Medicaid Billing | Medicaid: Number | Delete | Recertification | 200532040A (OK) | | 2/28/2025 9:29 AM |
Medicaid Billing | NPI: Number | Delete | Recertification | 1669895108 (OK) | | 2/28/2025 9:29 AM |
Details | Last Recertification Date | Update | Recertification | 1/31/2024 9:39:12 AM | 2/28/2025 9:29:33 AM | 2/28/2025 9:29 AM |
Contacts | Primary Contact | Update | PC Change Request | Wesley, Brian
Pharmacist
Board of Regents of the University of Oklahoma
4052711047 | Larson, Stephan
Business Manager
University of Oklahoma Health Sciences Center
4052718001-42535 | 2/8/2024 12:43 PM |
Details | Last Recertification Date | Update | Recertification | 2/24/2023 2:22:38 PM | 1/31/2024 9:39:12 AM | 1/31/2024 9:39 AM |
Contacts | Authorizing Official | Update | AO Change Request | Chudnaya, Anna
Administrative Manager
Oklahoma Center for Bleeding and Clotting Disorders
4052718001-42535 | Lay, Kimberly F
Accounting Manager
Oklahoma Center for Bleeding and Clotting Disorders
4052718001-42317 | 3/13/2023 6:57 AM |
Addresses | Main Address | Update | Recertification |
1200 Children Ave A2
14709
OKLAHOMA CITY, OK 73104 |
1200 Children Ave A2
14712
OKLAHOMA CITY, OK 73104 | 2/24/2023 2:22 PM |
Details | Last Recertification Date | Update | Recertification | 2/8/2022 3:29:56 PM | 2/24/2023 2:22:38 PM | 2/24/2023 2:22 PM |
Contacts | Authorizing Official | Update | AO Change Request | Luttrell, Reanna Marie
Administrative Manager
Oklahoma Center for Bleeding and Clotting Disorders
4052715311-42535 | Chudnaya, Anna
Administrative Manager
Oklahoma Center for Bleeding and Clotting Disorders
4052718001-42535 | 2/24/2023 6:31 AM |
Details | Last Recertification Date | Update | Recertification | 2/8/2021 8:35:22 AM | 2/8/2022 3:29:56 PM | 2/8/2022 3:29 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/10/2021 6:07 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 200928550A | 3/10/2021 6:07 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | OK | 3/10/2021 6:07 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1356746267 | 3/5/2021 9:49 AM |
Medicaid Billing | NPI: State | Insert | Change Request | | OK | 3/5/2021 9:49 AM |
Addresses | Main Address | Update | Recertification |
1200 Children Ave
7911
OKLAHOMA CITY, OK 73104 |
1200 Children Ave A2
14709
OKLAHOMA CITY, OK 73104 | 2/8/2021 8:35 AM |
Medicaid Billing | NPI: Number | Delete | Recertification | 1669895108 ( ) | | 2/8/2021 8:35 AM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1669895108 | 2/8/2021 8:35 AM |
Medicaid Billing | NPI: State | Insert | Recertification | | OK | 2/8/2021 8:35 AM |
Details | Last Recertification Date | Update | Recertification | 2/4/2020 10:16:48 AM | 2/8/2021 8:35:22 AM | 2/8/2021 8:35 AM |
Addresses | Shipping Address | Delete | Recertification | OKLAHOMA CENTER FOR BLEEDING DISORDERS
1200 Children Ave, 7303
OKLAHOMA CITY, OK 73014 | | 2/4/2020 10:16 AM |
Addresses | Main Address | Update | Recertification |
