| Details | Last Recertification Date | Update | Recertification | 2/7/2024 11:59:25 AM | 2/24/2025 5:47:24 PM | 2/24/2025 5:47 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 5/29/2024 4:59 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 30003921950015 | 5/29/2024 4:59 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | KS | 5/29/2024 4:59 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1447756457 | 5/29/2024 4:59 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | KS | 5/29/2024 4:59 PM |
| Addresses | Shipping Address | Delete | Recertification | Hunter Health Community Pharmacy
527 N Grove St
100
Wichita, KS 67214 | | 2/7/2024 11:59 AM |
| Addresses | Shipping Address | Delete | Recertification | Hunter Health Clinic, Inc.
2750 S Roosevelt St
Wichita, KS 67210 | | 2/7/2024 11:59 AM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2023 1:02:36 PM | 2/7/2024 11:59:25 AM | 2/7/2024 11:59 AM |
| Addresses | Billing Address | Insert | Change Request | | Hunter Health Clinic, Inc.
2318 E Central Ave
Wichita, KS 67214 | 9/29/2023 1:10 PM |
| Addresses | Shipping Address | Insert | Change Request | | Hunter Health Community Pharmacy
527 N Grove St
100
Wichita, KS 67214 | 9/29/2023 1:10 PM |
| Addresses | Shipping Address | Insert | Change Request | | Hunter Health Clinic, Inc.
2750 S Roosevelt St
Wichita, KS 67210 | 9/29/2023 1:10 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2022 5:33:45 PM | 2/2/2023 1:02:36 PM | 2/2/2023 1:02 PM |
| Contacts | Primary Contact | Update | Change Request | Subair, Eyinade O
Quality, Compliance and Risk Manager
Hunter Health
3162601455-2216 | Blanco, Cassandra
Pharmacy Director
Hunter Health
3162604726 | 1/5/2023 6:03 PM |
| Contacts | Primary Contact | Update | Change Request | Kila, Eyinade
Manager of Quality, Compliance and Risk
Hunter Health
3162622415-2216 | Subair, Eyinade O
Quality, Compliance and Risk Manager
Hunter Health
3162601455-2216 | 5/16/2022 2:05 PM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2021 3:07:12 PM | 2/1/2022 5:33:45 PM | 2/1/2022 5:33 PM |
| Contacts | Primary Contact | Update | Change Request | Nickel, Daneil
Director of Business Operations
Hunter Health
3162622415 | Kila, Eyinade
Manager of Quality, Compliance and Risk
Hunter Health
3162622415-2216 | 12/21/2021 2:08 PM |
| Contacts | Authorizing Official | Update | Change Request | Feimer, Amy
CEO
Hunter Health
3162623611-1111 | Feimer, Amy
CEO
Hunter Health
3164917611 | 12/21/2021 2:08 PM |
| Contacts | Primary Contact | Update | Change Request | Clarke, Jessica
Director of Business Operations
Hunter Health
3162622415-1122 | Nickel, Daneil
Director of Business Operations
Hunter Health
3162622415 | 5/26/2021 11:47 AM |
| Details | Last Recertification Date | Update | Recertification | 2/18/2020 6:38:18 PM | 2/16/2021 3:07:12 PM | 2/16/2021 3:07 PM |
| Contacts | Primary Contact | Update | Change Request | Cooks, Jessika
Chief Clinical Operations Officer
Hunter Health
3162623611-2202 | Clarke, Jessica
Director of Business Operations
Hunter Health
3162622415-1122 | 8/13/2020 4:58 PM |
| Details | Is Authorizing Official EHB Data | Update | Change Request | False | | 8/13/2020 4:58 PM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2019 10:35:26 AM | 2/18/2020 6:38:18 PM | 2/18/2020 6:38 PM |
| Details | Last Recertification Date | Update | Recertification | 2/28/2018 1:48:17 PM | 2/8/2019 10:35:26 AM | 2/8/2019 10:35 AM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2017 12:00:00 AM | 2/28/2018 1:48:17 PM | 2/28/2018 1:48 PM |
