| Details | Last Recertification Date | Update | Recertification | 9/12/2023 7:44:18 AM | 8/21/2024 11:48:25 AM | 8/21/2024 11:48 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Wagner, Jordan
Pharmacy Co-Director
Van Diest Medical Center
5158327744 | Wagner, Jordan
Director of Pharmacy
Van Diest Medical Center
5158327744 | 6/13/2024 10:15 AM |
| Details | Last Recertification Date | Update | Recertification | 9/6/2022 2:02:31 PM | 9/12/2023 7:44:18 AM | 9/12/2023 7:44 AM |
| Details | Last Recertification Date | Update | Recertification | 9/3/2021 3:24:34 PM | 9/6/2022 2:02:31 PM | 9/6/2022 2:02 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Heinrichs, Alice
CFO
Van Diest Medical Center
5158327751 | Allers, Ashley Nicole
CFO
Hamilton County Public Hospital
5158327705 | 3/21/2022 8:12 AM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2020 10:58:53 AM | 9/3/2021 3:24:34 PM | 9/3/2021 3:24 PM |
| Details | Last Recertification Date | Update | Recertification | 9/5/2019 7:45:38 AM | 9/2/2020 10:58:53 AM | 9/2/2020 10:58 AM |
| Contacts | Primary Contact | Update | Recertification | Johnson, Karen
Director of Pharmacy
Hamilton County Public Hospital d/b/a/ VanDiest Medical Center
5158327745 | Wagner, Jordan
Pharmacy Co-Director
Van Diest Medical Center
5158327744 | 9/5/2019 7:45 AM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2018 10:50:00 AM | 9/5/2019 7:45:38 AM | 9/5/2019 7:45 AM |
| Details | Last Recertification Date | Update | Recertification | 11/29/2017 8:45:23 AM | 9/7/2018 10:50:00 AM | 9/7/2018 10:50 AM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2016 12:00:00 AM | 11/29/2017 8:45:23 AM | 11/29/2017 8:45 AM |
| Contacts | Authorizing Official | Update | | Heinrichs, Alice
CFO
5158327751 | Heinrichs, Alice
CFO
Van Diest Medical Center
5158327751 | 9/29/2017 11:13 AM |
| Contacts | Primary Contact | Update | | Johnson, Karen
Director of Pharmacy
5158327745 | Johnson, Karen
Director of Pharmacy
Hamilton County Public Hospital d/b/a/ VanDiest Medical Center
5158327745 | 9/27/2017 12:47 PM |
| Contacts | Authorizing Official | Insert | | | Heinrichs, Alice
CFO
5158327751 | 4/18/2017 9:21 PM |
| Addresses | Main Address | Insert | | |
2350 Hospital Drive
Webster City, IA 50595 | 8/17/2016 1:23 PM |
| Addresses | Billing Address | Insert | | | Van Diest Medical Center
PO Box 430
Webster City, IA 50595-0430 | 8/17/2016 1:23 PM |
| Contacts | Primary Contact | Update | | Nedved, Max
Director of Pharmacy
5158327744 | Johnson, Karen
Director of Pharmacy
5158327745 | 8/17/2016 1:23 PM |
| Contacts | Signed By | Insert | | | Mason, Robert L.
CEO
5158327700 | 8/17/2016 1:23 PM |
| Details | Last Recertification Date | Update | | 9/8/2015 12:00:00 AM | 8/17/2016 12:00:00 AM | 8/17/2016 1:23 PM |
| Details | Last Recertification Date | Update | | 8/11/2014 12:00:00 AM | 9/8/2015 12:00:00 AM | 9/8/2015 8:39 PM |
| Contacts | Primary Contact | Insert | | | Nedved, Max
Director of Pharmacy
5158327744 | 9/8/2014 7:46 AM |
| Details | Last Recertification Date | Update | | | 8/11/2014 12:00:00 AM | 8/11/2014 3:56 PM |
| Details | 340B ID | Update | | CAH060076-00 | CAH161361-00 | 6/14/2014 5:28 PM |
| Details | Medicare Provider Number | Update | | 060076 | 161361 | 6/14/2014 5:28 PM |
| Details | Comments Public | Insert | | | 6/14/2014 - 340B ID updated with correct Medicare provider number. | 6/14/2014 5:28 PM |
| Dates | Participating Approval Date | Update | | | 1/9/2014 12:00:00 AM | 1/9/2014 2:41 PM |
| Details | State | Update | | Pending | Active | 1/9/2014 2:41 PM |
| Dates | Start Date | Update | | | 4/1/2014 12:00:00 AM | 1/9/2014 2:41 PM |
| Details | 340B ID | Update | | ONLINE_REG | CAH060076-00 | 1/9/2014 2:03 PM |
| Details | Last Recertification Date | Insert | | | | 1/7/2014 1:28 PM |
| Details | Grant Number | Insert | | | | 1/7/2014 1:28 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/7/2014 1:28 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/7/2014 1:28 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/7/2014 1:28 PM |
| Details | Medicare Provider Number | Insert | | | 060076 | 1/7/2014 1:28 PM |
| Details | Entity Name | Insert | | | Hamilton County Public Hospital d/b/a Van Diest Medical Center | 1/7/2014 1:28 PM |
| Details | Program Code | Insert | | | CAH | 1/7/2014 1:28 PM |
| Details | Entity Subname | Insert | | | | 1/7/2014 1:28 PM |
| Dates | Participating Approval Date | Insert | | | | 1/7/2014 1:28 PM |
| Details | State | Insert | | | Pending | 1/7/2014 1:28 PM |
| Dates | Registration Date | Insert | | | 1/7/2014 12:00:00 AM | 1/7/2014 1:28 PM |
| Dates | Signed By Date | Insert | | | 1/7/2014 12:00:00 AM | 1/7/2014 1:28 PM |
| Dates | Start Date | Insert | | | | 1/7/2014 1:28 PM |
| Terminations | Termination Comments | Insert | | | | 1/7/2014 1:28 PM |
| Terminations | Termination Date | Insert | | | | 1/7/2014 1:28 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/7/2014 1:28 PM |
| Terminations | Termination Reason | Insert | | | | 1/7/2014 1:28 PM |