| Contacts | Primary Contact | Update | Change Request | Watson, Amy
Director of Pharmacy
Asante
5417895031 | Nguyen, Ruthie
Manager Pharmacy Shared Services
Asante
5417895379 | 3/7/2025 7:05 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2023 2:27:19 PM | 8/29/2024 8:00:46 AM | 8/29/2024 8:00 AM |
| Details | Last Recertification Date | Update | Recertification | 9/9/2022 12:53:51 PM | 8/26/2023 2:27:19 PM | 8/26/2023 2:27 PM |
| Contacts | Authorizing Official | Update | Change Request | Wojtal, Greg
Chief Administrative and Finance Officer
Asante
5417894549 | Rowenhorst, Heather
CFO
Asante
5417895098 | 5/24/2023 9:13 AM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2021 11:28:49 AM | 9/9/2022 12:53:51 PM | 9/9/2022 12:53 PM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2020 7:18:08 AM | 8/25/2021 11:28:49 AM | 8/25/2021 11:28 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1770587107 ( ) | | 8/18/2020 7:18 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1770587107 | 8/18/2020 7:18 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | OR | 8/18/2020 7:18 AM |
| Details | Last Recertification Date | Update | Recertification | 9/24/2019 10:02:53 AM | 8/18/2020 7:18:08 AM | 8/18/2020 7:18 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2018 3:49:19 PM | 9/24/2019 10:02:53 AM | 9/24/2019 10:02 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/11/2019 12:03 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 162008 | 6/11/2019 12:03 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | OR | 6/11/2019 12:03 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1770587107 | 6/11/2019 12:03 PM |
| Details | Last Recertification Date | Update | Recertification | 11/15/2017 10:35:32 PM | 8/22/2018 3:49:19 PM | 8/22/2018 3:49 PM |
| Details | Last Recertification Date | Update | Recertification | 9/6/2016 12:00:00 AM | 11/15/2017 10:35:32 PM | 11/15/2017 10:35 PM |
| Contacts | Authorizing Official | Update | | Wojtal, Greg
Chief Administrative and Finance Officer
5417894549 | Wojtal, Greg
Chief Administrative and Finance Officer
Asante
5417894549 | 9/21/2017 1:54 PM |
| Contacts | Primary Contact | Update | | Watson, Amy
Director of Pharmacy
5417895031 | Watson, Amy
Director of Pharmacy
Asante
5417895031 | 9/20/2017 6:58 PM |
| Contacts | Primary Contact | Update | | FEYERHARM, JEFFREY
RRMC PHARMACY MANAGER
5417894252 | Watson, Amy
Director of Pharmacy
5417895031 | 1/24/2017 8:42 AM |
| Contacts | Authorizing Official | Update | | HAAS, MARVIN D.
CAFO
5417894916 | Wojtal, Greg
Chief Administrative and Finance Officer
5417894549 | 1/24/2017 8:42 AM |
| Addresses | Main Address | Insert | | |
2825 EAST BARNETT ROAD
MEDFORD, OR 97504 | 1/17/2017 7:08 AM |
| Details | Last Recertification Date | Update | | 8/13/2015 12:00:00 AM | 9/6/2016 12:00:00 AM | 9/6/2016 6:04 PM |
| Details | Last Recertification Date | Update | | 8/11/2014 12:00:00 AM | 8/13/2015 12:00:00 AM | 8/13/2015 4:46 PM |
| Contacts | Primary Contact | Update | | FEYERHARM, JEFFERY
RRMC PHARMACY MANAGER
5417894252 | FEYERHARM, JEFFREY
RRMC PHARMACY MANAGER
5417894252 | 8/11/2014 10:13 AM |
| Details | Last Recertification Date | Update | | 9/9/2013 12:00:00 AM | 8/11/2014 12:00:00 AM | 8/11/2014 10:13 AM |
| Details | Entity Name | Update | | ROGUE VALLEY MEDICAL CENTER | ASANTE ROGUE REGIONAL MEDICAL CENTER | 8/4/2014 2:37 PM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 9/9/2013 12:00:00 AM | 9/9/2013 9:36 PM |
| Contacts | Primary Contact | Update | | HAAS, MARVIN D.
CAFO
5417894916 | FEYERHARM, JEFFERY
RRMC PHARMACY MANAGER
5417894252 | 4/12/2013 2:07 PM |
| Contacts | Authorizing Official | Insert | | | HAAS, MARVIN D.
CAFO
5417894916 | 5/21/2012 7:27 AM |
| Contacts | Primary Contact | Insert | | | HAAS, MARVIN D.
CAFO
5417894916 | 5/21/2012 7:27 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/21/2012 7:27 AM |
| Details | Last Recertification Date | Insert | | | | 3/10/2011 10:57 AM |
| Details | Grant Number | Insert | | | | 3/10/2011 10:57 AM |
| Details | 340B ID | Insert | | | DSH380018 | 3/10/2011 10:57 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 3/10/2011 10:57 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 3/10/2011 10:57 AM |
| Details | Medicare Provider Number | Insert | | | 380018 | 3/10/2011 10:57 AM |
| Details | Entity Name | Insert | | | ROGUE VALLEY MEDICAL CENTER | 3/10/2011 10:57 AM |
| Details | Program Code | Insert | | | DSH | 3/10/2011 10:57 AM |
| Details | Entity Subname | Insert | | | | 3/10/2011 10:57 AM |
| Dates | Participating Approval Date | Insert | | | 3/10/2011 12:00:00 AM | 3/10/2011 10:57 AM |
| Details | State | Insert | | | Active | 3/10/2011 10:57 AM |
| Dates | Registration Date | Insert | | | 3/4/2011 12:00:00 AM | 3/10/2011 10:57 AM |
| Dates | Signed By Date | Insert | | | 2/18/2011 12:00:00 AM | 3/10/2011 10:57 AM |
| Dates | Start Date | Insert | | | 4/1/2011 12:00:00 AM | 3/10/2011 10:57 AM |
| Terminations | Termination Comments | Insert | | | | 3/10/2011 10:57 AM |
| Terminations | Termination Date | Insert | | | | 3/10/2011 10:57 AM |
| Terminations | Termination Effective Date | Insert | | | | 3/10/2011 10:57 AM |
| Terminations | Termination Reason | Insert | | | | 3/10/2011 10:57 AM |