| Details | Last Recertification Date | Update | Recertification | 8/29/2023 10:53:15 AM | 8/13/2024 5:26:41 PM | 8/13/2024 5:26 PM |
| Contacts | Primary Contact | Update | Recertification | Heatongrindel, Beth
Executive Assistant
Coquille Valley Hospital
5413963101 | Heatongrindel, Beth
Executive Assistant
Coquille Valley Hospital
5413963101-1052 | 8/12/2024 2:29 PM |
| Addresses | Shipping Address | Insert | Change Request | | Coquille Valley Hospital Community Pharmacy
55 East First Street
Coquille, OR 97423 | 2/21/2024 6:21 AM |
| Addresses | Shipping Address | Insert | Change Request | | Coquille Valley Hospital Pharmacy
940 East Fifth Street
Coquille, OR 97423 | 2/21/2024 6:21 AM |
| Addresses | Main Address | Update | Change Request |
940 EAST 5TH ST
COQUILLE, OR 97423 |
940 E. 5th Street
COQUILLE, OR 97423 | 2/21/2024 6:21 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 2/21/2024 6:21 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 381312 | 2/21/2024 6:21 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | OR | 2/21/2024 6:21 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1730223967 | 2/21/2024 6:21 AM |
| Medicaid Billing | NPI: State | Insert | Change Request | | OR | 2/21/2024 6:21 AM |
| Details | Last Recertification Date | Update | Recertification | 9/13/2022 7:43:40 AM | 8/29/2023 10:53:15 AM | 8/29/2023 10:53 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2021 3:51:31 PM | 9/13/2022 7:43:40 AM | 9/13/2022 7:43 AM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2020 11:37:13 AM | 8/26/2021 3:51:31 PM | 8/26/2021 3:51 PM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2019 9:34:09 AM | 8/18/2020 11:37:13 AM | 8/18/2020 11:37 AM |
| Details | Last Recertification Date | Update | Recertification | 8/20/2018 12:02:12 PM | 8/28/2019 9:34:09 AM | 8/28/2019 9:34 AM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2016 12:00:00 AM | 8/20/2018 12:02:12 PM | 8/20/2018 12:02 PM |
| Terminations | Termination Reason | Update | | Failure to recertify | | 7/21/2018 12:21 PM |
| Details | State | Update | | Approved | Active | 4/1/2018 12:00 AM |
| Contacts | Signed By | Insert | Reinstatement | | Lang, Jeffrey M.
CEO
Coquille Valley Hospital
5413961052 | 1/10/2018 3:28 PM |
| Dates | Participating Approval Date | Update | Reinstatement | | 1/10/2018 3:28:42 PM | 1/10/2018 3:28 PM |
| Details | State | Update | Reinstatement | Pending | Approved | 1/10/2018 3:28 PM |
| Dates | Signed By Date | Update | Reinstatement | 9/23/2010 12:00:00 AM | 1/10/2018 12:41:56 PM | 1/10/2018 3:28 PM |
| Dates | Start Date | Update | Reinstatement | | 4/1/2018 12:00:00 AM | 1/10/2018 3:28 PM |
| Terminations | Termination Reason | Update | Reinstatement | | Failure to recertify | 1/10/2018 3:28 PM |
| Details | Comments Public | Insert | Reinstatement | | Started 1/1/2011; Terminated 1/1/2018; reinstated 4/1/2018. | 1/8/2018 2:58 PM |
| Contacts | Primary Contact | Update | Reinstatement | Heatongrindel, Beth
Administrative Assistant
Coquille Valley Hospital
5413963101 | Heatongrindel, Beth
Executive Assistant
Coquille Valley Hospital
5413963101 | 1/2/2018 11:30 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 1/1/2018 12:00:00 AM | | 1/2/2018 11:30 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 10/7/2010 12:00:00 AM | | 1/2/2018 11:30 AM |
| Details | State | Update | Reinstatement | Terminated | Pending | 1/2/2018 11:30 AM |
| Dates | Registration Date | Update | Reinstatement | 9/23/2010 12:00:00 AM | 1/2/2018 11:30:00 AM | 1/2/2018 11:30 AM |
| Dates | Start Date | Update | Reinstatement | 1/1/2011 12:00:00 AM | | 1/2/2018 11:30 AM |
| Terminations | Termination Date | Update | Reinstatement | 1/1/2018 12:00:00 AM | | 1/2/2018 11:30 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 1/1/2018 12:00:00 AM | | 1/2/2018 11:30 AM |
| Terminations | Termination Reason | Update | Reinstatement | Failure to recertify | | 1/2/2018 11:30 AM |
| Details | State | Update | | To Be Terminated | Terminated | 1/1/2018 12:00 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 1/1/2018 12:00:00 AM | 12/7/2017 11:22 AM |
| Details | State | Update | Recertification | Active | To Be Terminated | 12/7/2017 11:22 AM |
| Terminations | Termination Date | Update | Recertification | | 1/1/2018 12:00:00 AM | 12/7/2017 11:22 AM |
| Terminations | Termination Effective Date | Update | Recertification | | 1/1/2018 12:00:00 AM | 12/7/2017 11:22 AM |
| Terminations | Termination Reason | Update | Recertification | | Failure to recertify | 12/7/2017 11:22 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Lautermilch, Karen
CEO
5413963101-1052 | Lang, Jeffrey M.
