| Contacts | Authorizing Official | Update | Profile Change Request | Rase-Shuttleworth, Kim
Director of Billing
FAIRFIELD COMMUNITY HEALTH CENTER
7402776043-1011 | Rase-Shuttleworth, Kim
Revenue Specialist
FAIRFIELD COMMUNITY HEALTH CENTER
7402776043-1011 | 2/12/2024 1:54 PM |
| Details | State | Update | | To Be Terminated | Terminated | 10/1/2023 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 7/1/2023 12:00:00 AM | 7/18/2023 6:31 PM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 7/18/2023 6:31 PM |
| Terminations | Termination Comments | Update | Termination Request | | We moved all of our locations into one location at 220 E Walnut St Lancaster, Ohio 43130-4464 please see 340BID CHC12890-00 | 7/18/2023 6:31 PM |
| Terminations | Termination Date | Update | Termination Request | | 10/1/2023 12:00:00 AM | 7/18/2023 6:31 PM |
| Terminations | Termination Effective Date | Update | Termination Request | | 7/1/2023 12:00:00 AM | 7/18/2023 6:31 PM |
| Terminations | Termination Reason | Update | Termination Request | | Site closure | 7/18/2023 6:31 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | OPA Cancel Termination Request | 7/1/2023 12:00:00 AM | | 6/28/2023 10:21 AM |
| Details | State | Update | OPA Cancel Termination Request | To Be Terminated | Active | 6/28/2023 10:21 AM |
| Terminations | Termination Comments | Update | OPA Cancel Termination Request | this location is being merged into our new location of the primary 340B location site. 220 E Walnut St Lancaster Ohio 43130-4464 and the site id that it is merging with is the primary location id Contract Entity ID CHC12890-00 | | 6/28/2023 10:21 AM |
| Terminations | Termination Date | Update | OPA Cancel Termination Request | 7/1/2023 12:00:00 AM | | 6/28/2023 10:21 AM |
| Terminations | Termination Effective Date | Update | OPA Cancel Termination Request | 7/1/2023 12:00:00 AM | | 6/28/2023 10:21 AM |
| Terminations | Termination Reason | Update | OPA Cancel Termination Request | Site closure | | 6/28/2023 10:21 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 7/1/2023 12:00:00 AM | 6/12/2023 5:09 PM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 6/12/2023 5:09 PM |
| Terminations | Termination Comments | Update | Termination Request | | this location is being merged into our new location of the primary 340B location site. 220 E Walnut St Lancaster Ohio 43130-4464 and the site id that it is merging with is the primary location id Contract Entity ID CHC12890-00 | 6/12/2023 5:09 PM |
| Terminations | Termination Date | Update | Termination Request | | 7/1/2023 12:00:00 AM | 6/12/2023 5:09 PM |
| Terminations | Termination Effective Date | Update | Termination Request | | 7/1/2023 12:00:00 AM | 6/12/2023 5:09 PM |
| Terminations | Termination Reason | Update | Termination Request | | Site closure | 6/12/2023 5:09 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2022 9:54:25 AM | 1/30/2023 10:13:11 AM | 1/30/2023 10:13 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2021 8:27:55 AM | 2/1/2022 9:54:25 AM | 2/1/2022 9:54 AM |
| Details | Last Recertification Date | Update | Recertification | 1/27/2020 12:27:56 PM | 2/1/2021 8:27:55 AM | 2/1/2021 8:27 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Rase, Kim
Director of Billing
FAIRFIELD COMMUNITY HEALTH CENTER
7402776043-1011 | Rase-Shuttleworth, Kim
Director of Billing
FAIRFIELD COMMUNITY HEALTH CENTER
7402776043-1011 | 10/5/2020 6:39 AM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2019 8:47:13 AM | 1/27/2020 12:27:56 PM | 1/27/2020 12:27 PM |
| Contacts | Authorizing Official | Update | Change Request | Althaus, Lauree
Director of Finance
Fairfield Community Health Center
7402776043-1001 | Rase, Kim
Director of Billing
FAIRFIELD COMMUNITY HEALTH CENTER
7402776043-1011 | 6/18/2019 11:24 AM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2018 8:48:55 AM | 1/29/2019 8:47:13 AM | 1/29/2019 8:47 AM |
| Contacts | Primary Contact | Update | Recertification | Althaus, Lauree
Director of Finance
Fairfield Community Health Center
7402776043-1001 | Fisher, Daniel Edward
