Details | Last Recertification Date | Update | Recertification | 2/9/2024 9:51:48 AM | 2/24/2025 2:13:03 PM | 2/24/2025 2:13 PM |
Contacts | Authorizing Official | Update | Group Change Request | Coppenrath, Maria
SVP, CFO
Greater Lawrence Family Health Center
9787257400-6667 | Paris, Steven
Interim President & Chief Executive Officer
Greater Lawrence Family Health Center, Inc.
9787257400 | 1/13/2025 1:33 PM |
Addresses | Shipping Address | Delete | Change Request | Greater Lawrence Family Health Center Pharmacy
73D Winthrop Ave
Lawrence, MA 01843 | | 8/30/2024 5:35 PM |
Details | Last Recertification Date | Update | Recertification | 2/23/2023 1:34:20 PM | 2/9/2024 9:51:48 AM | 2/9/2024 9:51 AM |
Addresses | Shipping Address | Insert | Group Change Request | | Greater Lawrence Family Health Center Pharmacy
73D Winthrop Ave
Lawrence, MA 01843 | 1/22/2024 1:37 PM |
Contacts | Primary Contact | Update | Profile Change Request | McManus, Danielle
340B Program Manager
Greater Lawrence Family Health Center
9785181269 | McManus, Danielle
340B Program Manager
Greater Lawrence Family Health Center
9786896646 | 10/19/2023 3:09 PM |
Contacts | Primary Contact | Update | Group Change Request | Martin, Diane
SVP, Chief Pharmacy Officer
Greater Lawrence Family Health Center
9786896635 | McManus, Danielle
340B Program Manager
Greater Lawrence Family Health Center
9785181269 | 10/19/2023 1:05 PM |
Details | Last Recertification Date | Update | Recertification | 2/17/2022 3:17:23 PM | 2/23/2023 1:34:20 PM | 2/23/2023 1:34 PM |
Contacts | Primary Contact | Update | Profile Change Request | Martin, Diane
SVP Pharmacy Operations
Greater Lawrence Family Health Center
9786896635 | Martin, Diane
SVP, Chief Pharmacy Officer
Greater Lawrence Family Health Center
9786896635 | 2/14/2023 7:02 PM |
Details | Last Recertification Date | Update | Recertification | 2/24/2021 7:38:33 PM | 2/17/2022 3:17:23 PM | 2/17/2022 3:17 PM |
Contacts | Authorizing Official | Update | Group Change Request | Silva, John M
President and CEO
Greater Lawrence Family Health Center
9787257400 | Coppenrath, Maria
SVP, CFO
Greater Lawrence Family Health Center
9787257400-6667 | 9/20/2021 12:09 PM |
Addresses | Shipping Address | Insert | Recertification | | Greater Lawrence Family Health Center Pharmacy
755 Main St
Suite C
Haverhill, MA 01830 | 2/24/2021 7:38 PM |
Medicaid Billing | NPI: Number | Delete | Recertification | 1851504963 ( ) | | 2/24/2021 7:38 PM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1851504963 | 2/24/2021 7:38 PM |
Medicaid Billing | NPI: State | Insert | Recertification | | MA | 2/24/2021 7:38 PM |
Details | Last Recertification Date | Update | Recertification | 2/18/2020 3:17:31 PM | 2/24/2021 7:38:33 PM | 2/24/2021 7:38 PM |
Details | Last Recertification Date | Update | Recertification | 2/13/2019 9:44:10 AM | 2/18/2020 3:17:31 PM | 2/18/2020 3:17 PM |
Contacts | Primary Contact | Update | Profile Change Request | Martin, Diane
VP Pharmacy Operations
Greater Lawrence Family Health Center
9786896635 | Martin, Diane
SVP Pharmacy Operations
Greater Lawrence Family Health Center
9786896635 | 10/14/2019 4:28 PM |
Details | Last Recertification Date | Update | Recertification | 2/21/2018 3:09:50 PM | 2/13/2019 9:44:10 AM | 2/13/2019 9:44 AM |
Addresses | Shipping Address | Delete | Change Request | Greater Lawrence Family Health Center Pharmacy, Inc
73A Winthrop Ave
Lawrence, MA 01843 | | 1/18/2019 8:59 AM |
Addresses | Shipping Address | Insert | Change Request | | Greater Lawrence Family Health Center Pharmacy
73 A Winthrop Ave
Lawrence, MA 01843 | 1/18/2019 8:59 AM |
Addresses | Shipping Address | Insert | Change Request | | Greater Lawrence Family Health Center Pharmacy
34 Haverhill St
Lawrence, MA 01841 | 1/18/2019 8:59 AM |
Addresses | Shipping Address | Insert | Change Request | | Greater Lawrence Family Health Center Pharmacy
700 Essex St
Lawrence, MA 01841 | 1/18/2019 8:59 AM |
Addresses | Shipping Address | Insert | Change Request | | Greater Lawrence Family Health Center Pharmacy
150 Park St
Lawrence, MA 01841 | 1/18/2019 8:59 AM |
Addresses | Shipping Address | Insert | Change Request | | Greater Lawrence Family Health Center Pharmacy
147 Pelham St
Methuen, MA 01844 | 1/18/2019 8:59 AM |
Medicaid Billing | Medicaid: Number | Update | Change Request | 110020863 | 110020863D | 1/18/2019 8:59 AM |
Addresses | Shipping Address | Insert | Recertification | | Greater Lawrence Family Health Center Pharmacy, Inc
73A Winthrop Ave
Lawrence, MA 01843 | 2/21/2018 3:09 PM |
