| Details | Last Recertification Date | Update | Recertification | 8/16/2023 1:16:00 PM | 8/13/2024 2:27:58 PM | 8/13/2024 2:27 PM |
| Contacts | Primary Contact | Update | Change Request | Logsdon, Michael Wayne
Director of Pharmacy
Thayer County Health Services
4027684611 | Kimberlin, Rebekah Joy
Director of Pharmacy
Thayer County Health Services
4027684611 | 8/7/2024 10:12 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2022 1:10:51 PM | 8/16/2023 1:16:00 PM | 8/16/2023 1:16 PM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2021 10:12:21 AM | 8/26/2022 1:10:51 PM | 8/26/2022 1:10 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Cook, Scott
Interim CEO
Thayer County Health Services
4027684614 | Rokusek, Brian P
President
TCHS
4027684614 | 2/14/2022 10:54 AM |
| Details | Last Recertification Date | Update | Recertification | 8/20/2020 11:04:33 AM | 8/24/2021 10:12:21 AM | 8/24/2021 10:12 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Edwards, Paul
CEO
Thayer County Heath Services
4027684614 | Cook, Scott
Interim CEO
Thayer County Health Services
4027684614 | 8/20/2021 3:33 PM |
| Addresses | Shipping Address | Insert | Change Request | | Thayer County Memorial Hospital dba Thayer County Health Services
120 Park Avenue
Hebron, NE 68370 | 11/30/2020 6:21 AM |
| Addresses | Shipping Address | Insert | Change Request | | Thayer County Pharmacy
428 Lincoln Ave
Hebron, NE 68370 | 11/30/2020 6:21 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2019 5:25:57 AM | 8/20/2020 11:04:33 AM | 8/20/2020 11:04 AM |
| Contacts | Authorizing Official | Update | Change Request | Burd, David
CEO
Thayer County Health Services
4027684614 | Edwards, Paul
CEO
Thayer County Heath Services
4027684614 | 6/10/2020 9:03 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2018 3:34:20 PM | 8/22/2019 5:25:57 AM | 8/22/2019 5:25 AM |
| Details | Last Recertification Date | Update | Recertification | 11/15/2017 1:07:55 PM | 8/21/2018 3:34:20 PM | 8/21/2018 3:34 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Logsdon, Michael Wayne
Director of Pharmacy
Thayer County Health Services
4027684315 | Logsdon, Michael Wayne
Director of Pharmacy
Thayer County Health Services
4027684611 | 4/30/2018 1:56 PM |
| Details | Last Recertification Date | Update | Recertification | 8/10/2016 12:00:00 AM | 11/15/2017 1:07:55 PM | 11/15/2017 1:07 PM |
| Contacts | Primary Contact | Update | Change Request | Burd, David
CEO
4027684614 | Logsdon, Michael Wayne
Director of Pharmacy
Thayer County Health Services
4027684315 | 10/13/2017 10:47 AM |
| Contacts | Authorizing Official | Update | | Burd, David
CEO
4027684614 | Burd, David
CEO
Thayer County Health Services
4027684614 | 10/13/2017 10:42 AM |
| Addresses | Main Address | Insert | | |
120 Park Avenue
Hebron, NE 68370 | 1/6/2017 2:26 PM |
| Contacts | Signed By | Insert | | | beck, joyce
CEO
4027684614 | 1/6/2017 2:26 PM |
| Contacts | Authorizing Official | Update | | Burcham, Michael
CEO
4027684614 | Burd, David
CEO
4027684614 | 1/6/2017 2:26 PM |
| Contacts | Primary Contact | Update | | Burcham, Michael
CEO
4027684614 | Burd, David
CEO
4027684614 | 1/6/2017 2:26 PM |
| Contacts | Authorizing Official | Update | | Pracheil, Michael
CFO
4027684634 | Burcham, Michael
CEO
4027684614 | 8/10/2016 11:41 AM |
