| Details | Last Recertification Date | Update | Recertification | 2/13/2024 9:43:18 AM | 2/11/2025 7:14:37 PM | 2/11/2025 7:14 PM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2023 12:27:13 PM | 2/13/2024 9:43:18 AM | 2/13/2024 9:43 AM |
| Addresses | Shipping Address | Insert | Change Request | | Neighborhood Health Pharmacy
1721 S. Calhoun Street
Fort Wayne, IN 46802 | 10/4/2023 11:15 AM |
| Addresses | Billing Address | Update | Change Request | Neighborhood Health Clinics, Inc
PO Box 11949
Fort Wayne, IN 46846-1949 | Neighborhood Health Clinics, Inc
PO Box 11949
Fort Wayne, IN 46862 | 10/4/2023 11:15 AM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2022 1:11:26 PM | 2/8/2023 12:27:13 PM | 2/8/2023 12:27 PM |
| Contacts | Primary Contact | Update | Group Change Request | Hamilton, Mark Grove
VP/Chief Financial Officer
Neighborhood Health Clinics, Inc.
2604582641-3623 | Mekonnen, Andrea
Pharmacy Director
Neighborhood Health Clinic
2604582641-3775 | 7/29/2022 12:43 PM |
| Contacts | Primary Contact | Update | Recertification | Yergler, Rick
VP/Chief Finance Officer
Neighborhood Health Clinics, Inc.
2604582641 | Hamilton, Mark Grove
VP/Chief Financial Officer
Neighborhood Health Clinics, Inc.
2604582641-3623 | 2/8/2022 1:11 PM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2021 10:08:22 AM | 2/8/2022 1:11:26 PM | 2/8/2022 1:11 PM |
| Contacts | Primary Contact | Update | Recertification | Johnson-Taylor, Shalon
Quality & Risk Management Director
Neighborhood Health Clinic
2604583610 | Yergler, Rick
VP/Chief Finance Officer
Neighborhood Health Clinics, Inc.
2604582641 | 2/8/2021 10:08 AM |
| Details | Last Recertification Date | Update | Recertification | 2/24/2020 8:25:49 PM | 2/8/2021 10:08:22 AM | 2/8/2021 10:08 AM |
| Contacts | Primary Contact | Update | Change Request | Klingenberger, Janine
Clinical Director
Neighborhood Health Clinics, Inc.
2604582641-3610 | Johnson-Taylor, Shalon
Quality & Risk Management Director
Neighborhood Health Clinic
2604583610 | 3/9/2020 4:25 PM |
| Details | Is Authorizing Official EHB Data | Update | Change Request | False | | 3/9/2020 4:25 PM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2019 10:10:12 AM | 2/24/2020 8:25:49 PM | 2/24/2020 8:25 PM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2018 4:22:51 PM | 1/31/2019 10:10:12 AM | 1/31/2019 10:10 AM |
| Details | Last Recertification Date | Update | Recertification | 2/15/2017 12:00:00 AM | 2/14/2018 4:22:51 PM | 2/14/2018 4:22 PM |
| Contacts | Primary Contact | Update | Recertification | Klingenberger, Janine
Clinical Director
2604582641-3610 | Klingenberger, Janine
Clinical Director
Neighborhood Health Clinics, Inc.
2604582641-3610 | 2/14/2018 4:21 PM |
| Contacts | Authorizing Official | Update | | Zaegel, Angela
CEO
2604582641-3634 | Zaegel, Angela
CEO
Neighborhood Health Clinics, Inc.
2604582641-3634 | 2/14/2018 4:01 PM |
| Contacts | Primary Contact | Insert | | | Klingenberger, Janine
Clinical Director
2604582641-3610 | 2/15/2017 10:36 AM |
| Contacts | Authorizing Official | Insert | | | Zaegel, Angela
CEO
2604582641-3634 | 2/15/2017 10:36 AM |
| Contacts | Signed By | Insert | | | Haupert, Mary S.
President/CEO
2604582644 | 2/15/2017 10:36 AM |
| Addresses | Main Address | Insert | | |
3350 E PAULDING RD
FORT WAYNE, IN 46816-4513 | 2/15/2017 10:36 AM |
| Details | Last Recertification Date | Update | | 2/12/2016 12:00:00 AM | 2/15/2017 12:00:00 AM | 2/15/2017 10:35 AM |
| Details | Last Recertification Date | Update | | 1/28/2015 12:00:00 AM | 2/12/2016 12:00:00 AM | 2/12/2016 10:15 AM |
| Addresses | Shipping Address | Insert | | | Neighborhood Health Clinics, Inc
1717 S Calhoun St
Fort Wayne, IN 46802 | 1/28/2015 1:20 PM |
| Details | Last Recertification Date | Update | | | 1/28/2015 12:00:00 AM | 1/28/2015 1:20 PM |
| Details | Is Authorizing Official EHB Data | Update | | | False | 1/28/2015 1:20 PM |
| Addresses | Billing Address | Insert | | | Neighborhood Health Clinics, Inc
PO Box 11949
Fort Wayne, IN 46846-1949 | 4/11/2014 5:40 PM |
| Details | 340B ID | Update | | ONLINE_REG | CH05848B | 4/11/2014 5:40 PM |
| Dates | Participating Approval Date | Update | | | 4/11/2014 12:00:00 AM | 4/11/2014 5:40 PM |
| Details | State | Update | | Pending | Active | 4/11/2014 5:40 PM |
| Dates | Start Date | Update | | | 7/1/2014 12:00:00 AM | 4/11/2014 5:40 PM |
| Details | Last Recertification Date | Insert | | | | 4/1/2014 2:49 PM |
| Details | Grant Number | Insert | | | H80CS00548 | 4/1/2014 2:49 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 4/1/2014 2:49 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/1/2014 2:49 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/1/2014 2:49 PM |
| Details | Medicare Provider Number | Insert | | | | 4/1/2014 2:49 PM |
| Details | Entity Name | Insert | | | NEIGHBORHOOD HEALTH CLINICS INC. | 4/1/2014 2:49 PM |
| Details | Program Code | Insert | | | CH | 4/1/2014 2:49 PM |
| Details | Entity Subname | Insert | | | Southeast Clinic | 4/1/2014 2:49 PM |
| Dates | Participating Approval Date | Insert | | | | 4/1/2014 2:49 PM |
| Details | State | Insert | | | Pending | 4/1/2014 2:49 PM |
| Dates | Registration Date | Insert | | | 4/1/2014 12:00:00 AM | 4/1/2014 2:49 PM |
| Dates | Signed By Date | Insert | | | 4/1/2014 12:00:00 AM | 4/1/2014 2:49 PM |
| Dates | Start Date | Insert | | | | 4/1/2014 2:49 PM |
| Terminations | Termination Comments | Insert | | | | 4/1/2014 2:49 PM |
| Terminations | Termination Date | Insert | | | | 4/1/2014 2:49 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/1/2014 2:49 PM |
| Terminations | Termination Reason | Insert | | | | 4/1/2014 2:49 PM |