| Details | State | Update | | Approved | Active | 4/1/2025 12:01 AM |
| Addresses | Billing Address | Insert | Reinstatement | | AdventHealth Hendersonville
c/o AdventHealth
902 Inspiration Ave.
Suite 9100
Altamonte Springs, FL 32714 | 2/6/2025 7:37 AM |
| Contacts | Signed By | Update | Reinstatement | Randolph, Karsten
VP/CFO
8286812420 | Burroughs, Steven
VP of Finance / CFO
AdventHealth Hendersonville
8286812102 | 2/6/2025 7:37 AM |
| Contacts | Primary Contact | Update | Reinstatement | Phillips, Larry D
Director Supply Chain and 340B Pharmacy
Adventhealth Hendersonville
8286812720 | Kirkpatrick, Rafael
SE Region 340B Coordinator
Adventhealth
9564668487 | 2/6/2025 7:37 AM |
| Details | Last Recertification Date | Update | Reinstatement | 8/30/2023 10:59:40 AM | | 2/6/2025 7:37 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 7/1/2024 12:00:00 AM | | 2/6/2025 7:37 AM |
| Details | Entity Name | Update | Reinstatement | AdventHealth Hendersonville | ADVENTHEALTH HENDERSONVILLE | 2/6/2025 7:37 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 8/30/2012 12:00:00 AM | 2/6/2025 7:37:12 AM | 2/6/2025 7:37 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 2/6/2025 7:37 AM |
| Dates | Registration Date | Update | Reinstatement | 8/15/2012 12:00:00 AM | 1/13/2025 9:33:52 AM | 2/6/2025 7:37 AM |
| Dates | Signed By Date | Update | Reinstatement | 8/15/2012 12:00:00 AM | 1/14/2025 1:46:13 PM | 2/6/2025 7:37 AM |
| Dates | Start Date | Update | Reinstatement | 10/1/2012 12:00:00 AM | 4/1/2025 12:00:00 AM | 2/6/2025 7:37 AM |
| Terminations | Termination Date | Update | Reinstatement | 7/1/2024 12:00:00 AM | | 2/6/2025 7:37 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 7/1/2024 12:00:00 AM | | 2/6/2025 7:37 AM |
| Terminations | Termination Reason | Update | Reinstatement | Change of covered entity type | | 2/6/2025 7:37 AM |
| Details | Comments Public | Insert | Reinstatement | | Participated starting 10/1/2012, terminated 7/1/2024. Reinstated 4/1/2025. | 1/27/2025 12:30 PM |
| Details | State | Update | | To Be Terminated | Terminated | 7/1/2024 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | | 7/1/2024 12:00:00 AM | 4/22/2024 2:49 PM |
| Details | State | Update | Hospital Type Change Request | Active | To Be Terminated | 4/22/2024 2:49 PM |
| Terminations | Termination Date | Update | Hospital Type Change Request | | 7/1/2024 12:00:00 AM | 4/22/2024 2:49 PM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | | 7/1/2024 12:00:00 AM | 4/22/2024 2:49 PM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | | Change of covered entity type | 4/22/2024 2:49 PM |
| Details | Last Recertification Date | Update | Recertification | 9/8/2022 7:28:09 AM | 8/30/2023 10:59:40 AM | 8/30/2023 10:59 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Nudd, Brandon M
President & CEO
AdventHealth Hendersonville
8286812102 | Burroughs, Steven
VP of Finance / CFO
AdventHealth Hendersonville
8286812102 | 4/3/2023 10:28 AM |
| Contacts | Primary Contact | Update | PC Change Request | Horn, Jonathan
340B Coordinator
AdventHealth
7708784891 | Phillips, Larry D
Director Supply Chain and 340B Pharmacy
Adventhealth Hendersonville
8286812720 | 3/28/2023 8:33 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Stenstrom, Ella
CFO
Park Ridge Health
8286812102 | Nudd, Brandon M
President & CEO
AdventHealth Hendersonville
8286812102 | 12/13/2022 3:49 PM |
| Medicaid Billing | Medicaid: Number | Delete | Group Change Request | 3407195 (NC) | | 10/14/2022 10:43 AM |
| Medicaid Billing | NPI: Number | Delete | Group Change Request | 1992740468 (NC) | | 10/14/2022 10:43 AM |
| Contacts | Primary Contact | Update | Recertification | Roselli, Jessica
340B Coordinator
AdventHealth Hendersonville
8286812168 | Horn, Jonathan
340B Coordinator
AdventHealth
7708784891 | 9/8/2022 7:28 AM |
| Details | Last Recertification Date | Update | Recertification | 9/8/2021 1:00:35 PM | 9/8/2022 7:28:09 AM | 9/8/2022 7:28 AM |
| Details | Last Recertification Date | Update | Recertification | 9/3/2020 12:45:27 PM | 9/8/2021 1:00:35 PM | 9/8/2021 1:00 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/3/2020 12:45 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 3400023S | 9/3/2020 12:45 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | NC | 9/3/2020 12:45 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/3/2020 12:45 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 3407195 | 9/3/2020 12:45 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | NC | 9/3/2020 12:45 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1427075027 | 9/3/2020 12:45 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NC | 9/3/2020 12:45 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1265466452 | 9/3/2020 12:45 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NC | 9/3/2020 12:45 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1992740468 | 9/3/2020 12:45 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NC | 9/3/2020 12:45 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1427075027 ( ) | | 9/3/2020 12:45 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2019 4:15:45 PM | 9/3/2020 12:45:27 PM | 9/3/2020 12:45 PM |
| Contacts | Primary Contact | Update | Change Request | Bayne, Christina
Interim 340B Regional Mgr
Southeast Region
8286508298 | Roselli, Jessica
340B Coordinator
AdventHealth Hendersonville
8286812168 | 11/21/2019 4:10 PM |
| Details | Last Recertification Date | Update | Recertification | 9/4/2018 9:12:44 AM | 8/23/2019 4:15:45 PM | 8/23/2019 4:15 PM |
| Addresses | Billing Address | Update | Change Request | AdventHealth Hendersonville
