| Contacts | Primary Contact | Update | Recertification | Griffith, Bethany
Practice Manager
Southview Health Center
9372586330-6000 | Griffith, Bethany
Practice Manager
Patterson Park Health Center
9372586330-6000 | 2/12/2019 2:20 PM |
| Details | State | Update | | To Be Terminated | Terminated | 1/1/2019 12:05 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 6/1/2018 12:00:00 AM | 10/3/2018 9:23 AM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 10/3/2018 9:23 AM |
| Terminations | Termination Comments | Update | Termination Request | | The services that were previously provided at this location have been relocated to our new Patterson Park Health Center. | 10/3/2018 9:23 AM |
| Terminations | Termination Date | Update | Termination Request | | 1/1/2019 12:00:00 AM | 10/3/2018 9:23 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 6/1/2018 12:00:00 AM | 10/3/2018 9:23 AM |
| Terminations | Termination Reason | Update | Termination Request | | Site closure | 10/3/2018 9:23 AM |
| Details | Last Recertification Date | Update | Recertification | 1/26/2017 12:00:00 AM | 2/23/2018 1:23:02 PM | 2/23/2018 1:23 PM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/23/2018 1:23 PM |
| Contacts | Primary Contact | Update | Recertification | Griffith, Bethany
Practice Manager
9372586332 | Griffith, Bethany
Practice Manager
Southview Health Center
9372586330-6000 | 2/23/2018 1:23 PM |
| Contacts | Authorizing Official | Update | | HOPKINS, GREGORY
EXECUTIVE DIRECTOR
9375869733-1023 | HOPKINS, GREGORY
EXECUTIVE DIRECTOR
Community Health Centers of Greater Dayton
9375869733-1023 | 2/8/2018 1:10 PM |
| Contacts | Signed By | Update | | HOPKINS, GREGORY
EXECUTIVE DIRECTOR
9375869733-1023 | HOPKINS, GREGORY
EXECUTIVE DIRECTOR
Community Health Centers of Greater Dayton
9375869733-1023 | 2/8/2018 1:10 PM |
| Contacts | Authorizing Official | Insert | | | HOPKINS, GREGORY
EXECUTIVE DIRECTOR
9375869733-1023 | 4/27/2017 4:26 PM |
| Contacts | Signed By | Insert | | | HOPKINS, GREGORY
EXECUTIVE DIRECTOR
9375869733-1023 | 4/27/2017 4:26 PM |
| Addresses | Main Address | Insert | | |
25 Thorpe
Dayton, OH 45420-1823 | 1/26/2017 2:06 PM |
| Contacts | Primary Contact | Update | | Medlock, Diana
Practice Manager
9372586330 | Griffith, Bethany
Practice Manager
9372586332 | 1/26/2017 2:06 PM |
| Details | Last Recertification Date | Update | | 3/3/2016 12:00:00 AM | 1/26/2017 12:00:00 AM | 1/26/2017 2:06 PM |
| Contacts | Primary Contact | Insert | | | Medlock, Diana
Practice Manager
9372586330 | 3/3/2016 3:22 PM |
| Details | Last Recertification Date | Update | | 2/12/2015 12:00:00 AM | 3/3/2016 12:00:00 AM | 3/3/2016 3:22 PM |
| Details | Last Recertification Date | Update | | 3/23/2014 12:00:00 AM | 2/12/2015 12:00:00 AM | 2/12/2015 1:21 PM |
| Details | Is Authorizing Official EHB Data | Update | | | False | 2/12/2015 1:21 PM |
| Details | Last Recertification Date | Update | | | 3/23/2014 12:00:00 AM | 3/23/2014 2:54 PM |
| Addresses | Billing Address | Insert | | | Community Health Centers of Greater Dayton
1323 W 3rd St
Dayton, OH 45402-6714 | 5/22/2013 1:58 PM |
| Details | 340B ID | Update | | IS-FN-CHC11332-04 | CHC11332-04 | 5/22/2013 1:58 PM |
| Dates | Participating Approval Date | Update | | | 5/22/2013 12:00:00 AM | 5/22/2013 1:58 PM |
| Details | State | Update | | Pending | Active | 5/22/2013 1:58 PM |
| Dates | Start Date | Update | | | 7/1/2013 12:00:00 AM | 5/22/2013 1:58 PM |
| Details | 340B ID | Update | | ONLINE_REG | IS-FN-CHC11332-04 | 4/27/2013 1:01 PM |
| Details | Last Recertification Date | Insert | | | | 4/5/2013 5:04 PM |
| Details | Grant Number | Insert | | | H80CS12882 | 4/5/2013 5:04 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 4/5/2013 5:04 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/5/2013 5:04 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/5/2013 5:04 PM |
| Details | Medicare Provider Number | Insert | | | | 4/5/2013 5:04 PM |
| Details | Entity Name | Insert | | | COMMUNITY HEALTH CENTERS OF GREATER DAYTON | 4/5/2013 5:04 PM |
| Details | Program Code | Insert | | | CH | 4/5/2013 5:04 PM |
| Details | Entity Subname | Insert | | | Community Health Centers of Greater Dayton - Southview Health Center | 4/5/2013 5:04 PM |
| Dates | Participating Approval Date | Insert | | | | 4/5/2013 5:04 PM |
| Details | State | Insert | | | Pending | 4/5/2013 5:04 PM |
| Dates | Registration Date | Insert | | | 4/5/2013 12:00:00 AM | 4/5/2013 5:04 PM |
| Dates | Signed By Date | Insert | | | 4/5/2013 12:00:00 AM | 4/5/2013 5:04 PM |
| Dates | Start Date | Insert | | | | 4/5/2013 5:04 PM |
| Terminations | Termination Comments | Insert | | | | 4/5/2013 5:04 PM |
| Terminations | Termination Date | Insert | | | | 4/5/2013 5:04 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/5/2013 5:04 PM |
| Terminations | Termination Reason | Insert | | | | 4/5/2013 5:04 PM |