| Contacts | Primary Contact | Update | Recertification | Cooks, Jessika
Chief Clinical Operations Officer
3162623611-2202 | Cooks, Jessika
Chief Clinical Operations Officer
Hunter Health
3162623611-2202 | 2/28/2018 1:47 PM |
| Contacts | Authorizing Official | Update | | Feimer, Amy
CEO
3162623611-1111 | Feimer, Amy
CEO
Hunter Health
3162623611-1111 | 12/4/2017 5:08 PM |
| Addresses | Main Address | Insert | | |
2750 S ROOSEVELT ST
WICHITA, KS 67210-1304 | 8/13/2017 7:37 PM |
| Contacts | Authorizing Official | Insert | | | Feimer, Amy
CEO
3162623611-1111 | 8/13/2017 7:37 PM |
| Contacts | Primary Contact | Update | | Harzman, Connie
Patient Centered Medical Home Director
3162623611-1110 | Cooks, Jessika
Chief Clinical Operations Officer
3162623611-2202 | 8/13/2017 7:37 PM |
| Contacts | Signed By | Insert | | | Base, Michelle
CEO
3162623611 | 8/13/2017 7:37 PM |
| Details | Last Recertification Date | Update | | 3/7/2016 12:00:00 AM | 2/13/2017 12:00:00 AM | 2/16/2017 9:53 AM |
| Details | Last Recertification Date | Update | | 2/3/2015 12:00:00 AM | 3/7/2016 12:00:00 AM | 3/7/2016 12:56 PM |
| Contacts | Primary Contact | Update | | Harbaugh, Olinda
COO
3162623611 | Harzman, Connie
Patient Centered Medical Home Director
3162623611-1110 | 3/6/2016 3:37 PM |
| Details | Last Recertification Date | Update | | 3/13/2014 12:00:00 AM | 2/3/2015 12:00:00 AM | 2/3/2015 1:52 PM |
| Details | Is Authorizing Official EHB Data | Update | | | False | 2/3/2015 1:52 PM |
| Details | Last Recertification Date | Update | | | 3/13/2014 12:00:00 AM | 3/13/2014 3:06 PM |
| Contacts | Primary Contact | Insert | | | Harbaugh, Olinda
COO
3162623611 | 9/17/2013 10:45 AM |
| Details | 340B ID | Update | | ISJMCH070150B | CH070150B | 9/14/2013 11:43 PM |
| Dates | Participating Approval Date | Update | | | 9/14/2013 12:00:00 AM | 9/14/2013 11:43 PM |
| Details | State | Update | | Pending | Active | 9/14/2013 11:43 PM |
| Dates | Start Date | Update | | | 10/1/2013 12:00:00 AM | 9/14/2013 11:43 PM |
| Details | 340B ID | Update | | ONLINE_REG | ISJMCH070150B | 8/9/2013 11:37 PM |
| Details | Last Recertification Date | Insert | | | | 7/11/2013 3:27 PM |
| Details | Grant Number | Insert | | | H80CS00622 | 7/11/2013 3:27 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 7/11/2013 3:27 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/11/2013 3:27 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/11/2013 3:27 PM |
| Details | Medicare Provider Number | Insert | | | | 7/11/2013 3:27 PM |
| Details | Entity Name | Insert | | | HUNTER HEALTH CLINIC INC, THE | 7/11/2013 3:27 PM |
| Details | Program Code | Insert | | | CH | 7/11/2013 3:27 PM |
| Details | Entity Subname | Insert | | | BROOKSIDE SATELLITE OF HUNT.HLTH | 7/11/2013 3:27 PM |
| Dates | Participating Approval Date | Insert | | | | 7/11/2013 3:27 PM |
| Details | State | Insert | | | Pending | 7/11/2013 3:27 PM |
| Dates | Registration Date | Insert | | | 7/11/2013 12:00:00 AM | 7/11/2013 3:27 PM |
| Dates | Signed By Date | Insert | | | 7/11/2013 12:00:00 AM | 7/11/2013 3:27 PM |
| Dates | Start Date | Insert | | | | 7/11/2013 3:27 PM |
| Terminations | Termination Comments | Insert | | | | 7/11/2013 3:27 PM |
| Terminations | Termination Date | Insert | | | | 7/11/2013 3:27 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/11/2013 3:27 PM |
| Terminations | Termination Reason | Insert | | | | 7/11/2013 3:27 PM |