| Details | Last Recertification Date | Update | Recertification | 1/31/2024 11:00:36 AM | 2/13/2025 1:11:18 PM | 2/13/2025 1:11 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2023 9:22:20 AM | 1/31/2024 11:00:36 AM | 1/31/2024 11:00 AM |
| Details | Last Recertification Date | Update | Recertification | 2/26/2021 10:16:16 AM | 2/1/2023 9:22:20 AM | 2/1/2023 9:22 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | OPA Cancel Termination Request | 3/31/2022 12:00:00 AM | | 3/16/2022 10:36 AM |
| Details | State | Update | OPA Cancel Termination Request | To Be Terminated | Active | 3/16/2022 10:36 AM |
| Terminations | Termination Date | Update | OPA Cancel Termination Request | 4/1/2022 12:00:00 AM | | 3/16/2022 10:36 AM |
| Terminations | Termination Effective Date | Update | OPA Cancel Termination Request | 3/31/2022 12:00:00 AM | | 3/16/2022 10:36 AM |
| Terminations | Termination Reason | Update | OPA Cancel Termination Request | Failure to recertify | | 3/16/2022 10:36 AM |
| Details | Comments Public | Insert | OPA Edit | | Last Recertification Date 03/16/2022 | 3/16/2022 10:34 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 3/31/2022 12:00:00 AM | 3/4/2022 7:29 AM |
| Details | State | Update | Recertification | Active | To Be Terminated | 3/4/2022 7:29 AM |
| Terminations | Termination Date | Update | Recertification | | 4/1/2022 12:00:00 AM | 3/4/2022 7:29 AM |
| Terminations | Termination Effective Date | Update | Recertification | | 3/31/2022 12:00:00 AM | 3/4/2022 7:29 AM |
| Terminations | Termination Reason | Update | Recertification | | Failure to recertify | 3/4/2022 7:29 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1174839781 ( ) | | 2/26/2021 10:16 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1174839781 | 2/26/2021 10:16 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | TN | 2/26/2021 10:16 AM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2020 4:09:26 PM | 2/26/2021 10:16:16 AM | 2/26/2021 10:16 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/13/2020 4:09 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 441811 | 2/13/2020 4:09 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | TN | 2/13/2020 4:09 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1174839781 | 2/13/2020 4:09 PM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2019 3:55:08 PM | 2/13/2020 4:09:26 PM | 2/13/2020 4:09 PM |
| Details | Last Recertification Date | Update | Recertification | 3/5/2018 4:38:41 PM | 2/4/2019 3:55:08 PM | 2/4/2019 3:55 PM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2017 12:00:00 AM | 3/5/2018 4:38:41 PM | 3/5/2018 4:38 PM |
| Contacts | Authorizing Official | Update | | BEARD, KATINA
CEO
6153401265 | BEARD, KATINA
CEO
Matthew Walker Comprehensive Health Center, Inc
6153401265 | 2/28/2018 11:40 AM |
| Contacts | Primary Contact | Update | | HENRY, KENDALL
DIRECTOR OF PHARMACY
6153291900 | HENRY, KENDALL
DIRECTOR OF PHARMACY
Matthew Walker Comprehensive Health Center Pharmacy
6153291900 | 2/19/2018 5:25 PM |
| Addresses | Main Address | Insert | | |
739 Presidents Place
Suite 100
Smyrna, TN 37167-6845 | 2/13/2017 6:59 AM |
| Contacts | Signed By | Insert | | | McKissack, Jeff
Chief Executive Officer
6153401297 | 2/13/2017 6:59 AM |
| Contacts | Authorizing Official | Insert | | | BEARD, KATINA
CEO
6153401265 | 2/13/2017 6:59 AM |
| Contacts | Primary Contact | Update | | Bennette, Nikia
Director of Pharmacy
6153291900 | HENRY, KENDALL
DIRECTOR OF PHARMACY
6153291900 | 2/13/2017 6:59 AM |
| Details | Last Recertification Date | Update | | 2/18/2016 12:00:00 AM | 2/13/2017 12:00:00 AM | 2/13/2017 6:59 AM |
| Contacts | Primary Contact | Insert | | | Bennette, Nikia
Director of Pharmacy
6153291900 | 2/18/2016 1:44 PM |
| Details | Last Recertification Date | Update | | 3/2/2015 12:00:00 AM | 2/18/2016 12:00:00 AM | 2/18/2016 1:44 PM |
| Details | Last Recertification Date | Update | | 3/10/2014 12:00:00 AM | 3/2/2015 12:00:00 AM | 3/2/2015 9:48 AM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/10/2014 12:00:00 AM | 3/10/2014 1:55 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/19/2013 10:53 AM |
| Addresses | Billing Address | Insert | | | Matthew Walker Comprehensive Health Center, Inc.
1035 14th Avenue North
Nashville, TN 37208-3050 | 11/16/2012 4:47 PM |
| Addresses | Shipping Address | Insert | | | Matthew Walker Comprehensive Health Center
1035 14th Avenue North
Nashville, TN 37208-3050 | 11/16/2012 4:47 PM |
| Details | 340B ID | Update | | IS-FF-CH04142D | CH04142D | 11/16/2012 4:47 PM |
| Dates | Participating Approval Date | Update | | | 11/16/2012 12:00:00 AM | 11/16/2012 4:47 PM |
| Details | State | Update | | Pending | Active | 11/16/2012 4:47 PM |
| Dates | Start Date | Update | | | 1/1/2013 12:00:00 AM | 11/16/2012 4:47 PM |
| Details | 340B ID | Update | | ONLINE_REG | IS-FF-CH04142D | 11/7/2012 11:08 AM |
| Details | Entity Name | Update | | Matthew Walker Comprehensive Health Center | Matthew Walker Comprehensive Health Center, Inc. | 11/7/2012 11:08 AM |
| Details | Comments Public | Insert | | | 11/7/12 - Reviewed registration and forwarded to IS for approval. | 11/7/2012 11:08 AM |
| Details | Last Recertification Date | Insert | | | | 9/13/2012 11:06 AM |
| Details | Grant Number | Insert | | | H80CS00710 | 9/13/2012 11:06 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 9/13/2012 11:06 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 9/13/2012 11:06 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 9/13/2012 11:06 AM |
| Details | Medicare Provider Number | Insert | | | | 9/13/2012 11:06 AM |
| Details | Entity Name | Insert | | | Matthew Walker Comprehensive Health Center | 9/13/2012 11:06 AM |
| Details | Program Code | Insert | | | CH | 9/13/2012 11:06 AM |
| Details | Entity Subname | Insert | | | | 9/13/2012 11:06 AM |
| Dates | Participating Approval Date | Insert | | | | 9/13/2012 11:06 AM |
| Details | State | Insert | | | Pending | 9/13/2012 11:06 AM |
| Dates | Registration Date | Insert | | | 9/13/2012 12:00:00 AM | 9/13/2012 11:06 AM |
| Dates | Signed By Date | Insert | | | 9/13/2012 12:00:00 AM | 9/13/2012 11:06 AM |
| Dates | Start Date | Insert | | | | 9/13/2012 11:06 AM |
| Terminations | Termination Comments | Insert | | | | 9/13/2012 11:06 AM |
| Terminations | Termination Date | Insert | | | | 9/13/2012 11:06 AM |
| Terminations | Termination Effective Date | Insert | | | | 9/13/2012 11:06 AM |
| Terminations | Termination Reason | Insert | | | | 9/13/2012 11:06 AM |