| Details | Last Recertification Date | Update | Recertification | 2/19/2024 1:31:22 AM | 2/26/2025 12:20:24 PM | 2/26/2025 12:20 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Wardlaw, Ernest Stan
Chief Executive Officer
Sandhills Medical Foundation, Inc.
8039006612 | Cantave, Delgado
CEO
Sandhills Medical Foundation, Inc
8039006469 | 2/25/2025 11:02 AM |
| Details | Last Recertification Date | Update | Recertification | 2/24/2023 11:49:05 AM | 2/19/2024 1:31:22 AM | 2/19/2024 1:31 AM |
| Contacts | Authorizing Official | Update | Group Change Request | Roberts, David
Chief Executive Officer
Sandhills Medical Foundation, Inc.
8433356454 | Wardlaw, Ernest Stan
Chief Executive Officer
Sandhills Medical Foundation, Inc.
8039006612 | 11/16/2023 11:51 AM |
| Details | Entity Name | Update | Change Request | SANDHILLS MEDICAL FOUNDATION | SANDHILLS MEDICAL FOUNDATION, INC. | 5/2/2023 5:19 PM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2022 7:21:03 AM | 2/24/2023 11:49:05 AM | 2/24/2023 11:49 AM |
| Details | Entity Subname | Update | Recertification | SANDHILLS MEDICAL FOUNDATION Inc - Sumter Site | Sandhills Medical Foundation Inc. - Sumter Site | 2/24/2023 11:49 AM |
| Contacts | Authorizing Official | Update | Group Change Request | Dixon, Christopher W.
CEO
Sandhills Medical Foundation, Inc
8433356754 | Roberts, David
Chief Executive Officer
Sandhills Medical Foundation, Inc.
8433356454 | 8/12/2022 10:39 AM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2021 2:40:59 PM | 1/31/2022 7:21:03 AM | 1/31/2022 7:21 AM |
| Addresses | Main Address | Update | Change Request |
425 N Salem Ave
Sumter, SC 29150-4115 |
30 Cuttino Rd
Sumter, SC 29150-4115 | 1/27/2022 12:42 PM |
| Addresses | Shipping Address | Update | Change Request | SANDHILLS MEDICAL PHARMACY -2
425 N SALEM AVE
SUMTER, SC 29150 | SANDHILLS MEDICAL PHARMACY #2
30 Cuttino Rd
SUMTER, SC 29150 | 1/27/2022 12:42 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | SC | 2/13/2021 2:40 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | SC | 2/13/2021 2:40 PM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2020 1:40:35 AM | 2/13/2021 2:40:59 PM | 2/13/2021 2:40 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2019 9:02:53 AM | 1/31/2020 1:40:35 AM | 1/31/2020 1:40 AM |
| Details | Last Recertification Date | Update | Recertification | 3/6/2018 10:47:20 AM | 2/1/2019 9:02:53 AM | 2/1/2019 9:02 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2017 12:00:00 AM | 3/6/2018 10:47:20 AM | 3/6/2018 10:47 AM |
| Contacts | Authorizing Official | Update | | Dixon, Christopher W.
CEO
8433356754 | Dixon, Christopher W.
CEO
Sandhills Medical Foundation, Inc
8433356754 | 3/6/2018 10:36 AM |
| Contacts | Primary Contact | Update | | Rollings, Erin
DIRECTOR OF PHARMACY
8034385537 | Rollings, Erin
DIRECTOR OF PHARMACY
Sandhills Medical Foundation, Inc.
8034385537 | 10/17/2017 1:07 PM |
| Contacts | Authorizing Official | Update | | HIX, WARREN
CEO
8436583005-25 | Dixon, Christopher W.