| Contacts | Primary Contact | Update | | Meyer, Cameron
CFO
4027684634 | Burcham, Michael
CEO
4027684614 | 8/10/2016 11:41 AM |
| Details | Last Recertification Date | Update | | 8/5/2015 12:00:00 AM | 8/10/2016 12:00:00 AM | 8/10/2016 11:41 AM |
| Contacts | Primary Contact | Update | | Kroll, Karen
Director of Pharmacy
4027684611 | Meyer, Cameron
CFO
4027684634 | 8/17/2015 3:08 PM |
| Details | Last Recertification Date | Update | | 8/12/2014 12:00:00 AM | 8/5/2015 12:00:00 AM | 8/5/2015 9:57 AM |
| Details | Last Recertification Date | Update | | 9/9/2013 5:20:32 PM | 8/12/2014 12:00:00 AM | 8/12/2014 5:41 PM |
| Contacts | Authorizing Official | Insert | | | Pracheil, Michael
CFO
4027684634 | 9/9/2013 9:29 PM |
| Contacts | Primary Contact | Insert | | | Kroll, Karen
Director of Pharmacy
4027684611 | 9/9/2013 5:20 PM |
| Details | Last Recertification Date | Update | | | 9/9/2013 5:20:32 PM | 9/9/2013 5:20 PM |
| Details | 340B ID | Update | | ISDMCAH281304-00 | CAH281304-00 | 1/16/2013 4:06 PM |
| Dates | Participating Approval Date | Update | | | 1/16/2013 12:00:00 AM | 1/16/2013 4:06 PM |
| Details | State | Update | | Pending | Active | 1/16/2013 4:06 PM |
| Dates | Start Date | Update | | | 4/1/2013 12:00:00 AM | 1/16/2013 4:06 PM |
| Details | 340B ID | Update | | DMCAH281304-00 | ISDMCAH281304-00 | 1/16/2013 2:56 PM |
| Details | Entity Name | Update | | Thayer County Memorial Hospital | Thayer County Memorial Hospital dba Thayer County Health Services | 1/16/2013 2:56 PM |
| Details | 340B ID | Update | | DELETE011613A-No Documentation | DMCAH281304-00 | 1/16/2013 2:27 PM |
| Details | State | Update | | Rejected | Pending | 1/16/2013 2:27 PM |
| Details | 340B ID | Update | | DM011513B | DELETE011613A-No Documentation | 1/16/2013 12:26 PM |
| Details | State | Update | | Pending | Rejected | 1/16/2013 12:26 PM |
| Details | 340B ID | Update | | DM011313C | DM011513B | 1/15/2013 12:33 PM |
| Details | 340B ID | Update | | ONLINE_REG | DM011313C | 1/13/2013 10:12 AM |
| Details | Last Recertification Date | Insert | | | | 1/11/2013 11:28 AM |
| Details | Grant Number | Insert | | | | 1/11/2013 11:28 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/11/2013 11:28 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/11/2013 11:28 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/11/2013 11:28 AM |
| Details | Medicare Provider Number | Insert | | | 281304 | 1/11/2013 11:28 AM |
| Details | Entity Name | Insert | | | Thayer County Memorial Hospital | 1/11/2013 11:28 AM |
| Details | Program Code | Insert | | | CAH | 1/11/2013 11:28 AM |
| Details | Entity Subname | Insert | | | | 1/11/2013 11:28 AM |
| Dates | Participating Approval Date | Insert | | | | 1/11/2013 11:28 AM |
| Details | State | Insert | | | Pending | 1/11/2013 11:28 AM |
| Dates | Registration Date | Insert | | | 1/11/2013 12:00:00 AM | 1/11/2013 11:28 AM |
| Dates | Signed By Date | Insert | | | 1/11/2013 12:00:00 AM | 1/11/2013 11:28 AM |
| Dates | Start Date | Insert | | | | 1/11/2013 11:28 AM |
| Terminations | Termination Comments | Insert | | | | 1/11/2013 11:28 AM |
| Terminations | Termination Date | Insert | | | | 1/11/2013 11:28 AM |
| Terminations | Termination Effective Date | Insert | | | | 1/11/2013 11:28 AM |
| Terminations | Termination Reason | Insert | | | | 1/11/2013 11:28 AM |