| Details | Last Recertification Date | Update | Recertification | 1/31/2024 8:24:17 AM | 2/25/2025 3:17:37 PM | 2/25/2025 3:17 PM |
| Contacts | Primary Contact | Update | PC Change Request | Rentscheler, Jason Forrest
Chief Compliance and Information Officer
Wesley Community & Health Centers Inc.
6023689603 | Rentscheler, Jason
Chief Compliance and Information Officer
Wesley Community Centers Inc.
6023689603 | 6/17/2024 3:46 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Bandi, Blaine
Chief Executive Officer
Wesley Community Center, Inc
6023689616 | Bandi, Blaine
CEO
Wesley Community & Health Center
6023689616 | 5/20/2024 8:40 AM |
| Details | Last Recertification Date | Update | Recertification | 2/6/2023 12:49:03 PM | 1/31/2024 8:24:17 AM | 1/31/2024 8:24 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Rentscheler, Jason Forrest
Chief Operations Officer
Wesley Community & Health Centers Inc.
6023689603 | Rentscheler, Jason Forrest
Chief Compliance and Information Officer
Wesley Community & Health Centers Inc.
6023689603 | 1/29/2024 3:35 PM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2022 5:10:44 PM | 2/6/2023 12:49:03 PM | 2/6/2023 12:49 PM |
| Details | Last Recertification Date | Update | Recertification | 2/18/2021 6:48:36 PM | 1/31/2022 5:10:44 PM | 1/31/2022 5:10 PM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 338016 (AZ) | | 2/18/2021 6:48 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/18/2021 6:48 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 934329 | 2/18/2021 6:48 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | AZ | 2/18/2021 6:48 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | AZ | 2/18/2021 6:48 PM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2020 4:42:23 PM | 2/18/2021 6:48:36 PM | 2/18/2021 6:48 PM |
| Contacts | Primary Contact | Update | Change Request | Chambers, Jaree
COO
Wesley Health Center
6023689603 | Rentscheler, Jason Forrest
Chief Operations Officer
Wesley Community & Health Centers Inc.
6023689603 | 2/10/2020 8:23 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Bandi, Blaine
CAO
Wesley Community Center, Inc
6023689616 | Bandi, Blaine
Chief Executive Officer
Wesley Community Center, Inc
6023689616 | 2/5/2020 7:36 PM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2019 10:50:30 PM | 1/29/2020 4:42:23 PM | 1/29/2020 4:42 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2018 1:04:10 PM | 2/12/2019 10:50:30 PM | 2/12/2019 10:50 PM |
| Contacts | Primary Contact | Update | Change Request | Bandi, Blaine
CAO
Wesley Community Center, Inc
6023689616 | Chambers, Jaree
COO
Wesley Health Center
6023689603 | 1/28/2019 9:00 AM |
| Contacts | Authorizing Official | Update | Change Request | Chambers, Jaree
COO
Wesley Health Center
6023689603 | Bandi, Blaine
CAO
Wesley Community Center, Inc
6023689616 | 1/28/2019 9:00 AM |
| Contacts | Primary Contact | Update | Recertification | Chambers, Jaree
COO
Wesley Health Center
6023689603 | Bandi, Blaine
CAO
Wesley Community Center, Inc
6023689616 | 2/9/2018 1:04 PM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2017 12:00:00 AM | 2/9/2018 1:04:10 PM | 2/9/2018 1:04 PM |
| Contacts | Authorizing Official | Update | | Chambers, Jaree
COO
6023689603 | Chambers, Jaree
COO
Wesley Health Center
6023689603 | 1/8/2018 12:58 PM |
| Contacts | Primary Contact | Update | | Chambers, Jaree
COO
6023689603 | Chambers, Jaree
COO
Wesley Health Center
6023689603 | 1/8/2018 12:58 PM |
| Contacts | Authorizing Official | Insert | | | Chambers, Jaree
COO
6023689603 | 2/17/2017 7:47 AM |
| Contacts | Primary Contact | Update | | Mahlstede, Christine
COO/CFO
6023689603 | Chambers, Jaree
COO
6023689603 | 2/17/2017 7:47 AM |
| Addresses | Main Address | Insert | | |
1300 S. 10th St.
Phoenix, AZ 85034-4518 | 2/17/2017 7:47 AM |
| Contacts | Signed By | Insert | | | Viera, Emma
COO
6026150994 | 2/17/2017 7:47 AM |
| Details | Last Recertification Date | Update | | 2/26/2016 12:00:00 AM | 2/17/2017 12:00:00 AM | 2/17/2017 7:47 AM |
| Details | Last Recertification Date | Update | | 2/19/2015 12:00:00 AM | 2/26/2016 12:00:00 AM | 2/26/2016 9:49 AM |
| Contacts | Primary Contact | Insert | | | Mahlstede, Christine
COO/CFO
6023689603 | 2/19/2015 11:22 AM |
| Details | Last Recertification Date | Update | | 2/10/2014 12:00:00 AM | 2/19/2015 12:00:00 AM | 2/19/2015 11:22 AM |
| Details | Entity Name | Update | | Wesley Community Center | WESLEY COMMUNITY CENTER INC | 3/31/2014 4:25 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 2/10/2014 12:00:00 AM | 2/10/2014 12:02 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/6/2013 9:36 AM |
| Details | 340B ID | Update | | IS-FF-CHC12848 | CHC12848 | 6/19/2012 5:21 PM |
| Dates | Participating Approval Date | Update | | | 6/19/2012 12:00:00 AM | 6/19/2012 5:21 PM |
| Details | State | Update | | Pending | Active | 6/19/2012 5:21 PM |
| Dates | Start Date | Update | | | 7/1/2012 12:00:00 AM | 6/19/2012 5:21 PM |
| Details | 340B ID | Update | | ONLINE_REG | IS-FF-CHC12848 | 6/11/2012 10:02 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 5/7/2012 2:55 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 338016 | 5/7/2012 2:55 PM |
| Medicaid Billing | Medicaid: State | Insert | | | AZ | 5/7/2012 2:55 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1396910436 | 5/7/2012 2:55 PM |
| Details | Last Recertification Date | Insert | | | | 5/7/2012 2:55 PM |
| Details | Grant Number | Insert | | | H80CS12848 | 5/7/2012 2:55 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 5/7/2012 2:55 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 5/7/2012 2:55 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 5/7/2012 2:55 PM |
| Details | Medicare Provider Number | Insert | | | | 5/7/2012 2:55 PM |
| Details | Entity Name | Insert | | | Wesley Community Center | 5/7/2012 2:55 PM |
| Details | Program Code | Insert | | | CH | 5/7/2012 2:55 PM |
| Details | Entity Subname | Insert | | | Wesley Health Center | 5/7/2012 2:55 PM |
| Dates | Participating Approval Date | Insert | | | | 5/7/2012 2:55 PM |
| Details | State | Insert | | | Pending | 5/7/2012 2:55 PM |
| Dates | Registration Date | Insert | | | 5/7/2012 12:00:00 AM | 5/7/2012 2:55 PM |
| Dates | Signed By Date | Insert | | | 5/7/2012 12:00:00 AM | 5/7/2012 2:55 PM |
| Dates | Start Date | Insert | | | | 5/7/2012 2:55 PM |
| Terminations | Termination Comments | Insert | | | | 5/7/2012 2:55 PM |
| Terminations | Termination Date | Insert | | | | 5/7/2012 2:55 PM |
| Terminations | Termination Effective Date | Insert | | | | 5/7/2012 2:55 PM |
| Terminations | Termination Reason | Insert | | | | 5/7/2012 2:55 PM |