1200 Children Ave 7303
OKLAHOMA CITY, OK 73104 |
1200 Children Ave
7911
OKLAHOMA CITY, OK 73104 | 2/4/2020 10:16 AM |
Details | Last Recertification Date | Update | Recertification | 1/29/2019 8:54:04 AM | 2/4/2020 10:16:48 AM | 2/4/2020 10:16 AM |
Contacts | Authorizing Official | Update | AO Change Request | Davis, Scott
ASSOCIATE DIRECTOR, OFFICE OF RESEARCH ADMINISTRATION
Board of Regents of the University of Oklahoma
4052712090 | Luttrell, Reanna Marie
Administrative Manager
Oklahoma Center for Bleeding and Clotting Disorders
4052715311-42535 | 1/30/2020 7:45 AM |
Details | Last Recertification Date | Update | Recertification | 2/15/2018 8:50:00 AM | 1/29/2019 8:54:04 AM | 1/29/2019 8:54 AM |
Addresses | Shipping Address | Insert | Change Request | | OKLAHOMA CENTER FOR BLEEDING DISORDERS
1200 Children Ave, 7303
OKLAHOMA CITY, OK 73014 | 10/26/2018 10:14 AM |
Addresses | Main Address | Update | Change Request |
1200 Children Ave 10A
OKLAHOMA CITY, OK 73104 |
1200 Children Ave 7303
OKLAHOMA CITY, OK 73104 | 10/26/2018 10:14 AM |
Addresses | Billing Address | Update | Change Request | OKLAHOMA CENTER FOR BLEEDING DISORDERS
1200 Children Ave, 10A
OKLAHOMA CITY, OK 73104 | OKLAHOMA CENTER FOR BLEEDING DISORDERS
1200 Children Ave, 7303
OKLAHOMA CITY, OK 73104 | 10/26/2018 10:14 AM |
Addresses | Shipping Address | Delete | Change Request | OKLAHOMA CENTER FOR BLEEDING DISORDERS
1200 Children Ave, 10A
OKLAHOMA CITY, OK 73014 | | 10/26/2018 10:14 AM |
Contacts | Primary Contact | Update | Change Request | STONE, KATHY
PED HEM/ONC BUSINESS MANAGER
Oklahoma Center for Bleeding and Clotting
4052713661-4 | Wesley, Brian
Pharmacist
Board of Regents of the University of Oklahoma
4052711047 | 10/26/2018 10:14 AM |
Details | Last Recertification Date | Update | Recertification | 1/26/2017 12:00:00 AM | 2/15/2018 8:50:00 AM | 2/15/2018 8:50 AM |
Contacts | Primary Contact | Update | | STONE, KATHY
PED HEM/ONC BUSINESS MANAGER
4052713661-4 | STONE, KATHY
PED HEM/ONC BUSINESS MANAGER
Oklahoma Center for Bleeding and Clotting
4052713661-4 | 1/10/2018 12:25 PM |
Contacts | Authorizing Official | Update | | Davis, Scott
ASSOCIATE DIRECTOR, OFFICE OF RESEARCH ADMINISTRATION
4052712090 | Davis, Scott
ASSOCIATE DIRECTOR, OFFICE OF RESEARCH ADMINISTRATION
Board of Regents of the University of Oklahoma
4052712090 | 10/12/2017 1:04 PM |
Addresses | Main Address | Insert | | |
1200 Children Ave 10A
OKLAHOMA CITY, OK 73104 | 7/21/2017 1:37 PM |
Addresses | Billing Address | Insert | | | OKLAHOMA CENTER FOR BLEEDING DISORDERS
1200 Children Ave, 10A
OKLAHOMA CITY, OK 73104 | 7/21/2017 1:37 PM |
Addresses | Shipping Address | Insert | | | OKLAHOMA CENTER FOR BLEEDING DISORDERS
1200 Children Ave, 10A
OKLAHOMA CITY, OK 73014 | 7/21/2017 1:37 PM |
Contacts | Primary Contact | Insert | | | STONE, KATHY
PED HEM/ONC BUSINESS MANAGER
4052713661-4 | 7/21/2017 1:37 PM |
Contacts | Authorizing Official | Update | | ASCH, LISA C.
