| Details | Last Recertification Date | Update | Recertification | 2/16/2024 10:43:22 PM | 2/13/2025 9:36:47 PM | 2/13/2025 9:36 PM |
| Details | Last Recertification Date | Update | Recertification | 2/27/2023 7:09:01 AM | 2/16/2024 10:43:22 PM | 2/16/2024 10:43 PM |
| Contacts | Primary Contact | Update | PC Change Request | Styles, Kara
Grant Specialist
Neighborcare Health
2065487540 | Childs, Janine
CFO
Neighborcare Health
2065483034 | 2/7/2024 10:13 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1548326820 | 2/27/2023 7:09 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | WA | 2/27/2023 7:09 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1538225826 | 2/27/2023 7:09 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | WA | 2/27/2023 7:09 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1326410390 | 2/27/2023 7:09 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | WA | 2/27/2023 7:09 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1063653566 | 2/27/2023 7:09 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | WA | 2/27/2023 7:09 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1003276502 | 2/27/2023 7:09 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | WA | 2/27/2023 7:09 AM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2022 1:08:20 PM | 2/27/2023 7:09:01 AM | 2/27/2023 7:09 AM |
| Details | Entity Subname | Update | Recertification | Ballard Homeless Clinic at Neyer Urness House | Neighborcare Health Ballard Homeless Clinic at Nyer Urness House | 2/27/2023 7:09 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Vaughan, Meredith
COO & Interim CEO
Neighborcare Health
2065483052 | Collins, Rashad A.
CEO
Neighborcare Health
2065483052 | 2/7/2023 10:06 AM |
| Details | Last Recertification Date | Update | Recertification | 2/22/2021 10:36:12 AM | 2/16/2022 1:08:20 PM | 2/16/2022 1:08 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1275808214 | 2/22/2021 10:36 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | WA | 2/22/2021 10:36 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1275808214 ( ) | | 2/22/2021 10:36 AM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2020 3:45:01 PM | 2/22/2021 10:36:12 AM | 2/22/2021 10:36 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Erikson, Michael
Chief Executive Officer
Neighborcare Health
2065483050 | Vaughan, Meredith
COO & Interim CEO
Neighborcare Health
2065483052 | 2/16/2021 8:46 PM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2019 4:51:26 PM | 2/21/2020 3:45:01 PM | 2/21/2020 3:45 PM |
| Details | Last Recertification Date | Update | Recertification | 3/6/2018 5:50:55 PM | 2/14/2019 4:51:26 PM | 2/14/2019 4:51 PM |
| Contacts | Primary Contact | Update | Change Request | Amberson, Susan
Director of Grants & Compliance
Neighborcare Health
2065483265 | Styles, Kara
Grant Specialist
Neighborcare Health
2065487540 | 1/25/2019 1:59 PM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 6024418 (WA) | | 3/6/2018 5:50 PM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 6008965 (WA) | | 3/6/2018 5:50 PM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 6032171 (WA) | | 3/6/2018 5:50 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 3/6/2018 5:50 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 2021129 | 3/6/2018 5:50 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | WA | 3/6/2018 5:50 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1164629325 ( ) | | 3/6/2018 5:50 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1063653566 ( ) | | 3/6/2018 5:50 PM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2017 12:00:00 AM | 3/6/2018 5:50:55 PM | 3/6/2018 5:50 PM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 3/6/2018 5:50 PM |
| Contacts | Authorizing Official | Update | | Erikson, Michael
Chief Executive Officer
2065483050 | Erikson, Michael
Chief Executive Officer
Neighborcare Health
2065483050 | 10/12/2017 5:55 PM |
| Contacts | Primary Contact | Update | | Amberson, Susan
Director of Grants & Compliance
2065483265 | Amberson, Susan