CEO
8433356754 | 7/14/2017 11:45 AM |
| Contacts | Primary Contact | Update | | NORWOOD, ALYSSA
DIRECTOR OF PHARMACY
8034385537 | Rollings, Erin
DIRECTOR OF PHARMACY
8034385537 | 4/5/2017 2:59 PM |
| Addresses | Main Address | Insert | | |
425 N Salem Ave
Sumter, SC 29150-4115 | 1/30/2017 1:14 PM |
| Details | Last Recertification Date | Update | | 2/23/2016 12:00:00 AM | 1/30/2017 12:00:00 AM | 1/30/2017 1:14 PM |
| Addresses | Billing Address | Insert | | | SANDHILLS MEDICAL FOUNDATION, INC
409 EAST CHURCH STREET, PO BOX 249
JEFFERSON, SC 29718 | 11/23/2016 12:44 PM |
| Addresses | Shipping Address | Insert | | | SANDHILLS MEDICAL PHARMACY -2
425 N SALEM AVE
SUMTER, SC 29150 | 11/23/2016 12:44 PM |
| Contacts | Primary Contact | Update | | NORWOOD, ALYSSA
DIRECTOR OF PHARMACY
8034385537 | NORWOOD, ALYSSA
DIRECTOR OF PHARMACY
8034385537 | 5/25/2016 10:52 AM |
| Medicaid Billing | Medicaid: Number | Update | | 421887 | FQC056 | 2/23/2016 10:10 AM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 2/23/2016 10:10 AM |
| Details | Last Recertification Date | Update | | 3/4/2015 12:00:00 AM | 2/23/2016 12:00:00 AM | 2/23/2016 10:10 AM |
| Details | Last Recertification Date | Update | | 3/21/2014 12:00:00 AM | 3/4/2015 12:00:00 AM | 3/4/2015 8:53 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 3/21/2014 10:30 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 421887 | 3/21/2014 10:30 PM |
| Medicaid Billing | Medicaid: State | Insert | | | SC | 3/21/2014 10:30 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1780742825 | 3/21/2014 10:30 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/21/2014 12:00:00 AM | 3/21/2014 10:30 PM |
| Details | Entity Name | Update | | SANDHILLS MEDICAL FOUNDATION, INC | SANDHILLS MEDICAL FOUNDATION | 3/21/2014 10:30 PM |
| Details | Entity Subname | Update | | SANDHILLS MEDICAL CENTER | SANDHILLS MEDICAL FOUNDATION Inc - Sumter Site | 3/21/2014 10:30 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/14/2013 12:34 PM |
| Contacts | Primary Contact | Insert | | | NORWOOD, ALYSSA
DIRECTOR OF PHARMACY
8034385537 | 6/11/2012 8:56 AM |
| Contacts | Authorizing Official | Insert | | | HIX, WARREN
CEO
8436583005-25 | 6/11/2012 8:56 AM |
| Details | Last Recertification Date | Insert | | | | 1/21/2010 11:31 AM |
| Details | Grant Number | Insert | | | H80CS00501 | 1/21/2010 11:31 AM |
| Details | 340B ID | Insert | | | CH04505D | 1/21/2010 11:31 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/21/2010 11:31 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/21/2010 11:31 AM |
| Details | Medicare Provider Number | Insert | | | | 1/21/2010 11:31 AM |
| Details | Entity Name | Insert | | | SANDHILLS MEDICAL FOUNDATION, INC | 1/21/2010 11:31 AM |
| Details | Program Code | Insert | | | CH | 1/21/2010 11:31 AM |
| Details | Entity Subname | Insert | | | SANDHILLS MEDICAL CENTER | 1/21/2010 11:31 AM |
| Dates | Participating Approval Date | Insert | | | 9/2/2005 12:00:00 AM | 1/21/2010 11:31 AM |
| Details | State | Insert | | | Active | 1/21/2010 11:31 AM |
| Dates | Registration Date | Insert | | | 9/1/2005 12:00:00 AM | 1/21/2010 11:31 AM |
| Dates | Signed By Date | Insert | | | 8/31/2005 12:00:00 AM | 1/21/2010 11:31 AM |
| Dates | Start Date | Insert | | | 9/9/2005 12:00:00 AM | 1/21/2010 11:31 AM |
| Terminations | Termination Comments | Insert | | | | 1/21/2010 11:31 AM |
| Terminations | Termination Date | Insert | | | | 1/21/2010 11:31 AM |
| Terminations | Termination Effective Date | Insert | | | | 1/21/2010 11:31 AM |
| Terminations | Termination Reason | Insert | | | | 1/21/2010 11:31 AM |
| Details | Comments Public | Insert | | | 12/11/08 UPDATED ADDR (WAS 6 BARNETT DR) | 1/21/2010 11:31 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 9/1/2005 4:07 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 710149 | 9/1/2005 4:07 PM |
| Medicaid Billing | Medicaid: State | Insert | | | SC | 9/1/2005 4:07 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1215180591 | 9/1/2005 4:07 PM |