ASSOCIATE DIRECTOR, OFFICE OF RESEARCH ADMINISTRATION
4052712090 | Davis, Scott
ASSOCIATE DIRECTOR, OFFICE OF RESEARCH ADMINISTRATION
4052712090 | 7/21/2017 1:37 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/21/2017 1:37 PM |
Medicaid Billing | Medicaid: Number | Insert | | | 200532040A | 7/21/2017 1:37 PM |
Medicaid Billing | Medicaid: State | Insert | | | OK | 7/21/2017 1:37 PM |
Details | Last Recertification Date | Update | | 2/12/2016 12:00:00 AM | 1/26/2017 12:00:00 AM | 1/26/2017 1:29 PM |
Details | Last Recertification Date | Update | | 2/2/2015 12:00:00 AM | 2/12/2016 12:00:00 AM | 2/12/2016 7:31 AM |
Details | Last Recertification Date | Update | | 2/14/2014 12:00:00 AM | 2/2/2015 12:00:00 AM | 2/2/2015 9:31 PM |
Medicaid Billing | NPI: Number | Insert | | | 1669895108 | 5/2/2014 1:23 PM |
Contacts | Authorizing Official | Insert | | | ASCH, LISA C.
ASSOCIATE DIRECTOR, OFFICE OF RESEARCH ADMINISTRATION
4052712090 | 2/14/2014 1:02 PM |
Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 2/14/2014 12:00:00 AM | 2/14/2014 1:02 PM |
Details | Grant Number | Update | | H30MC00029 | H30MC24051 | 2/14/2014 11:13 AM |
Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/19/2013 9:36 AM |
Details | Grant Number | Update | | | H30MC00029 | 2/7/2012 11:56 AM |
Details | Comments Public | Insert | | | 2/7/12 update address to Childrens Ave 6/7/2011 ADDR CORRECTED (WAS SUITE 1450); 1/12/11 BILL/SHIP TO CHAGED (WAS 825 NE 10TH STREET SUITE 2200/SUITE 1450) 11/13/09 UPDATED ADDR (WAS 940 NE 13TH ST);11/13/09 ADDED BILL TO | 2/7/2012 11:56 AM |
Details | Grant Number | Update | | H30MC00029 | | 6/7/2011 4:18 PM |
Details | Last Recertification Date | Insert | | | | 11/29/2006 1:37 PM |
Details | Grant Number | Insert | | | H30MC00029 | 11/29/2006 1:37 PM |
Details | 340B ID | Insert | | | HM8413 | 11/29/2006 1:37 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 11/29/2006 1:37 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 11/29/2006 1:37 PM |
Details | Medicare Provider Number | Insert | | | | 11/29/2006 1:37 PM |
Details | Entity Name | Insert | | | UNIVERSITY OF OKLAHOMA HEALTH SCIENCE DBA OKLAHOMA CENTER FOR BLEEDING DISORDERS | 11/29/2006 1:37 PM |
Details | Program Code | Insert | | | HM | 11/29/2006 1:37 PM |
Details | Entity Subname | Insert | | | | 11/29/2006 1:37 PM |
Dates | Participating Approval Date | Insert | | | 11/29/2006 12:00:00 AM | 11/29/2006 1:37 PM |
Details | State | Insert | | | Active | 11/29/2006 1:37 PM |
Dates | Registration Date | Insert | | | 11/29/2006 12:00:00 AM | 11/29/2006 1:37 PM |
Dates | Signed By Date | Insert | | | 11/17/2006 12:00:00 AM | 11/29/2006 1:37 PM |
Dates | Start Date | Insert | | | 1/1/2007 12:00:00 AM | 11/29/2006 1:37 PM |
Terminations | Termination Comments | Insert | | | | 11/29/2006 1:37 PM |
Terminations | Termination Date | Insert | | | | 11/29/2006 1:37 PM |
Terminations | Termination Effective Date | Insert | | | | 11/29/2006 1:37 PM |
Terminations | Termination Reason | Insert | | | | 11/29/2006 1:37 PM |
Details | Comments Public | Insert | | | 6/7/2011 ADDR CORRECTED (WAS SUITE 1450); 1/12/11 BILL/SHIP TO CHAGED (WAS 825 NE 10TH STREET SUITE 2200/SUITE 1450) 11/13/09 UPDATED ADDR (WAS 940 NE 13TH ST);11/13/09 ADDED BILL TO | 11/29/2006 1:37 PM |