| Details | State | Update | | To Be Terminated | Terminated | 4/1/2021 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 12/31/2020 12:00:00 AM | 2/2/2021 8:24 AM |
| Details | State | Update | Recertification | Active | To Be Terminated | 2/2/2021 8:24 AM |
| Terminations | Termination Comments | Update | Recertification | | Site Closure has been approved by HRSA through a site CIS. | 2/2/2021 8:24 AM |
| Terminations | Termination Date | Update | Recertification | | 4/1/2021 12:00:00 AM | 2/2/2021 8:24 AM |
| Terminations | Termination Effective Date | Update | Recertification | | 4/1/2021 12:00:00 AM | 2/2/2021 8:24 AM |
| Terminations | Termination Reason | Update | Recertification | | Site closure | 2/2/2021 8:24 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2019 9:26:03 AM | 1/30/2020 7:04:27 AM | 1/30/2020 7:04 AM |
| Contacts | Primary Contact | Update | Change Request | SOLES, ISABEL
CLINICAL DIRECTOR
Palmetto Health Council, Inc.
4049298824-227 | Soles, Isabel Maria
Clinical Director
Palmetto Health Council, Inc.
4049298824-227 | 3/28/2019 1:20 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Soles, Isabel Maria
Clinical Director
Palmetto Health Council, Inc.
4049298824-227 | Wollenzien Jr., Jon W.
CEO
Palmetto Health Council, Inc.
4049298824-222 | 3/28/2019 11:49 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Wollenzien Jr., Jon W.
CEO
Palmetto Health Council, Inc.
4049298824-222 | Soles, Isabel Maria
Clinical Director
Palmetto Health Council, Inc.
4049298824-227 | 3/27/2019 7:02 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Wollenzien Jr., Jon W.
Chief Executive Officer
Palmetto Health Council, Inc.
4049298824-222 | Wollenzien Jr., Jon W.
CEO
Palmetto Health Council, Inc.
4049298824-222 | 3/19/2019 2:26 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2018 9:48:24 AM | 1/30/2019 9:26:03 AM | 1/30/2019 9:26 AM |
| Contacts | Primary Contact | Update | Recertification | Wollenzien Jr., Jon W.
Chief Executive Officer
Palmetto Health Council, Inc.
4049298824-222 | SOLES, ISABEL
CLINICAL DIRECTOR
Palmetto Health Council, Inc.
4049298824-227 | 2/9/2018 9:48 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2017 12:00:00 AM | 2/9/2018 9:48:24 AM | 2/9/2018 9:48 AM |
| Contacts | Authorizing Official | Update | | Wollenzien Jr., Jon W.
Chief Executive Officer
4049298824-222 | Wollenzien Jr., Jon W.
Chief Executive Officer
Palmetto Health Council, Inc.
4049298824-222 | 1/12/2018 9:53 AM |
| Contacts | Primary Contact | Update | | Wollenzien Jr., Jon W.
Chief Executive Officer
4049298824-222 | Wollenzien Jr., Jon W.
Chief Executive Officer
Palmetto Health Council, Inc.
4049298824-222 | 1/12/2018 9:53 AM |
| Addresses | Main Address | Insert | | |
51 Gay Connector
Greenville, GA 30222-3339 | 2/1/2017 12:34 PM |
| Contacts | Authorizing Official | Insert | | | Wollenzien Jr., Jon W.
Chief Executive Officer
4049298824-222 | 2/1/2017 12:34 PM |
| Contacts | Primary Contact | Insert | | | Wollenzien Jr., Jon W.
Chief Executive Officer
4049298824-222 | 2/1/2017 12:34 PM |
| Details | Last Recertification Date | Update | | 2/15/2016 12:00:00 AM | 2/1/2017 12:00:00 AM | 2/1/2017 12:34 PM |
| Details | Last Recertification Date | Update | | 2/3/2015 12:00:00 AM | 2/15/2016 12:00:00 AM | 2/15/2016 1:36 PM |
| Details | Last Recertification Date | Update | | 3/21/2014 12:00:00 AM | 2/3/2015 12:00:00 AM | 2/3/2015 12:57 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/21/2014 12:00:00 AM | 3/21/2014 10:11 PM |
| Details | Entity Name | Update | | PALMETTO HEALTH COUNCIL INC. | PALMETTO HEALTH COUNCIL, INC | 3/21/2014 10:11 PM |
| Details | Entity Subname | Update | | COMMUNITY MEDICAL CENTER OF GREENVILLE | Community Medical Center of Greenville | 3/21/2014 10:11 PM |
| Addresses | Billing Address | Insert | | | PALMETTO HEALTH COUNCIL INC.
547 PONCE DE LEON AVENUE
SUITE 200
ATLANTA, GA 30308 | 3/15/2013 7:12 AM |
| Addresses | Billing Address | Update | | PALMETTO HEALTH COUNCIL INC.
547 PONCE DE LEON AVENUE
SUITE 200
ATLANTA, GA 30308 | PALMETTO HEALTH COUNCIL INC.
643 Main Street
Palmetto, GA 30268 | 3/15/2013 7:12 AM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/15/2013 7:12 AM |
| Details | Last Recertification Date | Insert | | | | 3/26/2010 12:46 PM |
| Details | Grant Number | Insert | | | H80CS00460 | 3/26/2010 12:46 PM |
| Details | 340B ID | Insert | | | CH04526K | 3/26/2010 12:46 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 3/26/2010 12:46 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 3/26/2010 12:46 PM |
| Details | Medicare Provider Number | Insert | | | | 3/26/2010 12:46 PM |
| Details | Entity Name | Insert | | | PALMETTO HEALTH COUNCIL INC. | 3/26/2010 12:46 PM |
| Details | Program Code | Insert | | | CH | 3/26/2010 12:46 PM |
| Details | Entity Subname | Insert | | | COMMUNITY MEDICAL CENTER OF GREENVILLE | 3/26/2010 12:46 PM |
| Dates | Participating Approval Date | Insert | | | 3/9/2010 12:00:00 AM | 3/26/2010 12:46 PM |
| Details | State | Insert | | | Active | 3/26/2010 12:46 PM |
| Dates | Registration Date | Insert | | | 3/1/2010 12:00:00 AM | 3/26/2010 12:46 PM |
| Dates | Signed By Date | Insert | | | 2/5/2010 12:00:00 AM | 3/26/2010 12:46 PM |
| Dates | Start Date | Insert | | | 4/1/2010 12:00:00 AM | 3/26/2010 12:46 PM |
| Terminations | Termination Comments | Insert | | | | 3/26/2010 12:46 PM |
| Terminations | Termination Date | Insert | | | | 3/26/2010 12:46 PM |
| Terminations | Termination Effective Date | Insert | | | | 3/26/2010 12:46 PM |
| Terminations | Termination Reason | Insert | | | | 3/26/2010 12:46 PM |