CEO
Coquille Valley Hospital
5413961052 | 11/13/2017 9:02 AM |
| Contacts | Primary Contact | Update | | Heatongrindel, Beth
Administrative Assistant
5413963101 | Heatongrindel, Beth
Administrative Assistant
Coquille Valley Hospital
5413963101 | 10/31/2017 1:39 PM |
| Addresses | Main Address | Insert | | |
940 EAST 5TH ST
COQUILLE, OR 97423 | 8/30/2016 10:06 AM |
| Contacts | Authorizing Official | Update | | ZIELINSKI, DENNIS
CEO
5413963101 | Lautermilch, Karen
CEO
5413963101-1052 | 8/30/2016 10:06 AM |
| Contacts | Primary Contact | Update | | LUDINGTON, GAIL
FINANCIAL SERVICES DIRECTOR
5413963101 | Heatongrindel, Beth
Administrative Assistant
5413963101 | 8/30/2016 10:06 AM |
| Details | Last Recertification Date | Update | | 9/9/2015 12:00:00 AM | 8/23/2016 12:00:00 AM | 8/30/2016 10:06 AM |
| Details | Last Recertification Date | Update | | 9/9/2014 12:00:00 AM | 9/9/2015 12:00:00 AM | 9/9/2015 9:25 AM |
| Contacts | Primary Contact | Insert | | | LUDINGTON, GAIL
FINANCIAL SERVICES DIRECTOR
5413963101 | 9/9/2014 7:58 AM |
| Contacts | Authorizing Official | Insert | | | ZIELINSKI, DENNIS
CEO
5413963101 | 9/9/2014 7:58 AM |
| Details | Last Recertification Date | Update | | 9/12/2013 12:00:00 AM | 9/9/2014 12:00:00 AM | 9/9/2014 7:58 AM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 9/12/2013 12:00:00 AM | 9/12/2013 4:15 PM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 6/1/2012 10:16 AM |
| Details | Last Recertification Date | Insert | | | | 12/14/2010 8:08 AM |
| Details | Grant Number | Insert | | | | 12/14/2010 8:08 AM |
| Details | 340B ID | Insert | | | CAH381312-00 | 12/14/2010 8:08 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 12/14/2010 8:08 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 12/14/2010 8:08 AM |
| Details | Medicare Provider Number | Insert | | | 381312 | 12/14/2010 8:08 AM |
| Details | Entity Name | Insert | | | COQUILLE VALLEY HOSPITAL DISTRICT | 12/14/2010 8:08 AM |
| Details | Program Code | Insert | | | CAH | 12/14/2010 8:08 AM |
| Details | Entity Subname | Insert | | | | 12/14/2010 8:08 AM |
| Dates | Participating Approval Date | Insert | | | 10/7/2010 12:00:00 AM | 12/14/2010 8:08 AM |
| Details | State | Insert | | | Active | 12/14/2010 8:08 AM |
| Dates | Registration Date | Insert | | | 9/23/2010 12:00:00 AM | 12/14/2010 8:08 AM |
| Dates | Signed By Date | Insert | | | 9/23/2010 12:00:00 AM | 12/14/2010 8:08 AM |
| Dates | Start Date | Insert | | | 1/1/2011 12:00:00 AM | 12/14/2010 8:08 AM |
| Terminations | Termination Comments | Insert | | | | 12/14/2010 8:08 AM |
| Terminations | Termination Date | Insert | | | | 12/14/2010 8:08 AM |
| Terminations | Termination Effective Date | Insert | | | | 12/14/2010 8:08 AM |
| Terminations | Termination Reason | Insert | | | | 12/14/2010 8:08 AM |