| Contacts | Primary Contact | Update | PC Change Request | McCullough, Mary
Administrative Manager
ChesPenn Health Services
6104853800-629 | Ruvolo, David
Compliance Officer
ChesPenn Health Services
6104853800-635 | 2/26/2025 11:01 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2024 8:31:06 AM | 2/26/2025 10:47:15 AM | 2/26/2025 10:47 AM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2023 10:41:26 AM | 1/31/2024 8:31:06 AM | 1/31/2024 8:31 AM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2022 8:44:32 AM | 2/2/2023 10:41:26 AM | 2/2/2023 10:41 AM |
| Contacts | Authorizing Official | Update | Change Request | Brink, Cindy
Compliance Officer
ChesPenn Health Services
6104853800-635 | Harris McGovern, Susan
President and CEO
ChesPenn Health Services
6104853800-632 | 1/6/2023 11:11 AM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2021 12:26:45 PM | 2/4/2022 8:44:32 AM | 2/4/2022 8:44 AM |
| Details | Last Recertification Date | Update | Recertification | 2/6/2020 2:05:32 PM | 2/16/2021 12:26:45 PM | 2/16/2021 12:26 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Brink, Cindy
Contracts and Compliance Manager
ChesPenn Health Services
6104853800-635 | Brink, Cindy
Compliance Officer
ChesPenn Health Services
6104853800-635 | 2/5/2021 2:04 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Lucas, Michael G.
CEO and President
ChesPenn Health Services
6104853800-630 | Brink, Cindy
Contracts and Compliance Manager
ChesPenn Health Services
6104853800-635 | 2/12/2020 11:24 AM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2019 8:21:11 AM | 2/6/2020 2:05:32 PM | 2/6/2020 2:05 PM |
| Details | Last Recertification Date | Update | Recertification | 3/2/2018 12:35:47 PM | 2/5/2019 8:21:11 AM | 2/5/2019 8:21 AM |
| Addresses | Billing Address | Update | Recertification | CHESPENN HEALTH SERVICES
2600 W 9TH STREET - 2 NORTH
CHESTER, PA 19013 | CHESPENN HEALTH SERVICES
1510 Chester Pike, Suite 200
Eddystone, PA 19022 | 3/2/2018 12:35 PM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2017 12:00:00 AM | 3/2/2018 12:35:47 PM | 3/2/2018 12:35 PM |
| Contacts | Primary Contact | Update | | McCullough, Mary
Administrative Manager
6104853800-629 | McCullough, Mary
Administrative Manager
ChesPenn Health Services
6104853800-629 | 2/7/2018 2:59 PM |
| Contacts | Authorizing Official | Update | | Lucas, Michael G.
CEO and President
6104853800-630 | Lucas, Michael G.
CEO and President
ChesPenn Health Services
6104853800-630 | 2/7/2018 2:35 PM |
| Contacts | Authorizing Official | Insert | | | Lucas, Michael G.
CEO and President
6104853800-630 | 2/22/2017 1:05 PM |
| Contacts | Primary Contact | Insert | | | McCullough, Mary
Administrative Manager
6104853800-629 | 2/21/2017 9:52 AM |
| Addresses | Main Address | Insert | | |
125 E 9th St
Chester, PA 19013-6019 | 2/21/2017 8:42 AM |
| Details | Last Recertification Date | Update | | 2/17/2016 12:00:00 AM | 2/21/2017 12:00:00 AM | 2/21/2017 8:42 AM |
| Details | Last Recertification Date | Update | | 2/10/2015 12:00:00 AM | 2/17/2016 12:00:00 AM | 2/17/2016 11:13 AM |
| Details | Last Recertification Date | Update | | 3/19/2014 12:00:00 AM | 2/10/2015 12:00:00 AM | 2/10/2015 1:58 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/19/2014 12:00:00 AM | 3/19/2014 2:55 PM |
| Details | Entity Subname | Update | | EASTSIDE HEALTH CENTER | ChesPenn Eastside Health Center | 3/19/2014 2:55 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/4/2013 8:06 AM |
| Addresses | Billing Address | Insert | | | CHESPENN HEALTH SERVICES
2600 W 9TH STREET - 2 NORTH
CHESTER, PA 19013 | 1/14/2010 3:01 PM |
| Details | Last Recertification Date | Insert | | | | 1/14/2010 3:01 PM |
| Details | Grant Number | Insert | | | H80CS00738 | 1/14/2010 3:01 PM |
| Details | 340B ID | Insert | | | CH03393F | 1/14/2010 3:01 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/14/2010 3:01 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/14/2010 3:01 PM |
| Details | Medicare Provider Number | Insert | | | | 1/14/2010 3:01 PM |
| Details | Entity Name | Insert | | | CHESPENN HEALTH SERVICES | 1/14/2010 3:01 PM |
| Details | Program Code | Insert | | | CH | 1/14/2010 3:01 PM |
| Details | Entity Subname | Insert | | | EASTSIDE HEALTH CENTER | 1/14/2010 3:01 PM |
| Dates | Participating Approval Date | Insert | | | 12/17/2004 12:00:00 AM | 1/14/2010 3:01 PM |
| Details | State | Insert | | | Active | 1/14/2010 3:01 PM |
| Dates | Registration Date | Insert | | | 1/1/2005 12:00:00 AM | 1/14/2010 3:01 PM |
| Dates | Signed By Date | Insert | | | | 1/14/2010 3:01 PM |
| Dates | Start Date | Insert | | | 1/1/2005 12:00:00 AM | 1/14/2010 3:01 PM |
| Terminations | Termination Comments | Insert | | | | 1/14/2010 3:01 PM |
| Terminations | Termination Date | Insert | | | | 1/14/2010 3:01 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/14/2010 3:01 PM |
| Terminations | Termination Reason | Insert | | | | 1/14/2010 3:01 PM |
| Details | Comments Public | Insert | | | 1/14/10 UPDATED BILL TO ADD (WAS 1300 W 9TH STREET); NEW SITE 01/01/2005 | 1/14/2010 3:01 PM |