| Details | Last Recertification Date | Update | Recertification | 8/17/2023 4:49:17 PM | 8/15/2024 4:07:00 PM | 8/15/2024 4:07 PM |
| Contacts | Primary Contact | Update | PC Change Request | Ellingson, Reid
Director of Hospital Pharamcy
Regional Health Services of Howard County
5635476371 | Reinhart, Vicki
340B Coordinator
Regional Health Services of Howard County
5635476633 | 8/6/2024 8:39 AM |
| Contacts | Authorizing Official | Update | Change Request | Burkel, Gregory J.
EXECUTIVE FINANCE OFFICER
Mitchell County Regional Health Center
6417326070 | Brevig, Brandon
Chief Financial Officer
Regional Health Services of Howard County
5635476677 | 8/5/2024 1:59 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Burkel, Gregory J.
CHIEF FINANCIAL OFFICER
Mitchell County Regional Health Center
6417326070 | Burkel, Gregory J.
EXECUTIVE FINANCE OFFICER
Mitchell County Regional Health Center
6417326070 | 2/21/2024 3:10 PM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2022 9:43:04 AM | 8/17/2023 4:49:17 PM | 8/17/2023 4:49 PM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2021 8:55:22 PM | 8/26/2022 9:43:04 AM | 8/26/2022 9:43 AM |
| Contacts | Primary Contact | Update | Change Request | Ellingson, Reid
Director of Pharmacy
Regional Health Services of Howard County
5635472101 | Ellingson, Reid
Director of Hospital Pharamcy
Regional Health Services of Howard County
5635476371 | 3/31/2022 2:45 PM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2020 8:43:11 PM | 8/16/2021 8:55:22 PM | 8/16/2021 8:55 PM |
| Contacts | Primary Contact | Update | Change Request | Palmer, Heath
Director of Pharmacy
Regional Health Services of Howard Co
5635476371 | Ellingson, Reid
Director of Pharmacy
Regional Health Services of Howard County
5635472101 | 10/8/2020 8:56 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2019 9:33:00 AM | 8/19/2020 8:43:11 PM | 8/19/2020 8:43 PM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2018 10:18:15 AM | 8/21/2019 9:33:00 AM | 8/21/2019 9:33 AM |
| Details | Last Recertification Date | Update | Recertification | 11/16/2017 2:46:14 PM | 8/17/2018 10:18:15 AM | 8/17/2018 10:18 AM |
| Details | Last Recertification Date | Update | Recertification | 8/10/2016 12:00:00 AM | 11/16/2017 2:46:14 PM | 11/16/2017 2:46 PM |
| Contacts | Primary Contact | Update | | Palmer, Heath
Director of Pharmacy
5635476371 | Palmer, Heath
Director of Pharmacy
Regional Health Services of Howard Co
5635476371 | 10/24/2017 1:33 PM |
| Contacts | Authorizing Official | Update | | Burkel, Gregory J.
CHIEF FINANCIAL OFFICER
6417326070 | Burkel, Gregory J.
CHIEF FINANCIAL OFFICER
Mitchell County Regional Health Center
6417326070 | 10/2/2017 10:06 AM |
| Contacts | Authorizing Official | Insert | | | Burkel, Gregory J.
CHIEF FINANCIAL OFFICER
6417326070 | 4/7/2017 12:01 PM |
| Addresses | Main Address | Insert | | |
101 WEST MAIN STREET
LIME SPRINGS, IA 52155 | 8/10/2016 10:14 AM |
| Contacts | Signed By | Insert | | | MOSER, BRENDA
VP OF FINANCE
5635476358 | 8/10/2016 10:14 AM |
| Contacts | Primary Contact | Insert | | | Palmer, Heath
Director of Pharmacy
5635476371 | 8/10/2016 10:14 AM |
| Details | Last Recertification Date | Update | | 8/13/2015 12:00:00 AM | 8/10/2016 12:00:00 AM | 8/10/2016 10:14 AM |
| Details | Last Recertification Date | Update | | 8/12/2014 12:00:00 AM | 8/13/2015 12:00:00 AM | 8/13/2015 11:09 PM |
| Details | Last Recertification Date | Update | | | 8/12/2014 12:00:00 AM | 8/12/2014 9:22 AM |
| Addresses | Billing Address | Insert | | | REGIONAL HEALTH SERVICES OF HOWARD COUNTY
235 8TH AVENUE WEST
CRESCO, IA 52136 | 11/3/2013 7:01 PM |
| Dates | Participating Approval Date | Update | | | 11/3/2013 12:00:00 AM | 11/3/2013 7:01 PM |
| Details | State | Update | | Pending | Active | 11/3/2013 7:01 PM |
| Dates | Start Date | Update | | | 1/1/2014 12:00:00 AM | 11/3/2013 7:01 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | CAH161328-01 | 10/28/2013 10:19 AM |
| Details | Last Recertification Date | Insert | | | | 10/14/2013 11:41 AM |
| Details | Grant Number | Insert | | | | 10/14/2013 11:41 AM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 10/14/2013 11:41 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/14/2013 11:41 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/14/2013 11:41 AM |
| Details | Medicare Provider Number | Insert | | | 161328 | 10/14/2013 11:41 AM |
| Details | Entity Name | Insert | | | REGIONAL HEALTH SERVICES OF HOWARD COUNTY | 10/14/2013 11:41 AM |
| Details | Program Code | Insert | | | CAH | 10/14/2013 11:41 AM |
| Details | Entity Subname | Insert | | | LIME SPRINGS MEDICAL CLINIC | 10/14/2013 11:41 AM |
| Dates | Participating Approval Date | Insert | | | | 10/14/2013 11:41 AM |
| Details | State | Insert | | | Pending | 10/14/2013 11:41 AM |
| Dates | Registration Date | Insert | | | 10/14/2013 12:00:00 AM | 10/14/2013 11:41 AM |
| Dates | Signed By Date | Insert | | | 10/14/2013 12:00:00 AM | 10/14/2013 11:41 AM |
| Dates | Start Date | Insert | | | | 10/14/2013 11:41 AM |
| Terminations | Termination Comments | Insert | | | | 10/14/2013 11:41 AM |
| Terminations | Termination Date | Insert | | | | 10/14/2013 11:41 AM |
| Terminations | Termination Effective Date | Insert | | | | 10/14/2013 11:41 AM |
| Terminations | Termination Reason | Insert | | | | 10/14/2013 11:41 AM |