| Details | State | Update | | To Be Terminated | Terminated | 10/1/2023 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | | 10/1/2023 12:00:00 AM | 7/31/2023 8:33 AM |
| Details | State | Update | Hospital Type Change Request | Active | To Be Terminated | 7/31/2023 8:33 AM |
| Terminations | Termination Date | Update | Hospital Type Change Request | | 10/1/2023 12:00:00 AM | 7/31/2023 8:33 AM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | | 10/1/2023 12:00:00 AM | 7/31/2023 8:33 AM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | | Change of covered entity type | 7/31/2023 8:33 AM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 200134380 (IN) | | 9/4/2022 2:13 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1285613612 (IN) | | 9/4/2022 2:13 PM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2021 11:27:15 AM | 9/4/2022 2:13:53 PM | 9/4/2022 2:13 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Ranallo, Russ
VICE PRESIDENT, FINANCIAL SERVICES
Owensboro Health Regional Hospital - Owensboro, KY
2706857180 | Ranallo, Russ
Chief Financial Officer
Owensboro Health Regional Hospital - Owensboro, KY
2706857180 | 7/11/2022 4:16 PM |
| Contacts | Authorizing Official | Update | Change Request | Thomas, Jeff
Chief Financial Officer
Owensboro Health, Inc.
2704174813 | Ranallo, Russ
VICE PRESIDENT, FINANCIAL SERVICES
Owensboro Health Regional Hospital - Owensboro, KY
2706857180 | 6/21/2022 6:58 AM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2020 10:26:52 AM | 8/17/2021 11:27:15 AM | 8/17/2021 11:27 AM |
| Contacts | Authorizing Official | Update | Change Request | HACKBARTH, JOHN
SENIOR VP & CFO
Owensboro Health, Inc.
2704174813 | Thomas, Jeff
Chief Financial Officer
Owensboro Health, Inc.
2704174813 | 8/4/2021 7:09 AM |
| Contacts | Primary Contact | Update | Change Request | Ranallo, Russ
VICE PRESIDENT, FINANCIAL SERVICES
Owensboro Health Regional Hospital - Owensboro, KY
2706857180 | Collins, Jason
Director of Pharmacy
Owensboro Health Regional Hospital
2704176711 | 6/16/2021 8:20 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1285613612 | 9/2/2020 10:26 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | KY | 9/2/2020 10:26 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1285613612 | 9/2/2020 10:26 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | IN | 9/2/2020 10:26 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1285613612 ( ) | | 9/2/2020 10:26 AM |
| Details | Last Recertification Date | Update | Recertification | 8/20/2019 4:28:12 PM | 9/2/2020 10:26:52 AM | 9/2/2020 10:26 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2018 12:15:19 PM | 8/20/2019 4:28:12 PM | 8/20/2019 4:28 PM |
| Details | Last Recertification Date | Update | Recertification | 11/6/2017 9:35:45 AM | 8/22/2018 12:15:19 PM | 8/22/2018 12:15 PM |
| Details | Entity Name | Update | Recertification | OWENSBORO MEDICAL HEALTH SYSTEM | OWENSBORO HEALTH INC | 11/16/2017 1:04 PM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2016 12:00:00 AM | 11/6/2017 9:35:45 AM | 11/6/2017 9:35 AM |
| Contacts | Primary Contact | Update | Recertification | RANALLO, RUSS
VICE PRESIDENT, FINANCIAL SERVICES
2706857180 | Ranallo, Russ
VICE PRESIDENT, FINANCIAL SERVICES
Owensboro Health Regional Hospital - Owensboro, KY
2706857180 | 11/6/2017 9:35 AM |
| Contacts | Authorizing Official | Update | | HACKBARTH, JOHN
SENIOR VP & CFO
2704174813 | HACKBARTH, JOHN
SENIOR VP & CFO
Owensboro Health, Inc.