c/o Adventist Health System
902 Inspiration Ave.
Suite 9100
Altamonte Springs, FL 32714 | AdventHealth Hendersonville
c/o AdventHealth
902 Inspiration Ave.
Suite 9100
Altamonte Springs, FL 32714 | 8/14/2019 4:41 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Stenstrom, Ella
Interim CFO
Park Ridge Health
8286812102 | Stenstrom, Ella
CFO
Park Ridge Health
8286812102 | 7/25/2019 11:45 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Stenstrom, Ella
Interim CFO
Park Ridge Health
6123902075 | Stenstrom, Ella
Interim CFO
Park Ridge Health
8286812102 | 7/25/2019 11:45 AM |
| Addresses | Shipping Address | Insert | Change Request | | AdventHealth Hendersonville
100 Hospital Drive
Hendersonville, NC 28792 | 4/26/2019 1:54 PM |
| Addresses | Billing Address | Update | Change Request | Park Ridge Health
c/o Adventist Health System
902 Inspiration Ave.
Suite 9100
Altamonte Springs, FL 32714 | AdventHealth Hendersonville
c/o Adventist Health System
902 Inspiration Ave.
Suite 9100
Altamonte Springs, FL 32714 | 4/26/2019 1:54 PM |
| Addresses | Shipping Address | Delete | Change Request | Park Ridge Health
100 Hospital Drive
Hendersonville, NC 28792 | | 4/26/2019 1:54 PM |
| Details | Entity Subname | Update | Change Request | Park Ridge Health Surgery Specialists | AdventHealth Medical Group Surgery Specialists at Hendersonville | 4/26/2019 1:54 PM |
| Details | Entity Name | Update | Change Request | PARK RIDGE HEALTH | AdventHealth Hendersonville | 4/26/2019 1:48 PM |
| Contacts | Primary Contact | Update | Change Request | Molnar, Diane
340B Regional Manager
Southeast Region
8286812168 | Bayne, Christina
Interim 340B Regional Mgr
Southeast Region
8286508298 | 12/21/2018 10:51 AM |
| Contacts | Authorizing Official | Update | Change Request | Barber, Wendi
VP FINANCE, CFO
340023
8286812102 | Stenstrom, Ella
Interim CFO
Park Ridge Health
6123902075 | 11/26/2018 7:12 AM |
| Details | Last Recertification Date | Update | Recertification | 11/16/2017 4:53:07 PM | 9/4/2018 9:12:44 AM | 9/4/2018 9:12 AM |
