Contacts | Authorizing Official | Update | AO Change Request | Legel, Thomas
CFO
Confluence Health
5096621511 | Allen, Kelly M
CNO/Administrator
Confluence Health
5094333133 | 1/3/2025 9:24 AM |
Contacts | Primary Contact | Update | Profile Change Request | Clare, Kristy
340B Program Analyst
Central Washington Hospital
5096621511-32149 | Clare, Kristy
340B Pharmacy System Administrator
Confluence Health
5096621511-32149 | 12/13/2024 2:20 PM |
Addresses | Billing Address | Insert | Change Request | | Confluence Health
PO Box 1885
Wenatchee, WA 98807 | 10/9/2024 12:11 PM |
Addresses | Shipping Address | Delete | Recertification | Central Washington Hospital
1201 S. Miller Street
Wenatchee, WA 98801 | | 8/16/2024 7:46 AM |
Addresses | Shipping Address | Insert | Recertification | | Confluence Health Hospital
1201 S. Miller Street
Wenatchee, WA 98801 | 8/16/2024 7:46 AM |
Details | Last Recertification Date | Update | Recertification | 8/30/2023 8:07:25 PM | 8/16/2024 7:46:15 AM | 8/16/2024 7:46 AM |
Details | Entity Name | Update | Change Request | CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION DBA CENTRAL WASHINGTON HOSPITAL | CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION DBA CONFLUENCE HEALTH HOSPITAL | 9/21/2023 7:55 AM |
Details | Last Recertification Date | Update | Recertification | 9/13/2022 12:07:32 PM | 8/30/2023 8:07:25 PM | 8/30/2023 8:07 PM |
Details | Last Recertification Date | Update | Recertification | 8/17/2021 11:47:10 AM | 9/13/2022 12:07:32 PM | 9/13/2022 12:07 PM |
Details | Last Recertification Date | Update | Recertification | 8/24/2020 6:41:46 PM | 8/17/2021 11:47:10 AM | 8/17/2021 11:47 AM |
Medicaid Billing | NPI: Number | Delete | Recertification | 1508978388 ( ) | | 8/24/2020 6:41 PM |
Medicaid Billing | NPI: Number | Delete | Recertification | 1225165509 ( ) | | 8/24/2020 6:41 PM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1215970546 | 8/24/2020 6:41 PM |
Medicaid Billing | NPI: State | Insert | Recertification | | WA | 8/24/2020 6:41 PM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1225165509 | 8/24/2020 6:41 PM |
Medicaid Billing | NPI: State | Insert | Recertification | | WA | 8/24/2020 6:41 PM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1508978388 | 8/24/2020 6:41 PM |
Medicaid Billing | NPI: State | Insert | Recertification | | WA | 8/24/2020 6:41 PM |
Medicaid Billing | NPI: Number | Delete | Recertification | 1215970546 ( ) | | 8/24/2020 6:41 PM |
Details | Last Recertification Date | Update | Recertification | 8/23/2019 12:47:20 PM | 8/24/2020 6:41:46 PM | 8/24/2020 6:41 PM |
Contacts | Authorizing Official | Update | Change Request | Doyle, John
CFO
Central Washington Hospital
5094333809 | Legel, Thomas
CFO
Confluence Health
5096621511 | 4/3/2020 4:39 PM |
Addresses | Main Address | Update | Change Request |
1020 North Wenatchee Ave
Wenatchee, WA 98801 |
731 N. Chelan Ave
Wenatchee, WA 98801 | 12/18/2019 7:39 AM |
Contacts | Authorizing Official | Update | Change Request | Doyle, John
CFO
Central Washington Hospital
5094333809 | Doyle, John
CFO
Central Washington Hospital
5094333809 | 11/14/2019 4:45 PM |
Details | Last Recertification Date | Update | Recertification | 8/28/2018 1:13:15 PM | 8/23/2019 12:47:20 PM | 8/23/2019 12:47 PM |
Contacts | Primary Contact | Update | Change Request | Sieg, Michael
Director of Pharmacy
Central Washington Hospital
5094333556 | Clare, Kristy
340B Program Analyst
Central Washington Hospital
5096621511-32149 | 8/12/2019 3:23 PM |
Addresses | Main Address | Update | Change Request |
1020 North Wenatchee
Wenatchee, WA 98801 |
1020 North Wenatchee Ave
Wenatchee, WA 98801 | 8/2/2019 10:07 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 8/2/2019 10:07 AM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1043312 | 8/2/2019 10:07 AM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | WA | 8/2/2019 10:07 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 8/2/2019 10:07 AM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1012187 | 8/2/2019 10:07 AM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | WA | 8/2/2019 10:07 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 8/2/2019 10:07 AM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1005426 | 8/2/2019 10:07 AM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | WA | 8/2/2019 10:07 AM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1508978388 | 8/2/2019 10:07 AM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1225165509 | 8/2/2019 10:07 AM |
