
Charles River Community Health
6178707448 | 1/30/2019 12:37 PM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2018 10:01:26 AM | 1/30/2019 10:21:29 AM | 1/30/2019 10:21 AM |
| Contacts | Primary Contact | Update | Recertification | SOUZA, JAMES
CFO
6178707280 | Souza, James
CFO
Charles River Community Health
6178707280 | 2/14/2018 10:01 AM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2017 12:00:00 AM | 2/14/2018 10:01:26 AM | 2/14/2018 10:01 AM |
| Contacts | Authorizing Official | Update | AO Change Request | BROWNE, ELIZABETH
EXECUTIVE DIRECTOR
6172081611 | Browne, Elizabeth
Executive Director
Charles River Community Health
6172081511 | 2/12/2018 11:05 AM |
| Contacts | Authorizing Official | Insert | | | BROWNE, ELIZABETH
EXECUTIVE DIRECTOR
6172081611 | 5/11/2017 5:06 PM |
| Addresses | Main Address | Insert | | |
495 Western Avenue
Brighton, MA 02135 | 2/7/2017 11:58 AM |
| Contacts | Primary Contact | Insert | | | SOUZA, JAMES
CFO
6178707280 | 2/7/2017 11:58 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1891241816 | 2/7/2017 11:58 AM |
| Details | Last Recertification Date | Update | | 3/4/2016 12:00:00 AM | 2/7/2017 12:00:00 AM | 2/7/2017 11:58 AM |
| Details | Entity Name | Update | | CHARLES RIVER COMMUNITY HEALTH | Charles River Community Health at 495 Western Ave | 3/15/2016 3:08 PM |
| Details | Entity Name | Update | | JOSEPH M. SMITH COMMUNITY HEALTH CENTER, INC. | CHARLES RIVER COMMUNITY HEALTH | 3/15/2016 3:06 PM |
| Details | Entity Subname | Update | | Joseph M. Smith Community Health Center at Brighton | | 3/15/2016 3:06 PM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 3/4/2016 3:08 PM |
| Details | Last Recertification Date | Update | | 2/12/2015 12:00:00 AM | 3/4/2016 12:00:00 AM | 3/4/2016 3:08 PM |
| Details | Comments Public | Insert | | | 12/31/15 Site ID updated, needed due to 10/21/15 address update; 8/27/09 MEDI # ADDED - NEW SITE 04/01/2004 | 12/31/2015 8:44 PM |
| Details | Entity Subname | Update | | Joseph M. Smith Community Health Center at Allston | Joseph M. Smith Community Health Center at Brighton | 10/21/2015 12:23 PM |
| Details | Last Recertification Date | Update | | 3/15/2014 12:00:00 AM | 2/12/2015 12:00:00 AM | 2/12/2015 12:47 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/15/2014 12:00:00 AM | 3/15/2014 9:05 AM |
| Details | Entity Subname | Update | | | Joseph M. Smith Community Health Center at Allston | 3/15/2014 9:05 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1295068559 | 2/27/2013 12:48 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/27/2013 12:48 PM |
| Details | Last Recertification Date | Insert | | | | 8/27/2009 9:48 AM |
| Details | Grant Number | Insert | | | H80CS00378 | 8/27/2009 9:48 AM |
| Details | 340B ID | Insert | | | CH011890 | 8/27/2009 9:48 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/27/2009 9:48 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/27/2009 9:48 AM |
| Details | Medicare Provider Number | Insert | | | | 8/27/2009 9:48 AM |
| Details | Entity Name | Insert | | | JOSEPH M. SMITH COMMUNITY HEALTH CENTER, INC. | 8/27/2009 9:48 AM |
| Details | Program Code | Insert | | | CH | 8/27/2009 9:48 AM |
| Details | Entity Subname | Insert | | | | 8/27/2009 9:48 AM |
| Dates | Participating Approval Date | Insert | | | 3/17/2004 12:00:00 AM | 8/27/2009 9:48 AM |
| Details | State | Insert | | | Active | 8/27/2009 9:48 AM |
| Dates | Registration Date | Insert | | | 4/1/2004 12:00:00 AM | 8/27/2009 9:48 AM |
| Dates | Signed By Date | Insert | | | 8/11/2009 12:00:00 AM | 8/27/2009 9:48 AM |
| Dates | Start Date | Insert | | | 4/1/2004 12:00:00 AM | 8/27/2009 9:48 AM |
| Terminations | Termination Comments | Insert | | | | 8/27/2009 9:48 AM |
| Terminations | Termination Date | Insert | | | | 8/27/2009 9:48 AM |
| Terminations | Termination Effective Date | Insert | | | | 8/27/2009 9:48 AM |
| Terminations | Termination Reason | Insert | | | | 8/27/2009 9:48 AM |
| Details | Comments Public | Insert | | | 8/27/09 MEDI # ADDED - NEW SITE 04/01/2004 | 8/27/2009 9:48 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 4/1/2004 12:00 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 1301446 | 4/1/2004 12:00 AM |
| Medicaid Billing | Medicaid: State | Insert | | | MA | 4/1/2004 12:00 AM |