Yes
AR | 145573749,117778749 | 1689870065,1154386597 |
JEFFERSON COMPREHENSIVE CARE SYSTEM INC
1101 TENNESSEE STREET
PINE BLUFF, AR 71601
Contract Detail | KROGER PHARMACY #550 | 1100 EAST ROOSEVELT ROAD |
| LITTLE ROCK | AR | 72206 | 10/12/2023 | 01/01/2024 | | | 01/01/2024 |
Details | Last Recertification Date | Update | Recertification | 2/23/2024 10:12:07 AM | 3/7/2025 10:24:19 AM | 3/7/2025 10:24 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 9/13/2024 9:41 AM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 117778749 | 9/13/2024 9:41 AM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | AR | 9/13/2024 9:41 AM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1154386597 | 9/13/2024 9:41 AM |
Medicaid Billing | NPI: State | Insert | Change Request | | AR | 9/13/2024 9:41 AM |
Details | Last Recertification Date | Update | Recertification | 2/15/2023 3:35:51 PM | 2/23/2024 10:12:07 AM | 2/23/2024 10:12 AM |
Details | Last Recertification Date | Update | Recertification | 2/8/2022 11:39:05 AM | 2/15/2023 3:35:51 PM | 2/15/2023 3:35 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 7/25/2022 2:38 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 145573749 | 7/25/2022 2:38 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | AR | 7/25/2022 2:38 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1689870065 | 7/25/2022 2:38 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | AR | 7/25/2022 2:38 PM |
Details | Last Recertification Date | Update | Recertification | 2/22/2021 11:22:31 AM | 2/8/2022 11:39:05 AM | 2/8/2022 11:39 AM |
Details | Last Recertification Date | Update | Recertification | 2/19/2020 12:57:33 PM | 2/22/2021 11:22:31 AM | 2/22/2021 11:22 AM |
Details | Last Recertification Date | Update | Recertification | 1/30/2019 2:53:47 PM | 2/19/2020 12:57:33 PM | 2/19/2020 12:57 PM |
Addresses | Main Address | Update | Change Request |
1225 MARTIN LUTHER KING
LITTLE ROCK, AR 72202 |
3000 Springer Blvd Ste. B
LITTLE ROCK, AR 72206 | 8/12/2019 7:12 AM |
Details | Entity Subname | Update | Change Request | OPEN HANDS CLINIC | Homeless Open Hands | 8/12/2019 7:12 AM |
Details | Last Recertification Date | Update | Recertification | 2/23/2018 11:50:07 AM | 1/30/2019 2:53:47 PM | 1/30/2019 2:53 PM |
Details | Last Recertification Date | Update | Recertification | 1/25/2017 12:00:00 AM | 2/23/2018 11:50:07 AM | 2/23/2018 11:50 AM |
Contacts | Primary Contact | Update | Recertification | Evans-McField, Chanda
Chief Financial Officer
8705432300 | Evans-McField, Chanda
Chief Financial Officer
Jefferson Comprehensive Care System, Inc.
8705432300 | 2/23/2018 11:36 AM |
Contacts | Authorizing Official | Update | | Brown, Sandra J.
Chief Executive Officer
8705432300 | Brown, Sandra J.
Chief Executive Officer
Jefferson Comprehensive Care System, Inc
8705432300 | 10/10/2017 12:39 PM |
Contacts | Authorizing Official | Insert | | | Brown, Sandra J.
Chief Executive Officer
8705432300 | 1/26/2017 9:50 AM |
Contacts | Primary Contact | Insert | | | Evans-McField, Chanda
Chief Financial Officer
8705432300 | 1/26/2017 9:50 AM |
Addresses | Main Address | Insert | | |
1225 MARTIN LUTHER KING
LITTLE ROCK, AR 72202 | 1/25/2017 12:04 PM |
Details | Last Recertification Date | Update | | 3/3/2016 12:00:00 AM | 1/25/2017 12:00:00 AM | 1/25/2017 12:03 PM |
Details | Last Recertification Date | Update | | 3/4/2015 12:00:00 AM | 3/3/2016 12:00:00 AM | 3/3/2016 10:08 AM |
Details | Last Recertification Date | Update | | 3/19/2014 12:00:00 AM | 3/4/2015 12:00:00 AM | 3/4/2015 11:48 AM |
Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/19/2014 12:00:00 AM | 3/19/2014 3:35 PM |
Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/15/2013 11:03 AM |
Addresses | Billing Address | Insert | | | JEFFERSON COMPREHENSIVE CARE SYSTEM INC
PO BOX 1285
PINE BLUFF, AR 71613-1285 | 1/17/2013 3:03 PM |
Addresses | Shipping Address | Insert | | | JEFFERSON COMPREHENSIVE CARE SYSTEM INC
1101 TENNESSEE STREET
PINE BLUFF, AR 71601 | 12/6/2006 9:59 AM |
Details | Last Recertification Date | Insert | | | | 12/6/2006 9:59 AM |
Details | Grant Number | Insert | | | H80CS00727 | 12/6/2006 9:59 AM |
Details | 340B ID | Insert | | | CH06011P | 12/6/2006 9:59 AM |
Details | Is Authorizing Official EHB Data | Insert | | | | 12/6/2006 9:59 AM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 12/6/2006 9:59 AM |
Details | Medicare Provider Number | Insert | | | | 12/6/2006 9:59 AM |
Details | Entity Name | Insert | | | JEFFERSON COMPREHENSIVE CARE SYSTEM INC | 12/6/2006 9:59 AM |
Details | Program Code | Insert | | | CH | 12/6/2006 9:59 AM |
Details | Entity Subname | Insert | | | OPEN HANDS CLINIC | 12/6/2006 9:59 AM |
Dates | Participating Approval Date | Insert | | | 12/4/2006 12:00:00 AM | 12/6/2006 9:59 AM |
Details | State | Insert | | | Active | 12/6/2006 9:59 AM |
Dates | Registration Date | Insert | | | 12/4/2006 12:00:00 AM | 12/6/2006 9:59 AM |
Dates | Signed By Date | Insert | | | 11/30/2006 12:00:00 AM | 12/6/2006 9:59 AM |
Dates | Start Date | Insert | | | 1/1/2007 12:00:00 AM | 12/6/2006 9:59 AM |
Terminations | Termination Comments | Insert | | | | 12/6/2006 9:59 AM |
Terminations | Termination Date | Insert | | | | 12/6/2006 9:59 AM |
Terminations | Termination Effective Date | Insert | | | | 12/6/2006 9:59 AM |
Terminations | Termination Reason | Insert | | | | 12/6/2006 9:59 AM |