2704174813 | 10/30/2017 3:47 PM |
| Contacts | Authorizing Official | Update | | HACKBARTH, JOHN
SENIOR VP & CFO
2706918214 | HACKBARTH, JOHN
SENIOR VP & CFO
2704174813 | 8/9/2017 12:57 PM |
| Addresses | Main Address | Insert | | |
1006 FORD AVE
OWENSBORO, KY 42301 | 8/25/2016 3:23 PM |
| Contacts | Primary Contact | Update | | RANALLO, RUSS
VICE PRESIDENT, FINANCIAL SERVICES
2706857180 | RANALLO, RUSS
VICE PRESIDENT, FINANCIAL SERVICES
2706857180 | 8/25/2016 3:23 PM |
| Details | Last Recertification Date | Update | | 8/14/2015 12:00:00 AM | 8/25/2016 12:00:00 AM | 8/25/2016 3:23 PM |
| Details | Entity Subname | Update | | RDI OUTPATIENT IMAGING- HEALTHPARK | Owensboro Health Outpatient Imaging - HEALTHPARK | 8/25/2016 3:23 PM |
| Details | Last Recertification Date | Update | | 8/28/2014 12:00:00 AM | 8/14/2015 12:00:00 AM | 8/14/2015 7:58 AM |
| Addresses | Billing Address | Insert | | | Owensboro Health Regional Hospital
P.O. BOX 20007
OWENSBORO, KY 42304 | 8/28/2014 11:28 AM |
| Addresses | Shipping Address | Insert | | | Owensboro Health Regional Hospital
1201 Pleasant Valley Road
OWENSBORO, KY 42303 | 8/28/2014 11:28 AM |
| Details | Last Recertification Date | Update | | 8/21/2013 2:06:58 PM | 8/28/2014 12:00:00 AM | 8/28/2014 11:28 AM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 8/21/2013 2:06:58 PM | 8/21/2013 2:06 PM |
| Contacts | Authorizing Official | Update | | HACKBARTH, JOHN
SENIOR VP & CFO
2706918214 | HACKBARTH, JOHN
SENIOR VP & CFO
2706918214 | 5/10/2012 8:19 AM |
| Contacts | Primary Contact | Update | | RANALLO, RUSS
VICE PRESIDENT, FINANCIAL SERVICES
2706857180 | RANALLO, RUSS
VICE PRESIDENT, FINANCIAL SERVICES
2706857180 | 5/10/2012 8:19 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/10/2012 8:19 AM |
| Contacts | Authorizing Official | Insert | | | HACKBARTH, JOHN
SENIOR VP & CFO
2706918214 | 8/12/2010 1:14 PM |
| Contacts | Primary Contact | Insert | | | RANALLO, RUSS
VICE PRESIDENT, FINANCIAL SERVICES
2706857180 | 8/12/2010 1:14 PM |
| Details | Last Recertification Date | Insert | | | | 8/5/2010 3:25 PM |
| Details | Grant Number | Insert | | | | 8/5/2010 3:25 PM |
| Details | 340B ID | Insert | | | SCH180038-02 | 8/5/2010 3:25 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/5/2010 3:25 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/5/2010 3:25 PM |
| Details | Medicare Provider Number | Insert | | | 180038 | 8/5/2010 3:25 PM |
| Details | Entity Name | Insert | | | OWENSBORO MEDICAL HEALTH SYSTEM | 8/5/2010 3:25 PM |
| Details | Program Code | Insert | | | SCH | 8/5/2010 3:25 PM |
| Details | Entity Subname | Insert | | | RDI OUTPATIENT IMAGING- HEALTHPARK | 8/5/2010 3:25 PM |
| Dates | Participating Approval Date | Insert | | | 8/5/2010 12:00:00 AM | 8/5/2010 3:25 PM |
| Details | State | Insert | | | Active | 8/5/2010 3:25 PM |
| Dates | Registration Date | Insert | | | 8/4/2010 12:00:00 AM | 8/5/2010 3:25 PM |
| Dates | Signed By Date | Insert | | | 8/2/2010 12:00:00 AM | 8/5/2010 3:25 PM |
| Dates | Start Date | Insert | | | 8/5/2010 12:00:00 AM | 8/5/2010 3:25 PM |
| Terminations | Termination Comments | Insert | | | | 8/5/2010 3:25 PM |
| Terminations | Termination Date | Insert | | | | 8/5/2010 3:25 PM |
| Terminations | Termination Effective Date | Insert | | | | 8/5/2010 3:25 PM |
| Terminations | Termination Reason | Insert | | | | 8/5/2010 3:25 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/4/2010 3:45 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 1022441 | 8/4/2010 3:45 PM |
| Medicaid Billing | Medicaid: State | Insert | | | KY | 8/4/2010 3:45 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/4/2010 3:45 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 200134380 | 8/4/2010 3:45 PM |
| Medicaid Billing | Medicaid: State | Insert | | | IN | 8/4/2010 3:45 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1285613612 | 8/4/2010 3:45 PM |