| Details | Last Recertification Date | Update | Recertification | 2/1/2024 8:23:17 AM | 2/20/2025 3:26:11 PM | 2/20/2025 3:26 PM |
| Contacts | Authorizing Official | Update | Change Request | Branum, Don
CEO
Christ Community Health Services Augusta
4193410715 | Campbell, Robert Allan
CMO
Christ Community Health Services, Augusta, Inc.
7067995708 | 4/26/2024 9:33 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/1/2024 8:23 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 003127080A | 2/1/2024 8:23 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | GA | 2/1/2024 8:23 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/1/2024 8:23 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | FQC158 | 2/1/2024 8:23 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | SC | 2/1/2024 8:23 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1588912703 | 2/1/2024 8:23 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | GA | 2/1/2024 8:23 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1588912703 | 2/1/2024 8:23 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | SC | 2/1/2024 8:23 AM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2023 2:38:19 PM | 2/1/2024 8:23:17 AM | 2/1/2024 8:23 AM |
| Details | Entity Subname | Update | Change Request | Christ Community Health Services Augusta: Laney Walker | Christ Community Health: Medical District CHC | 3/28/2023 7:54 AM |
| Details | Last Recertification Date | Update | Recertification | 2/18/2022 8:41:58 AM | 2/9/2023 2:38:19 PM | 2/9/2023 2:38 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Bostwick, Jacob
Director of Finance
Christ Community
7069220600-320 | Branum, Don
CEO
Christ Community Health Services Augusta
4193410715 | 2/8/2023 10:40 PM |
| Addresses | Billing Address | Update | Recertification | Christ Community Health Services Augusta
PO Box 2344
Augusta, GA 30903 | Christ Community Health
PO Box 2344
Augusta, GA 30903-2344 | 2/18/2022 8:41 AM |
| Details | Last Recertification Date | Update | Recertification | 2/10/2021 11:10:37 AM | 2/18/2022 8:41:58 AM | 2/18/2022 8:41 AM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2020 11:45:27 AM | 2/10/2021 11:10:37 AM | 2/10/2021 11:10 AM |
| Contacts | Primary Contact | Update | Change Request | Ruege, Zach
Pharmacist
Christ Community
7069220600-243 | Gandhi, Purnank
Contract Pharmacy Program Manager
Christ Community Health
7065721907 | 12/1/2020 2:56 PM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2019 9:21:14 AM | 2/3/2020 11:45:27 AM | 2/3/2020 11:45 AM |
| Contacts | Authorizing Official | Update | Change Request | Bostwick, Jacob
Finance Director
Christ Community
7063961474 | Bostwick, Jacob
Director of Finance
Christ Community
7069220600-320 | 1/14/2020 1:30 PM |
| Contacts | Authorizing Official | Update | Change Request | Drake III, Thomas J.
Executive Director
Christ Community Health Services Augusta
7069223017 | Bostwick, Jacob
Finance Director
Christ Community
7063961474 | 12/16/2019 7:17 AM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2018 10:27:59 AM | 1/31/2019 9:21:14 AM | 1/31/2019 9:21 AM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2017 12:00:00 AM | 2/16/2018 10:27:59 AM | 2/16/2018 10:27 AM |
| Contacts | Primary Contact | Update | Change Request | Bostwick, Jacob
Director of Finance
7063961460 | Ruege, Zach
Pharmacist
Christ Community
7069220600-243 | 12/14/2017 12:00 PM |
| Details | Is Authorizing Official EHB Data | Update | Change Request | False | | 12/14/2017 12:00 PM |
| Contacts | Authorizing Official | Update | | Drake III, Thomas J.
Executive Director
7069223017 | Drake III, Thomas J.
Executive Director
Christ Community Health Services Augusta
7069223017 | 10/11/2017 12:35 PM |
| Contacts | Signed By | Update | | Drake III, Thomas J.
Executive Director
7069223017 | Drake III, Thomas J.
Executive Director
Christ Community Health Services Augusta
7069223017 | 10/11/2017 12:35 PM |
| Contacts | Authorizing Official | Insert | | | Drake III, Thomas J.
