| Contacts | Authorizing Official | Update | AO Change Request | Paul, Tracey L.
CFO
North Country Hospital
8023343271-271 | Schaffner, Fred Bernard
CFO
North Country Hospital
8023347331-506 | 8/22/2024 2:43 PM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2023 3:22:03 PM | 8/22/2024 12:53:03 PM | 8/22/2024 12:53 PM |
| Addresses | Billing Address | Insert | Recertification | | North Country Hospital
189 Prouty Drive
Newport, VT 05855 | 8/17/2023 3:22 PM |
| Addresses | Shipping Address | Insert | Recertification | | North Country Hospital
189 Prouty Drive
Newport, VT 05855 | 8/17/2023 3:22 PM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2022 9:43:27 AM | 8/17/2023 3:22:03 PM | 8/17/2023 3:22 PM |
| Contacts | Primary Contact | Update | PC Change Request | Manning, Valarie
Director of Pharmacy
North Country Health Systems
8023343210-8618 | Donovan, Jillian L
Pharmacist
North Country Hospital
8023343210-616 | 8/17/2023 2:41 PM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2021 1:14:41 PM | 9/1/2022 9:43:27 AM | 9/1/2022 9:43 AM |
| Details | Entity Name | Update | Change Request | NORTH COUNTRY HEALTH SYSTEM | NORTH COUNTRY HOSPITAL AND HEALTH CENTER INC | 4/5/2022 2:48 PM |
| Contacts | Primary Contact | Update | PC Change Request | Onusseit, Monika
Pharmacy Director, Clinical Pharmacist
North Country Health system
8023343210-618 | Manning, Valarie
Director of Pharmacy
North Country Health Systems
8023343210-8618 | 3/2/2022 10:21 AM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2020 3:03:04 PM | 8/24/2021 1:14:41 PM | 8/24/2021 1:14 PM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2019 9:23:19 AM | 8/17/2020 3:03:04 PM | 8/17/2020 3:03 PM |
| Contacts | Primary Contact | Update | Change Request | Wilkins, Pamela Lee
340B Coordinator
NORTH COUNTRY HEALTH SYSTEM
8023343283 | Onusseit, Monika
Pharmacy Director, Clinical Pharmacist
North Country Health system
8023343210-618 | 1/23/2020 10:19 AM |
| Contacts | Authorizing Official | Update | Change Request | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
North Country Health System
8023343253 | Paul, Tracey L.
CFO
North Country Hospital
8023343271-271 | 1/15/2020 2:12 PM |
| Contacts | Primary Contact | Update | Recertification | Omar, Michael
Director of Pharmacy
North Country Hospital
8023347331-616 | Wilkins, Pamela Lee
340B Coordinator
NORTH COUNTRY HEALTH SYSTEM
8023343283 | 8/28/2019 9:23 AM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2018 1:45:10 PM | 8/28/2019 9:23:19 AM | 8/28/2019 9:23 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
North Country Hospital and Health Ctr., Inc.
8023343253 | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
North Country Health System
8023343253 | 3/21/2019 12:37 PM |
| Contacts | Signed By | Update | Profile Change Request | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
North Country Hospital and Health Ctr., Inc.
8023343253 | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
North Country Health System
8023343253 | 3/21/2019 12:37 PM |
| Details | Last Recertification Date | Update | Recertification | 11/8/2017 11:05:15 AM | 8/28/2018 1:45:10 PM | 8/28/2018 1:45 PM |
| Details | Last Recertification Date | Update | Recertification | 10/26/2017 8:28:39 AM | 11/8/2017 11:05:15 AM | 11/8/2017 11:05 AM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2016 12:00:00 AM | 10/26/2017 8:28:39 AM | 10/26/2017 8:28 AM |
| Contacts | Authorizing Official | Update | | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
8023343253 | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
North Country Hospital and Health Ctr., Inc.