Addresses | Shipping Address | Insert | Recertification | | Central Washington Hospital
1201 S. Miller Street
Wenatchee, WA 98801 | 8/28/2018 1:13 PM |
Addresses | Shipping Address | Delete | Recertification | Central Washington Hospital
1201 S. Miller
Wenatchee, WA 98801 | | 8/28/2018 1:13 PM |
Details | Last Recertification Date | Update | Recertification | 11/20/2017 5:04:50 PM | 8/28/2018 1:13:15 PM | 8/28/2018 1:13 PM |
Contacts | Primary Contact | Update | Profile Change Request | Sieg, Michael
Director of Pharmacy
Central Washington Hospital
5096656021 | Sieg, Michael
Director of Pharmacy
Central Washington Hospital
5094333556 | 8/27/2018 11:52 AM |
Contacts | Authorizing Official | Update | Profile Change Request | Doyle, John
CFO
Central Washington Hospital
5096656015 | Doyle, John
CFO
Central Washington Hospital
5094333809 | 8/27/2018 11:14 AM |
Details | Last Recertification Date | Update | Recertification | 8/22/2016 12:00:00 AM | 11/20/2017 5:04:50 PM | 11/20/2017 5:04 PM |
Contacts | Authorizing Official | Update | | Doyle, John
CFO
5096656015 | Doyle, John
CFO
Central Washington Hospital
5096656015 | 10/10/2017 2:01 PM |
Contacts | Primary Contact | Update | | Sieg, Michael
Director of Pharmacy
5096656021 | Sieg, Michael
Director of Pharmacy
Central Washington Hospital
5096656021 | 9/21/2017 9:20 AM |
Contacts | Authorizing Official | Insert | | | Doyle, John
CFO
5096656015 | 2/7/2017 9:05 AM |
Contacts | Primary Contact | Update | | Adams, Glenn
Director of Pharmacy
5096656012 | Sieg, Michael
Director of Pharmacy
5096656021 | 2/7/2017 9:05 AM |
Contacts | Signed By | Insert | | | JACOBS, STEVEN R.
CFO
5096656014 | 2/7/2017 9:05 AM |
Addresses | Main Address | Insert | | |
1020 North Wenatchee
Wenatchee, WA 98801 | 1/20/2017 4:12 PM |
Addresses | Shipping Address | Insert | | | Central Washington Hospital
1201 S. Miller
Wenatchee, WA 98801 | 1/20/2017 4:12 PM |
Medicaid Billing | NPI: Number | Insert | | | 1215970546 | 1/20/2017 4:12 PM |
Details | Last Recertification Date | Update | | 8/19/2015 12:00:00 AM | 8/22/2016 12:00:00 AM | 8/22/2016 7:05 AM |
Contacts | Primary Contact | Update | | Adams, Glenn
Director of Pharmacy
5096644868-5916 | Adams, Glenn
Director of Pharmacy
5096656012 | 8/22/2016 7:05 AM |
Details | Last Recertification Date | Update | | 9/4/2014 12:00:00 AM | 8/19/2015 12:00:00 AM | 8/19/2015 9:34 AM |
Contacts | Primary Contact | Insert | | | Adams, Glenn
Director of Pharmacy
5096644868-5916 | 12/22/2014 9:14 AM |
Details | Last Recertification Date | Update | | 9/5/2013 5:39:54 AM | 9/4/2014 12:00:00 AM | 9/4/2014 12:31 PM |
Details | Last Recertification Date | Update | | | 9/5/2013 5:39:54 AM | 9/5/2013 5:39 AM |
Details | 340B ID | Update | | ISDMDSH500016B | DSH500016B | 5/15/2013 5:23 PM |
Dates | Participating Approval Date | Update | | | 5/15/2013 12:00:00 AM | 5/15/2013 5:23 PM |
Details | State | Update | | Pending | Active | 5/15/2013 5:23 PM |
Dates | Start Date | Update | | | 7/1/2013 12:00:00 AM | 5/15/2013 5:23 PM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | ISDMDSH500016B | 4/25/2013 1:39 PM |
Details | Last Recertification Date | Insert | | | | 4/12/2013 6:28 PM |
Details | Grant Number | Insert | | | | 4/12/2013 6:28 PM |
Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 4/12/2013 6:28 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 4/12/2013 6:28 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/12/2013 6:28 PM |
Details | Medicare Provider Number | Insert | | | 500016 | 4/12/2013 6:28 PM |
Details | Entity Name | Insert | | | CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION DBA CENTRAL WASHINGTON HOSPITAL | 4/12/2013 6:28 PM |
Details | Program Code | Insert | | | DSH | 4/12/2013 6:28 PM |
Details | Entity Subname | Insert | | | Hospice | 4/12/2013 6:28 PM |
Dates | Participating Approval Date | Insert | | | | 4/12/2013 6:28 PM |
Details | State | Insert | | | Pending | 4/12/2013 6:28 PM |
Dates | Registration Date | Insert | | | 4/12/2013 12:00:00 AM | 4/12/2013 6:28 PM |
Dates | Signed By Date | Insert | | | 4/12/2013 12:00:00 AM | 4/12/2013 6:28 PM |
Dates | Start Date | Insert | | | | 4/12/2013 6:28 PM |
Terminations | Termination Comments | Insert | | | | 4/12/2013 6:28 PM |
Terminations | Termination Date | Insert | | | | 4/12/2013 6:28 PM |
Terminations | Termination Effective Date | Insert | | | | 4/12/2013 6:28 PM |
Terminations | Termination Reason | Insert | | | | 4/12/2013 6:28 PM |