Director of Grants & Compliance
Neighborcare Health
2065483265 | 10/10/2017 5:29 PM |
| Contacts | Authorizing Official | Insert | | | Erikson, Michael
Chief Executive Officer
2065483050 | 5/1/2017 6:05 PM |
| Contacts | Primary Contact | Update | | LOLAGI, SHANDI
EXECUTIVE ASSISTANT
2065483005 | Amberson, Susan
Director of Grants & Compliance
2065483265 | 5/1/2017 6:05 PM |
| Contacts | Signed By | Insert | | | SECORD, MARK
CEO
2065483050 | 4/5/2017 1:47 PM |
| Addresses | Main Address | Insert | | |
1753 NW 56th Street
Suite 200
Seattle, WA 98107-3144 | 2/17/2017 5:37 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1275808214 | 2/17/2017 5:37 PM |
| Details | Last Recertification Date | Update | | 3/7/2016 12:00:00 AM | 2/17/2017 12:00:00 AM | 2/17/2017 5:37 PM |
| Addresses | Billing Address | Insert | | | NEIGHBORCARE HEALTH
1200 12th Ave. S
Suite 901
Seattle, WA 98144 | 1/6/2017 8:56 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 1/6/2017 8:56 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 6008965 | 1/6/2017 8:56 AM |
| Medicaid Billing | Medicaid: State | Insert | | | WA | 1/6/2017 8:56 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 1/6/2017 8:56 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 6032171 | 1/6/2017 8:56 AM |
| Medicaid Billing | Medicaid: State | Insert | | | WA | 1/6/2017 8:56 AM |
| Medicaid Billing | NPI: Number | Update | | 1548326820 | 1164629325 | 1/6/2017 8:56 AM |
| Medicaid Billing | NPI: Number | Update | | 1275808214 | 1063653566 | 1/6/2017 8:56 AM |
| Details | Entity Subname | Update | | Ballard Homeless Clinic | Ballard Homeless Clinic at Neyer Urness House | 1/6/2017 8:56 AM |
| Contacts | Primary Contact | Insert | | | LOLAGI, SHANDI
EXECUTIVE ASSISTANT
2065483005 | 1/6/2017 8:55 AM |
| Details | Last Recertification Date | Update | | 3/6/2015 12:00:00 AM | 3/7/2016 12:00:00 AM | 3/7/2016 1:16 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1275808214 | 2/3/2016 12:49 PM |
| Details | Last Recertification Date | Update | | | 3/6/2015 12:00:00 AM | 3/6/2015 11:06 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1548326820 | 9/26/2014 2:20 PM |
| Details | Is Authorizing Official EHB Data | Update | | | False | 7/7/2014 7:10 PM |
| Details | 340B ID | Update | | ONLINE_REG | CH10064AR | 4/11/2014 1:26 PM |
| Dates | Participating Approval Date | Update | | | 4/11/2014 12:00:00 AM | 4/11/2014 1:26 PM |
| Details | State | Update | | Pending | Active | 4/11/2014 1:26 PM |
| Dates | Start Date | Update | | | 7/1/2014 12:00:00 AM | 4/11/2014 1:26 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 4/2/2014 1:07 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 6024418 | 4/2/2014 1:07 PM |
| Medicaid Billing | Medicaid: State | Insert | | | WA | 4/2/2014 1:07 PM |
| Details | Last Recertification Date | Insert | | | | 4/2/2014 1:07 PM |
| Details | Grant Number | Insert | | | H80CS00829 | 4/2/2014 1:07 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 4/2/2014 1:07 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/2/2014 1:07 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/2/2014 1:07 PM |
| Details | Medicare Provider Number | Insert | | | | 4/2/2014 1:07 PM |
| Details | Entity Name | Insert | | | NEIGHBORCARE HEALTH | 4/2/2014 1:07 PM |
| Details | Program Code | Insert | | | CH | 4/2/2014 1:07 PM |
| Details | Entity Subname | Insert | | | Ballard Homeless Clinic | 4/2/2014 1:07 PM |
| Dates | Participating Approval Date | Insert | | | | 4/2/2014 1:07 PM |
| Details | State | Insert | | | Pending | 4/2/2014 1:07 PM |
| Dates | Registration Date | Insert | | | 4/2/2014 12:00:00 AM | 4/2/2014 1:07 PM |
| Dates | Signed By Date | Insert | | | 4/2/2014 12:00:00 AM | 4/2/2014 1:07 PM |
| Dates | Start Date | Insert | | | | 4/2/2014 1:07 PM |
| Terminations | Termination Comments | Insert | | | | 4/2/2014 1:07 PM |
| Terminations | Termination Date | Insert | | | | 4/2/2014 1:07 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/2/2014 1:07 PM |
| Terminations | Termination Reason | Insert | | | | 4/2/2014 1:07 PM |