8023343253 | 10/10/2017 9:02 AM |
| Contacts | Signed By | Update | | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
8023343253 | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
North Country Hospital and Health Ctr., Inc.
8023343253 | 10/10/2017 9:02 AM |
| Contacts | Primary Contact | Update | | Omar, Michael
Director of Pharmacy
8023347331-616 | Omar, Michael
Director of Pharmacy
North Country Hospital
8023347331-616 | 10/3/2017 2:16 PM |
| Addresses | Main Address | Insert | | |
488 Elm Street
Barton, VT 05822 | 1/30/2017 4:19 PM |
| Contacts | Primary Contact | Insert | | | Omar, Michael
Director of Pharmacy
8023347331-616 | 1/30/2017 4:19 PM |
| Contacts | Authorizing Official | Insert | | | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
8023343253 | 1/30/2017 4:19 PM |
| Contacts | Signed By | Insert | | | BISSONETTE, ANDRE
V.P. FINANCE (C.F.O.)
8023343253 | 1/30/2017 4:19 PM |
| Details | Last Recertification Date | Update | | 8/5/2015 12:00:00 AM | 8/31/2016 12:00:00 AM | 8/31/2016 9:20 AM |
| Details | Last Recertification Date | Update | | 8/11/2014 12:00:00 AM | 8/5/2015 12:00:00 AM | 8/5/2015 10:13 AM |
| Details | Entity Subname | Update | | The Barton Clinic | North Country Primary Care-Barton/Orleans | 4/10/2015 1:18 PM |
| Details | Last Recertification Date | Update | | 8/19/2013 3:00:40 PM | 8/11/2014 12:00:00 AM | 8/11/2014 9:23 AM |
| Details | Last Recertification Date | Update | | | 8/19/2013 3:00:40 PM | 8/19/2013 3:00 PM |
| Details | 340B ID | Update | | IS-CA-CAH471304-02 | CAH471304-02 | 8/20/2012 3:48 PM |
| Dates | Participating Approval Date | Update | | | 8/20/2012 12:00:00 AM | 8/20/2012 3:48 PM |
| Details | State | Update | | Pending | Active | 8/20/2012 3:48 PM |
| Dates | Start Date | Update | | | 10/1/2012 12:00:00 AM | 8/20/2012 3:48 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | IS-CA-CAH471304-02 | 8/17/2012 12:03 PM |
| Details | Last Recertification Date | Insert | | | | 7/30/2012 11:36 AM |
| Details | Grant Number | Insert | | | | 7/30/2012 11:36 AM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 7/30/2012 11:36 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/30/2012 11:36 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/30/2012 11:36 AM |
| Details | Medicare Provider Number | Insert | | | 471304 | 7/30/2012 11:36 AM |
| Details | Entity Name | Insert | | | NORTH COUNTRY HEALTH SYSTEM | 7/30/2012 11:36 AM |
| Details | Program Code | Insert | | | CAH | 7/30/2012 11:36 AM |
| Details | Entity Subname | Insert | | | The Barton Clinic | 7/30/2012 11:36 AM |
| Dates | Participating Approval Date | Insert | | | | 7/30/2012 11:36 AM |
| Details | State | Insert | | | Pending | 7/30/2012 11:36 AM |
| Dates | Registration Date | Insert | | | 7/30/2012 12:00:00 AM | 7/30/2012 11:36 AM |
| Dates | Signed By Date | Insert | | | 7/30/2012 12:00:00 AM | 7/30/2012 11:36 AM |
| Dates | Start Date | Insert | | | | 7/30/2012 11:36 AM |
| Terminations | Termination Comments | Insert | | | | 7/30/2012 11:36 AM |
| Terminations | Termination Date | Insert | | | | 7/30/2012 11:36 AM |
| Terminations | Termination Effective Date | Insert | | | | 7/30/2012 11:36 AM |
| Terminations | Termination Reason | Insert | | | | 7/30/2012 11:36 AM |