| Details | Last Recertification Date | Update | Recertification | 9/8/2023 10:28:38 AM | 8/27/2024 10:43:02 AM | 8/27/2024 10:43 AM |
| Details | Last Recertification Date | Update | Recertification | 9/19/2022 7:12:53 AM | 9/8/2023 10:28:38 AM | 9/8/2023 10:28 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Everett, Curren
CEO
Fulton County Hospital
8708956096 | Reed, Anthony
CEO
Fulton County Hospital
8708952691-6099 | 8/31/2023 4:56 PM |
| Contacts | Primary Contact | Update | Recertification | Perryman, Jennifer
Operations & Risk Mgr.
Fulton County Hospital
8708956096 | Haley, Christy
340B Coordinator
Fulton County Hospital
8708952691-6013 | 9/19/2022 7:12 AM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2021 1:03:10 PM | 9/19/2022 7:12:53 AM | 9/19/2022 7:12 AM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2020 10:14:13 AM | 8/30/2021 1:03:10 PM | 8/30/2021 1:03 PM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2019 10:00:36 AM | 8/25/2020 10:14:13 AM | 8/25/2020 10:14 AM |
| Details | Last Recertification Date | Update | Recertification | 9/10/2018 4:59:12 PM | 8/28/2019 10:00:36 AM | 8/28/2019 10:00 AM |
| Details | Last Recertification Date | Update | Recertification | 11/9/2017 9:32:59 AM | 9/10/2018 4:59:12 PM | 9/10/2018 4:59 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Willett, Charles
CEO/ADMINISTRATOR
Fulton County Hospital
8708956096 | Everett, Curren
CEO
Fulton County Hospital
8708956096 | 8/27/2018 11:58 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Perryman, Jennifer
Operations & Rish Mgr.
Fulton County Hospital
8708956096 | Perryman, Jennifer
Operations & Risk Mgr.
Fulton County Hospital
8708956096 | 8/16/2018 10:30 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Perryman, Jennifer
Administrative Assistant
Fulton County Hospital
8708956096 | Perryman, Jennifer
Operations & Rish Mgr.
Fulton County Hospital
8708956096 | 8/16/2018 10:29 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2016 12:00:00 AM | 11/9/2017 9:32:59 AM | 11/9/2017 9:32 AM |
| Contacts | Authorizing Official | Update | | Willett, Charles
CEO/ADMINISTRATOR
8708956096 | Willett, Charles
CEO/ADMINISTRATOR
Fulton County Hospital
8708956096 | 10/25/2017 7:04 PM |
| Contacts | Primary Contact | Update | | Perryman, Jennifer
Administrative Assistant
8708956096 | Perryman, Jennifer
Administrative Assistant
Fulton County Hospital
8708956096 | 10/23/2017 11:46 AM |
| Addresses | Main Address | Insert | | |
673 N MAIN ST
SALEM, AR 72576-0517 | 10/11/2016 7:17 AM |
| Addresses | Billing Address | Insert | | | FULTON COUNTY HOSPITAL
P.O. BOX 517
SALEM, AR 72576 | 10/11/2016 7:17 AM |
| Contacts | Primary Contact | Update | | Thompson, Kim
CEO/ADMINISTRATOR
8708956096 | Perryman, Jennifer
Administrative Assistant
8708956096 | 10/11/2016 7:17 AM |
| Contacts | Authorizing Official | Update | | Thompson, Kim
CEO/ADMINISTRATOR
8708956096 | Willett, Charles
CEO/ADMINISTRATOR
8708956096 | 10/11/2016 7:17 AM |
| Details | Last Recertification Date | Update | | 8/18/2015 12:00:00 AM | 8/26/2016 12:00:00 AM | 8/26/2016 2:25 PM |
| Details | Last Recertification Date | Update | | 8/27/2014 12:00:00 AM | 8/18/2015 12:00:00 AM | 8/18/2015 9:18 AM |
| Details | Last Recertification Date | Update | | 9/12/2013 12:00:00 AM | 8/27/2014 12:00:00 AM | 8/27/2014 1:43 PM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 9/12/2013 12:00:00 AM | 9/12/2013 2:37 PM |
| Contacts | Authorizing Official | Update | | HAMMOND, JOSEPH T.
CEO/ADMINISTRATOR
8708956000 | Thompson, Kim
CEO/ADMINISTRATOR
8708956096 | 12/20/2012 4:12 PM |
| Contacts | Primary Contact | Update | | HAMMOND, JOSEPH T.
CEO/ADMINISTRATOR
8708956000 | Thompson, Kim
CEO/ADMINISTRATOR
8708956096 | 12/20/2012 4:12 PM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 6/25/2012 8:39 AM |
| Contacts | Authorizing Official | Insert | | | HAMMOND, JOSEPH T.
CEO/ADMINISTRATOR
8708956000 | 9/24/2010 8:05 AM |
| Contacts | Primary Contact | Insert | | | HAMMOND, JOSEPH T.
CEO/ADMINISTRATOR
8708956000 | 9/24/2010 8:05 AM |
| Details | Last Recertification Date | Insert | | | | 9/24/2010 8:05 AM |
| Details | Grant Number | Insert | | | | 9/24/2010 8:05 AM |
| Details | 340B ID | Insert | | | CAH041322-01 | 9/24/2010 8:05 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 9/24/2010 8:05 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 9/24/2010 8:05 AM |
| Details | Medicare Provider Number | Insert | | | 041322 | 9/24/2010 8:05 AM |
| Details | Entity Name | Insert | | | FULTON COUNTY HOSPITAL | 9/24/2010 8:05 AM |
| Details | Program Code | Insert | | | CAH | 9/24/2010 8:05 AM |
| Details | Entity Subname | Insert | | | NORTH ARKANSAS FAMILY CLINIC | 9/24/2010 8:05 AM |
| Dates | Participating Approval Date | Insert | | | 9/24/2010 12:00:00 AM | 9/24/2010 8:05 AM |
| Details | State | Insert | | | Active | 9/24/2010 8:05 AM |
| Dates | Registration Date | Insert | | | 9/23/2010 12:00:00 AM | 9/24/2010 8:05 AM |
| Dates | Signed By Date | Insert | | | 9/14/2010 12:00:00 AM | 9/24/2010 8:05 AM |
| Dates | Start Date | Insert | | | 9/24/2010 12:00:00 AM | 9/24/2010 8:05 AM |
| Terminations | Termination Comments | Insert | | | | 9/24/2010 8:05 AM |
| Terminations | Termination Date | Insert | | | | 9/24/2010 8:05 AM |
| Terminations | Termination Effective Date | Insert | | | | 9/24/2010 8:05 AM |
| Terminations | Termination Reason | Insert | | | | 9/24/2010 8:05 AM |