Details | Last Recertification Date | Update | Recertification | 2/13/2017 12:00:00 AM | 2/21/2018 3:09:50 PM | 2/21/2018 3:09 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1699774646 ( ) | | 12/5/2017 1:54 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1760695878 ( ) | | 12/5/2017 1:54 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1679786784 ( ) | | 12/5/2017 1:54 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1255630448 ( ) | | 12/5/2017 1:54 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1013284843 ( ) | | 12/5/2017 1:54 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1912266065 ( ) | | 12/5/2017 1:54 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1669685780 ( ) | | 12/5/2017 1:54 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1306989702 ( ) | | 12/5/2017 1:54 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1679715643 ( ) | | 12/5/2017 1:54 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1326275926 ( ) | | 12/5/2017 1:54 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1447502463 ( ) | | 10/25/2017 2:48 PM |
Contacts | Authorizing Official | Insert | Change Request | | Silva, John M
President and CEO
Greater Lawrence Family Health Center
9787257400 | 10/25/2017 2:48 PM |
Contacts | Primary Contact | Update | | Martin, Diane
VP Pharmacy Operations
9786896635 | Martin, Diane
VP Pharmacy Operations
Greater Lawrence Family Health Center
9786896635 | 10/17/2017 2:57 PM |
Contacts | Primary Contact | Update | | URQUHART, ROBERT
CFO
9786896661 | Martin, Diane
VP Pharmacy Operations
9786896635 | 8/1/2017 2:45 PM |
Addresses | Main Address | Insert | | |
73 D WINTHROP AVE
LAWRENCE, MA 01843-3716 | 2/13/2017 10:55 AM |
Details | Last Recertification Date | Update | | 2/18/2016 12:00:00 AM | 2/13/2017 12:00:00 AM | 2/13/2017 10:55 AM |
Details | Last Recertification Date | Update | | 3/2/2015 12:00:00 AM | 2/18/2016 12:00:00 AM | 2/18/2016 10:03 AM |
Addresses | Billing Address | Insert | | | Greater Lawrence Family Health Center
1 Griffin Brook Drive, Suite 101
Methuen, MA 01844 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1447502463 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1679715643 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1326275926 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1760695878 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1679786784 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1255630448 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1013284843 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1912266065 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1669685780 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1306989702 | 2/8/2016 2:47 PM |
Medicaid Billing | NPI: Number | Insert | | | 1851504963 | 12/15/2015 9:31 AM |
Medicaid Billing | NPI: Number | Insert | | | 1699774646 | 3/2/2015 1:23 PM |
Details | Last Recertification Date | Update | | 3/17/2014 12:00:00 AM | 3/2/2015 12:00:00 AM | 3/2/2015 1:23 PM |
Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/17/2014 12:00:00 AM | 3/17/2014 12:17 PM |
Details | Entity Name | Update | | GREATER LAWRENCE FAMILY HEALTH CENTER - SOUTH | GREATER LAWRENCE FAMILY HEALTH CENTER INC | 3/17/2014 12:17 PM |
Details | Entity Subname | Update | | | GLFHC-SOUTH | 3/17/2014 12:17 PM |
Contacts | Primary Contact | Insert | | | URQUHART, ROBERT
CFO
9786896661 | 8/8/2013 12:52 PM |
Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/11/2013 2:33 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 9/11/2012 12:03 PM |
Medicaid Billing | Medicaid: Number | Insert | | | 110020863 | 9/11/2012 12:03 PM |
Medicaid Billing | Medicaid: State | Insert | | | MA | 9/11/2012 12:03 PM |
Details | Last Recertification Date | Insert | | | | 1/10/2007 1:59 PM |
Details | Grant Number | Insert | | | H80CS00314 | 1/10/2007 1:59 PM |
Details | 340B ID | Insert | | | CH01216P | 1/10/2007 1:59 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 1/10/2007 1:59 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/10/2007 1:59 PM |
Details | Medicare Provider Number | Insert | | | | 1/10/2007 1:59 PM |
Details | Entity Name | Insert | | | GREATER LAWRENCE FAMILY HEALTH CENTER - SOUTH | 1/10/2007 1:59 PM |
Details | Program Code | Insert | | | CH | 1/10/2007 1:59 PM |
Details | Entity Subname | Insert | | | | 1/10/2007 1:59 PM |
Dates | Participating Approval Date | Insert | | | 4/28/2004 12:00:00 AM | 1/10/2007 1:59 PM |
Details | State | Insert | | | Active | 1/10/2007 1:59 PM |
Dates | Registration Date | Insert | | | 7/1/2004 12:00:00 AM | 1/10/2007 1:59 PM |
Dates | Signed By Date | Insert | | | | 1/10/2007 1:59 PM |
Dates | Start Date | Insert | | | 7/1/2004 12:00:00 AM | 1/10/2007 1:59 PM |
Terminations | Termination Comments | Insert | | | | 1/10/2007 1:59 PM |
Terminations | Termination Date | Insert | | | | 1/10/2007 1:59 PM |
Terminations | Termination Effective Date | Insert | | | | 1/10/2007 1:59 PM |
Terminations | Termination Reason | Insert | | | | 1/10/2007 1:59 PM |
Details | Comments Public | Insert | | | NEW ADD 7/1/04; 1/10/07 - UPDATED ADDRESS (WAS PLAZA ONE FOURTEEN, 3730 WINTHROP AVE (RT 114)) | 1/10/2007 1:59 PM |