| Details | Last Recertification Date | Update | Recertification | 8/14/2023 1:02:06 PM | 8/20/2024 5:15:15 PM | 8/20/2024 5:15 PM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2022 9:53:36 AM | 8/14/2023 1:02:06 PM | 8/14/2023 1:02 PM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2021 3:47:32 PM | 8/25/2022 9:53:36 AM | 8/25/2022 9:53 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Stephens, Ruth M
Interim CEO
Brown County Hospital
4023872800-128 | Hallock, Mirya
CEO
Brown County Hospital
4023872800 | 6/14/2022 6:43 AM |
| Contacts | Authorizing Official | Update | Change Request | Werner, John W
CEO
Brown County Hospital
4023872800 | Stephens, Ruth M
Interim CEO
Brown County Hospital
4023872800-128 | 12/1/2021 4:27 PM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2020 11:43:36 AM | 8/16/2021 3:47:32 PM | 8/16/2021 3:47 PM |
| Details | Last Recertification Date | Update | Recertification | 9/5/2019 2:08:03 PM | 8/26/2020 11:43:36 AM | 8/26/2020 11:43 AM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2018 9:22:29 AM | 9/5/2019 2:08:03 PM | 9/5/2019 2:08 PM |
| Details | Last Recertification Date | Update | Recertification | 11/28/2017 3:52:10 PM | 8/29/2018 9:22:29 AM | 8/29/2018 9:22 AM |
| Contacts | Authorizing Official | Update | AO Change Request | LaVallie, Tashina Marie
Sr. Acct
Brown County Hospital
4023872800 | Werner, John W
CEO
Brown County Hospital
4023872800 | 8/22/2018 12:55 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Goche, Jeanne Marie
CEO
Brown County Hospital
4023872800 | LaVallie, Tashina Marie
Sr. Acct
Brown County Hospital
4023872800 | 5/23/2018 6:42 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Sorensen, Shannon
CEO
Brown County Hospital
4023872800 | Goche, Jeanne Marie
CEO
Brown County Hospital
4023872800 | 2/28/2018 12:48 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2016 12:00:00 AM | 11/28/2017 3:52:10 PM | 11/28/2017 3:52 PM |
| Contacts | Primary Contact | Update | Recertification | Hasenohr, Erica
Clinic Manager
4023871900 | Hasenohr, Erica
Clinic Manager
Brown County Hospital
4023871900 | 11/28/2017 3:52 PM |
| Contacts | Authorizing Official | Update | | Sorensen, Shannon
CEO
4023872800 | Sorensen, Shannon
CEO
Brown County Hospital
4023872800 | 9/21/2017 10:20 PM |
| Addresses | Main Address | Insert | | |
913 E Zero Street
Ainsworth, NE 69210 | 8/23/2016 12:29 PM |
| Contacts | Primary Contact | Insert | | | Hasenohr, Erica
Clinic Manager
4023871900 | 8/23/2016 12:29 PM |
| Contacts | Authorizing Official | Update | | SORENSEN, SHANNON
CEO
4023872800 | Sorensen, Shannon
CEO
4023872800 | 8/23/2016 12:29 PM |
| Contacts | Signed By | Insert | | | Sells, Matt
CFO
4023872800 | 8/23/2016 12:29 PM |
| Details | Last Recertification Date | Update | | 8/31/2015 12:00:00 AM | 8/23/2016 12:00:00 AM | 8/23/2016 12:29 PM |
| Details | Last Recertification Date | Update | | 8/28/2014 12:00:00 AM | 8/31/2015 12:00:00 AM | 8/31/2015 1:39 PM |
| Details | Last Recertification Date | Update | | | 8/28/2014 12:00:00 AM | 8/28/2014 9:51 AM |
| Contacts | Authorizing Official | Insert | | | SORENSEN, SHANNON
CEO
4023872800 | 8/6/2014 3:14 PM |
| Dates | Participating Approval Date | Update | | | 2/18/2014 12:00:00 AM | 2/18/2014 6:58 AM |
| Details | State | Update | | Pending | Active | 2/18/2014 6:58 AM |
| Dates | Start Date | Update | | | 4/1/2014 12:00:00 AM | 2/18/2014 6:58 AM |
| Details | 340B ID | Update | | OUTPATIENT2_ONLINE_REG | CAH281325-01 | 1/29/2014 12:25 PM |
| Details | 340B ID | Update | | Delete11OUTPATIENT_ONLINE_REG | OUTPATIENT2_ONLINE_REG | 1/16/2014 3:21 PM |
| Details | State | Update | | Rejected | Pending | 1/16/2014 3:21 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | Delete11OUTPATIENT_ONLINE_REG | 1/16/2014 3:19 PM |
| Details | State | Update | | Pending | Rejected | 1/16/2014 3:19 PM |
| Details | Last Recertification Date | Insert | | | | 1/15/2014 4:09 PM |
| Details | Grant Number | Insert | | | | 1/15/2014 4:09 PM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 1/15/2014 4:09 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/15/2014 4:09 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/15/2014 4:09 PM |
| Details | Medicare Provider Number | Insert | | | 281325 | 1/15/2014 4:09 PM |
| Details | Entity Name | Insert | | | Brown County Hospital | 1/15/2014 4:09 PM |
| Details | Program Code | Insert | | | CAH | 1/15/2014 4:09 PM |
| Details | Entity Subname | Insert | | | Brown County Hospital dba Ainsworth Family Clinic | 1/15/2014 4:09 PM |
| Dates | Participating Approval Date | Insert | | | | 1/15/2014 4:09 PM |
| Details | State | Insert | | | Pending | 1/15/2014 4:09 PM |
| Dates | Registration Date | Insert | | | 1/15/2014 12:00:00 AM | 1/15/2014 4:09 PM |
| Dates | Signed By Date | Insert | | | 1/15/2014 12:00:00 AM | 1/15/2014 4:09 PM |
| Dates | Start Date | Insert | | | | 1/15/2014 4:09 PM |
| Terminations | Termination Comments | Insert | | | | 1/15/2014 4:09 PM |
| Terminations | Termination Date | Insert | | | | 1/15/2014 4:09 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/15/2014 4:09 PM |
| Terminations | Termination Reason | Insert | | | | 1/15/2014 4:09 PM |