Executive Director
7069223017 | 7/23/2017 7:21 AM |
| Contacts | Signed By | Insert | | | Drake III, Thomas J.
Executive Director
7069223017 | 7/23/2017 7:21 AM |
| Addresses | Main Address | Insert | | |
1226 Dantignac St
Augusta, GA 30901-2788 | 2/16/2017 5:29 PM |
| Contacts | Primary Contact | Update | | Major, Darius
Staff Accountant
7063961460 | Bostwick, Jacob
Director of Finance
7063961460 | 2/16/2017 5:29 PM |
| Details | Last Recertification Date | Update | | 2/29/2016 12:00:00 AM | 2/16/2017 12:00:00 AM | 2/16/2017 5:29 PM |
| Contacts | Primary Contact | Update | | Aceves, Jonathan
Administrator
7069220606 | Major, Darius
Staff Accountant
7063961460 | 2/29/2016 9:26 AM |
| Details | Last Recertification Date | Update | | 3/2/2015 12:00:00 AM | 2/29/2016 12:00:00 AM | 2/29/2016 9:26 AM |
| Contacts | Primary Contact | Insert | | | Aceves, Jonathan
Administrator
7069220606 | 3/2/2015 9:51 AM |
| Details | Last Recertification Date | Update | | 3/10/2014 12:00:00 AM | 3/2/2015 12:00:00 AM | 3/2/2015 9:51 AM |
| Details | Is Authorizing Official EHB Data | Update | | | False | 3/2/2015 9:51 AM |
| Details | Last Recertification Date | Update | | | 3/10/2014 12:00:00 AM | 3/10/2014 3:13 PM |
| Addresses | Billing Address | Insert | | | Christ Community Health Services Augusta
PO Box 2344
Augusta, GA 30903 | 4/11/2013 12:15 PM |
| Details | 340B ID | Update | | FN?-CHC24172-00 | CHC24172-00 | 4/11/2013 12:15 PM |
| Dates | Participating Approval Date | Update | | | 4/11/2013 12:00:00 AM | 4/11/2013 12:15 PM |
| Details | State | Update | | Pending | Active | 4/11/2013 12:15 PM |
| Dates | Start Date | Update | | | 7/1/2013 12:00:00 AM | 4/11/2013 12:15 PM |
| Details | 340B ID | Update | | IS-FN-CHC24172-00 | FN?-CHC24172-00 | 4/11/2013 12:11 PM |
| Details | 340B ID | Update | | ONLINE_REG | IS-FN-CHC24172-00 | 4/9/2013 11:37 AM |
| Details | Last Recertification Date | Insert | | | | 4/1/2013 5:07 PM |
| Details | Grant Number | Insert | | | H80CS24172 | 4/1/2013 5:07 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 4/1/2013 5:07 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/1/2013 5:07 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/1/2013 5:07 PM |
| Details | Medicare Provider Number | Insert | | | | 4/1/2013 5:07 PM |
| Details | Entity Name | Insert | | | CHRIST COMMUNITY HEALTH SERVICES AUGUSTA, INC. | 4/1/2013 5:07 PM |
| Details | Program Code | Insert | | | CH | 4/1/2013 5:07 PM |
| Details | Entity Subname | Insert | | | Christ Community Health Services Augusta: Laney Walker | 4/1/2013 5:07 PM |
| Dates | Participating Approval Date | Insert | | | | 4/1/2013 5:07 PM |
| Details | State | Insert | | | Pending | 4/1/2013 5:07 PM |
| Dates | Registration Date | Insert | | | 4/1/2013 12:00:00 AM | 4/1/2013 5:07 PM |
| Dates | Signed By Date | Insert | | | 4/1/2013 12:00:00 AM | 4/1/2013 5:07 PM |
| Dates | Start Date | Insert | | | | 4/1/2013 5:07 PM |
| Terminations | Termination Comments | Insert | | | | 4/1/2013 5:07 PM |
| Terminations | Termination Date | Insert | | | | 4/1/2013 5:07 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/1/2013 5:07 PM |
| Terminations | Termination Reason | Insert | | | | 4/1/2013 5:07 PM |