CFO
Fairfield Community Health Center
7402776043-1002 | 2/8/2018 8:48 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2017 12:00:00 AM | 2/8/2018 8:48:55 AM | 2/8/2018 8:48 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Althaus, Lauree
Director of AR
Fairfield Community Health Center
7402776043-1001 | Althaus, Lauree
Director of Finance
Fairfield Community Health Center
7402776043-1001 | 1/9/2018 10:19 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Althaus, Lauree
Director of AR
Fairfield Community Health Center
7402776043-1001 | Althaus, Lauree
Director of Finance
Fairfield Community Health Center
7402776043-1001 | 1/9/2018 10:19 AM |
| Contacts | Authorizing Official | Update | | Althaus, Lauree
Director of AR
7402776043-1001 | Althaus, Lauree
Director of AR
Fairfield Community Health Center
7402776043-1001 | 10/2/2017 1:27 PM |
| Contacts | Primary Contact | Update | | Althaus, Lauree
Director of AR
7402776043-1001 | Althaus, Lauree
Director of AR
Fairfield Community Health Center
7402776043-1001 | 10/2/2017 1:27 PM |
| Contacts | Authorizing Official | Update | | Fisher, Daniel
CFO
7402776043-1002 | Althaus, Lauree
Director of AR
7402776043-1001 | 7/7/2017 9:58 AM |
| Contacts | Primary Contact | Update | | Fisher, Daniel
CFO
7402776043-1002 | Althaus, Lauree
Director of AR
7402776043-1001 | 7/7/2017 9:58 AM |
| Addresses | Main Address | Insert | | |
216 Trace Dr
Lancaster, OH 43130-4151 | 2/1/2017 9:18 AM |
| Details | Last Recertification Date | Update | | 2/25/2016 12:00:00 AM | 2/1/2017 12:00:00 AM | 2/1/2017 9:17 AM |
| Contacts | Authorizing Official | Update | | Barwick, Ronald
CEO
7402776043-1003 | Fisher, Daniel
CFO
7402776043-1002 | 2/25/2016 1:47 PM |
| Contacts | Primary Contact | Update | | Barwick, Ronald
CEO
7402776043-1003 | Fisher, Daniel
CFO
7402776043-1002 | 2/25/2016 1:47 PM |
| Details | Last Recertification Date | Update | | 2/10/2015 12:00:00 AM | 2/25/2016 12:00:00 AM | 2/25/2016 1:47 PM |
| Details | Last Recertification Date | Update | | 3/23/2014 12:00:00 AM | 2/10/2015 12:00:00 AM | 2/10/2015 3:37 PM |
| Contacts | Authorizing Official | Insert | | | Barwick, Ronald
CEO
7402776043-1003 | 1/6/2015 4:05 PM |
| Contacts | Primary Contact | Insert | | | Barwick, Ronald
CEO
7402776043-1003 | 1/6/2015 4:05 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/23/2014 12:00:00 AM | 3/23/2014 3:10 PM |
| Details | Entity Subname | Update | | HUNTER TRACE | Fairfield Community Health Center - Hunter Trace | 3/23/2014 3:10 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/13/2013 11:23 AM |
| Addresses | Billing Address | Insert | | | FAIRFIELD COMMUNITY HEALTH CENTER
1155 EAST MAIN STREET
LANCASTER, OH 43130 | 6/14/2011 5:04 PM |
| Details | Last Recertification Date | Insert | | | | 6/14/2011 5:04 PM |
| Details | Grant Number | Insert | | | H80CS19595 | 6/14/2011 5:04 PM |
| Details | 340B ID | Insert | | | CHC12890-01 | 6/14/2011 5:04 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 6/14/2011 5:04 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 6/14/2011 5:04 PM |
| Details | Medicare Provider Number | Insert | | | | 6/14/2011 5:04 PM |
| Details | Entity Name | Insert | | | FAIRFIELD COMMUNITY HEALTH CENTER | 6/14/2011 5:04 PM |
| Details | Program Code | Insert | | | CH | 6/14/2011 5:04 PM |
| Details | Entity Subname | Insert | | | HUNTER TRACE | 6/14/2011 5:04 PM |
| Dates | Participating Approval Date | Insert | | | 6/14/2011 12:00:00 AM | 6/14/2011 5:04 PM |
| Details | State | Insert | | | Active | 6/14/2011 5:04 PM |
| Dates | Registration Date | Insert | | | 5/27/2011 12:00:00 AM | 6/14/2011 5:04 PM |
| Dates | Signed By Date | Insert | | | 5/19/2011 12:00:00 AM | 6/14/2011 5:04 PM |
| Dates | Start Date | Insert | | | 7/1/2011 12:00:00 AM | 6/14/2011 5:04 PM |
| Terminations | Termination Comments | Insert | | | | 6/14/2011 5:04 PM |
| Terminations | Termination Date | Insert | | | | 6/14/2011 5:04 PM |
| Terminations | Termination Effective Date | Insert | | | | 6/14/2011 5:04 PM |
| Terminations | Termination Reason | Insert | | | | 6/14/2011 5:04 PM |