| Addresses | Main Address | Update | Recertification |
80 Doctors Drive
Suite 1
Hendersonville, NC 28792 |
80 Doctors Drive
Suite 1
Hendersonville, NC 28792-7289 | 11/16/2017 4:53 PM |
| Addresses | Billing Address | Update | Recertification | Park Ridge Health
50 Hospital Drive
Suite G-A
Hendersonville, NC 28792 | Park Ridge Health
c/o Adventist Health System
902 Inspiration Ave.
Suite 9100
Altamonte Springs, FL 32714 | 11/16/2017 4:53 PM |
| Details | Last Recertification Date | Update | Recertification | 8/10/2016 12:00:00 AM | 11/16/2017 4:53:07 PM | 11/16/2017 4:53 PM |
| Contacts | Authorizing Official | Update | | Barber, Wendi
VP FINANCE, CFO
8286812102 | Barber, Wendi
VP FINANCE, CFO
340023
8286812102 | 9/24/2017 7:57 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Molnar, Diane
340B Regional Manager
Park Ridge Health
8286812168 | Molnar, Diane
340B Regional Manager
Southeast Region
8286812168 | 9/22/2017 10:04 AM |
| Contacts | Primary Contact | Update | | Molnar, Diane
340B Regional Manager
8286812168 | Molnar, Diane
340B Regional Manager
Park Ridge Health
8286812168 | 9/18/2017 3:08 PM |
| Contacts | Primary Contact | Insert | | | Molnar, Diane
340B Regional Manager
8286812168 | 8/10/2017 5:14 PM |
| Contacts | Authorizing Official | Insert | | | Barber, Wendi
VP FINANCE, CFO
8286812102 | 7/14/2017 10:59 AM |
| Contacts | Signed By | Insert | | | Randolph, Karsten
VP/CFO
8286812420 | 5/2/2017 3:23 PM |
| Addresses | Main Address | Insert | | |
80 Doctors Drive
Suite 1
Hendersonville, NC 28792 | 2/22/2017 1:18 PM |
| Addresses | Billing Address | Insert | | | Park Ridge Health
50 Hospital Drive
Suite G-A
Hendersonville, NC 28792 | 2/22/2017 1:18 PM |
| Addresses | Shipping Address | Insert | | | Park Ridge Health
100 Hospital Drive
Hendersonville, NC 28792 | 2/22/2017 1:18 PM |
| Details | Last Recertification Date | Update | | 8/11/2015 12:00:00 AM | 8/10/2016 12:00:00 AM | 8/10/2016 2:18 PM |
| Details | Last Recertification Date | Update | | 8/22/2014 12:00:00 AM | 8/11/2015 12:00:00 AM | 8/11/2015 1:31 PM |
| Details | Entity Subname | Update | | Park Ridge Health General, Thoracic, and Vascular Surgeons | Park Ridge Health Surgery Specialists | 1/23/2015 8:44 AM |
| Details | Last Recertification Date | Update | | 9/9/2013 12:00:00 AM | 8/22/2014 12:00:00 AM | 8/22/2014 8:13 AM |
| Details | Entity Subname | Update | | Park Ridge General Surgeons | Park Ridge Health General, Thoracic, and Vascular Surgeons | 7/17/2014 8:53 AM |
| Details | Last Recertification Date | Update | | | 9/9/2013 12:00:00 AM | 9/9/2013 6:41 AM |
| Details | 340B ID | Update | | IS-AP-DSH340023F | DSH340023F | 8/30/2012 4:18 PM |
| Dates | Participating Approval Date | Update | | | 8/30/2012 12:00:00 AM | 8/30/2012 4:18 PM |
| Details | State | Update | | Pending | Active | 8/30/2012 4:18 PM |
| Dates | Start Date | Update | | | 10/1/2012 12:00:00 AM | 8/30/2012 4:18 PM |
| Details | 340B ID | Update | | AP08161210 | IS-AP-DSH340023F | 8/27/2012 3:59 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | AP08161210 | 8/16/2012 7:57 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/15/2012 2:44 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 3400023 | 8/15/2012 2:44 PM |
| Medicaid Billing | Medicaid: State | Insert | | | NC | 8/15/2012 2:44 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1427075027 | 8/15/2012 2:44 PM |
| Details | Last Recertification Date | Insert | | | | 8/15/2012 2:44 PM |
| Details | Grant Number | Insert | | | | 8/15/2012 2:44 PM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 8/15/2012 2:44 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/15/2012 2:44 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/15/2012 2:44 PM |
| Details | Medicare Provider Number | Insert | | | 340023 | 8/15/2012 2:44 PM |
| Details | Entity Name | Insert | | | PARK RIDGE HEALTH | 8/15/2012 2:44 PM |
| Details | Program Code | Insert | | | DSH | 8/15/2012 2:44 PM |
| Details | Entity Subname | Insert | | | Park Ridge General Surgeons | 8/15/2012 2:44 PM |
| Dates | Participating Approval Date | Insert | | | | 8/15/2012 2:44 PM |
| Details | State | Insert | | | Pending | 8/15/2012 2:44 PM |
| Dates | Registration Date | Insert | | | 8/15/2012 12:00:00 AM | 8/15/2012 2:44 PM |
| Dates | Signed By Date | Insert | | | 8/15/2012 12:00:00 AM | 8/15/2012 2:44 PM |
| Dates | Start Date | Insert | | | | 8/15/2012 2:44 PM |
| Terminations | Termination Comments | Insert | | | | 8/15/2012 2:44 PM |
| Terminations | Termination Date | Insert | | | | 8/15/2012 2:44 PM |
| Terminations | Termination Effective Date | Insert | | | | 8/15/2012 2:44 PM |
| Terminations | Termination Reason | Insert | | | | 8/15/2012 2:44 PM |