| Contacts | Primary Contact | Update | Recertification | Dunn, Morgan
CEO
LifeBrite Hospital Group of Early, LLC
6013826315 | Gale, Stacey
Director of Pharmacy
LifeBrite Hospital Group of Early, LLC
2297234241-1006 | 8/12/2024 10:28 AM |
| Details | Last Recertification Date | Update | Recertification | | 8/12/2024 10:28:00 AM | 8/12/2024 10:28 AM |
| Details | State | Update | | Approved | Active | 4/1/2024 12:01 AM |
| Contacts | Authorizing Official | Update | Reinstatement | Cushing, Ginger Maddox
administrator
LifeBrite Hospital Group of EArly, LLC
2297244235 | Dunn, Morgan
CEO
LifeBrite Hospital Group of Early, LLC
6013826315 | 1/16/2024 10:47 AM |
| Contacts | Primary Contact | Update | Reinstatement | Gale, Stacey
Pharmacist
Lifebrite Hospital Group of Early, LLC
2297244208 | Dunn, Morgan
CEO
LifeBrite Hospital Group of Early, LLC
6013826315 | 1/16/2024 10:47 AM |
| Contacts | Signed By | Insert | Reinstatement | | Dunn, Morgan
CEO
LifeBrite Hospital Group of Early, LLC
6013826315 | 1/16/2024 10:47 AM |
| Details | Last Recertification Date | Update | Reinstatement | 11/29/2017 6:50:52 AM | | 1/16/2024 10:47 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 3/5/2018 12:00:00 AM | | 1/16/2024 10:47 AM |
| Details | Entity Name | Update | Reinstatement | LifeBrite Hospital Group of Early, LLC D/B/A LifeBrite Community Hospital of Early, LLC | LIFEBRITE COMMUNITY HOSPITAL OF EARL | 1/16/2024 10:47 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 9/27/2010 12:00:00 AM | 1/16/2024 10:47:56 AM | 1/16/2024 10:47 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 1/16/2024 10:47 AM |
| Dates | Registration Date | Update | Reinstatement | 9/27/2010 12:00:00 AM | 1/5/2024 11:08:39 AM | 1/16/2024 10:47 AM |
| Dates | Signed By Date | Update | Reinstatement | 9/20/2010 12:00:00 AM | 1/11/2024 11:02:23 AM | 1/16/2024 10:47 AM |
| Dates | Start Date | Update | Reinstatement | 9/27/2010 12:00:00 AM | 4/1/2024 12:00:00 AM | 1/16/2024 10:47 AM |
| Terminations | Termination Date | Update | Reinstatement | 4/1/2018 12:00:00 AM | | 1/16/2024 10:47 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 3/5/2018 12:00:00 AM | | 1/16/2024 10:47 AM |
| Terminations | Termination Reason | Update | Reinstatement | Business decision by the Covered Entity | | 1/16/2024 10:47 AM |
| Contacts | Primary Contact | Update | Reinstatement | Gale, Stacey
pharmacist
Lifebrite Hospital Group
2297244208 | Gale, Stacey
Pharmacist
Lifebrite Hospital Group of Early, LLC
2297244208 | 1/11/2024 11:43 AM |
| Details | Comments Public | Insert | Reinstatement | | Participating Start Date 9/27/2010, Termination Date
4/1/2018, Reinstatement 4/1/2024 | 1/11/2024 11:18 AM |
| Details | State | Update | | To Be Terminated | Terminated | 4/1/2018 12:00 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 3/5/2018 12:00:00 AM | 3/5/2018 3:44 PM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 3/5/2018 3:44 PM |
| Terminations | Termination Date | Update | Termination Request | | 4/1/2018 12:00:00 AM | 3/5/2018 3:44 PM |
| Terminations | Termination Effective Date | Update | Termination Request | | 3/5/2018 12:00:00 AM | 3/5/2018 3:44 PM |
| Terminations | Termination Reason | Update | Termination Request | | Business decision by the Covered Entity | 3/5/2018 3:44 PM |
| Addresses | Billing Address | Update | Recertification | PIONEER HEALTH SERVICES
110 Pioneer Way
MAGEE, MS 39111 | LifeBrite Hospital Group. llc
3970 Five Forks Trickum Rd SW Ste A
Lilburn, GA 30047 | 11/29/2017 6:50 AM |
| Contacts | Primary Contact | Update | Recertification | Ilgenfritz, Carter
Corp. Dir. of Pharmacy Programs
6018496440-339 | Gale, Stacey
pharmacist
Lifebrite Hospital Group
2297244208 | 11/29/2017 6:50 AM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2016 12:00:00 AM | 11/29/2017 6:50:52 AM | 11/29/2017 6:50 AM |
| Details | Entity Subname | Update | Recertification | PIONEER HEALTH SERVICES OF EARLY COUNTY, LLC D/B/A PIONEER FAMILY MEDICAL OF EARLY | LIFEBRITE HOSPITAL GROUP OF EARLY COUNTY, LLC D/B/A LIFEBRITE FAMILY MEDICAL OF EARLY | 11/29/2017 6:50 AM |
| Details | Entity Name | Update | Recertification | PIONEER HEALTH SERVICES OF EARLY COUNTY, LLC D/B/A/ PIONEER COMMUNITY HOSPITAL OF EARLY COUNTY | LifeBrite Hospital Group of Early, LLC D/B/A LifeBrite Community Hospital of Early, LLC | 11/21/2017 11:36 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Cushing, Ginger
HOSPITAL CEO
2297244211 | Cushing, Ginger Maddox
administrator
LifeBrite Hospital Group of EArly, LLC
2297244235 | 11/17/2017 10:59 AM |
| Contacts | Authorizing Official | Update | | Dunn, Morgan
CEO
LifeBrite Hospital Group of Early, LLC
6013826315 | Cushing, Ginger
HOSPITAL CEO
Pioneer Community Hospital of Early
2297244211 | 10/11/2017 9:52 AM |
| Contacts | Authorizing Official | Update | | GAMBLE, ALLEN J.
HOSPITAL CEO
2297244211 | Cushing, Ginger
HOSPITAL CEO
2297244211 | 9/11/2017 3:29 PM |
| Addresses | Main Address | Insert | | |
11045 COLUMBIA ST.
BLAKELY, GA 39823 | 8/26/2016 8:49 AM |
| Addresses | Billing Address | Insert | | | PIONEER HEALTH SERVICES
110 Pioneer Way
MAGEE, MS 39111 | 8/26/2016 8:49 AM |
| Contacts | Primary Contact | Update | | Cook, Wade
Pharmacy Director
2297244208 | Ilgenfritz, Carter
Corp. Dir. of Pharmacy Programs
6018496440-339 | 8/26/2016 8:49 AM |
| Contacts | Authorizing Official | Insert | | | GAMBLE, ALLEN J.
HOSPITAL CEO
2297244211 | 8/26/2016 8:49 AM |
| Details | Last Recertification Date | Update | | 8/21/2015 12:00:00 AM | 8/25/2016 12:00:00 AM | 8/25/2016 2:16 PM |
| Details | Last Recertification Date | Update | | 8/19/2014 12:00:00 AM | 8/21/2015 12:00:00 AM | 8/21/2015 9:55 AM |
| Contacts | Primary Contact | Update | | BLACKWELL, EDEN
RESEARCH ANALYST
6018496440-325 | Cook, Wade
Pharmacy Director
2297244208 | 9/8/2014 7:46 AM |
| Details | Last Recertification Date | Update | | 9/5/2013 9:27:27 AM | 8/19/2014 12:00:00 AM | 8/19/2014 10:36 AM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 9/5/2013 9:27:27 AM | 9/5/2013 9:27 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/10/2012 8:30 AM |
| Details | Comments Public | Insert | | | 3/28/12 - Updated bill to (was P.O.BOX 1100)
| 3/28/2012 1:11 PM |
| Contacts | Primary Contact | Insert | | | BLACKWELL, EDEN
RESEARCH ANALYST
6018496440-325 | 12/2/2010 7:02 AM |
| Details | Last Recertification Date | Insert | | | | 9/27/2010 12:36 PM |
| Details | Grant Number | Insert | | | | 9/27/2010 12:36 PM |
| Details | 340B ID | Insert | | | CAH111314-02 | 9/27/2010 12:36 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 9/27/2010 12:36 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 9/27/2010 12:36 PM |
| Details | Medicare Provider Number | Insert | | | 111314 | 9/27/2010 12:36 PM |
| Details | Entity Name | Insert | | | PIONEER HEALTH SERVICES OF EARLY COUNTY, LLC D/B/A/ PIONEER COMMUNITY HOSPITAL OF EARLY COUNTY | 9/27/2010 12:36 PM |
| Details | Program Code | Insert | | | CAH | 9/27/2010 12:36 PM |
| Details | Entity Subname | Insert | | | PIONEER HEALTH SERVICES OF EARLY COUNTY, LLC D/B/A PIONEER FAMILY MEDICAL OF EARLY | 9/27/2010 12:36 PM |
| Dates | Participating Approval Date | Insert | | | 9/27/2010 12:00:00 AM | 9/27/2010 12:36 PM |
| Details | State | Insert | | | Active | 9/27/2010 12:36 PM |
| Dates | Registration Date | Insert | | | 9/27/2010 12:00:00 AM | 9/27/2010 12:36 PM |
| Dates | Signed By Date | Insert | | | 9/20/2010 12:00:00 AM | 9/27/2010 12:36 PM |
| Dates | Start Date | Insert | | | 9/27/2010 12:00:00 AM | 9/27/2010 12:36 PM |
| Terminations | Termination Comments | Insert | | | | 9/27/2010 12:36 PM |
| Terminations | Termination Date | Insert | | | | 9/27/2010 12:36 PM |
| Terminations | Termination Effective Date | Insert | | | | 9/27/2010 12:36 PM |
| Terminations | Termination Reason | Insert | | | | 9/27/2010 12:36 PM |