| Details | Last Recertification Date | Update | Recertification | 9/6/2023 10:49:12 AM | 8/15/2024 12:37:33 PM | 8/15/2024 12:37 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Van Driel, Allen
Chief Executive Officer
Smith County Memorial Hospital
7852826845 | Ragsdale, Sarah Jane
CEO
Great Plains of Smith Co Inc
7852826845-1102 | 1/10/2024 7:20 AM |
| Details | Last Recertification Date | Update | Recertification | 9/6/2022 9:13:53 PM | 9/6/2023 10:49:12 AM | 9/6/2023 10:49 AM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2021 9:02:45 AM | 9/6/2022 9:13:53 PM | 9/6/2022 9:13 PM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2020 9:35:25 AM | 9/7/2021 9:02:45 AM | 9/7/2021 9:02 AM |
| Contacts | Primary Contact | Update | Recertification | Clancy, Kristie
Pharmacy Coordinator
Smith County Memorial Hospital
7852826845-232 | Clancy, Kristie
Primary Contact
Great Plains of Smith County, Inc
7852826845 | 8/31/2020 9:35 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2019 7:52:25 AM | 8/31/2020 9:35:25 AM | 8/31/2020 9:35 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2018 9:41:39 AM | 8/21/2019 7:52:25 AM | 8/21/2019 7:52 AM |
| Details | Last Recertification Date | Update | Recertification | 11/6/2017 9:10:05 AM | 8/21/2018 9:41:39 AM | 8/21/2018 9:41 AM |
| Addresses | Billing Address | Insert | Change Request | | Great Plains of Smith County dba Smith County Memorial Hospital
921 E. Highway 36
P.O. Box 349
Smith Center, KS 66967-0349 | 7/30/2018 9:17 AM |
| Addresses | Main Address | Update | Change Request |
614 S. Main
P.O. Box 349
Smith Center, KS 66967 |
921 E. Highway 36
Smith Center, KS 66967 | 7/30/2018 9:17 AM |
| Details | Last Recertification Date | Update | Recertification | 10/25/2017 9:45:00 AM | 11/6/2017 9:10:05 AM | 11/6/2017 9:10 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2016 12:00:00 AM | 10/25/2017 9:45:00 AM | 10/25/2017 9:45 AM |
| Contacts | Primary Contact | Update | | Clancy, Kristie
Pharmacy Coordinator
7852826845 | Clancy, Kristie
Pharmacy Coordinator
Smith County Memorial Hospital
7852826845-232 | 10/20/2017 8:30 PM |
| Contacts | Authorizing Official | Update | | Van Driel, Allen
Chief Executive Officer
7852826845 | Van Driel, Allen
Chief Executive Officer
Smith County Memorial Hospital
7852826845 | 10/3/2017 9:03 AM |
| Contacts | Signed By | Update | | Van Driel, Allen
Chief Executive Officer
7852826845 | Van Driel, Allen
Chief Executive Officer
Smith County Memorial Hospital
7852826845 | 10/3/2017 9:03 AM |
| Addresses | Main Address | Insert | | |
614 S. Main
P.O. Box 349
Smith Center, KS 66967 | 8/26/2016 12:18 PM |
| Contacts | Primary Contact | Update | | Pauley, Dawn
Pharmacy Coordinator
7852826845 | Clancy, Kristie
Pharmacy Coordinator
7852826845 | 8/26/2016 12:18 PM |
| Contacts | Authorizing Official | Insert | | | Van Driel, Allen
Chief Executive Officer
7852826845 | 8/26/2016 12:18 PM |
| Contacts | Signed By | Insert | | | Van Driel, Allen
Chief Executive Officer
7852826845 | 8/26/2016 12:18 PM |
| Details | Last Recertification Date | Update | | 8/7/2015 12:00:00 AM | 8/26/2016 12:00:00 AM | 8/26/2016 12:18 PM |
| Details | Last Recertification Date | Update | | 9/3/2014 12:00:00 AM | 8/7/2015 12:00:00 AM | 8/7/2015 4:54 PM |
| Details | Last Recertification Date | Update | | | 9/3/2014 12:00:00 AM | 9/3/2014 10:48 AM |
| Contacts | Primary Contact | Insert | | | Pauley, Dawn
Pharmacy Coordinator
7852826845 | 6/11/2014 6:12 PM |
| Dates | Participating Approval Date | Update | | | 6/11/2014 12:00:00 AM | 6/11/2014 6:12 PM |
| Details | State | Update | | Pending | Active | 6/11/2014 6:12 PM |
| Dates | Start Date | Update | | | 7/1/2014 12:00:00 AM | 6/11/2014 6:12 PM |
| Details | 340B ID | Update | | ONLINE_REG | CAH171377-00 | 4/7/2014 9:52 AM |
| Details | Last Recertification Date | Insert | | | | 4/3/2014 8:25 AM |
| Details | Grant Number | Insert | | | | 4/3/2014 8:25 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 4/3/2014 8:25 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/3/2014 8:25 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/3/2014 8:25 AM |
| Details | Medicare Provider Number | Insert | | | 171377 | 4/3/2014 8:25 AM |
| Details | Entity Name | Insert | | | Great Plains of Smith County, dba Smith County Memorial Hospital | 4/3/2014 8:25 AM |
| Details | Program Code | Insert | | | CAH | 4/3/2014 8:25 AM |
| Details | Entity Subname | Insert | | | | 4/3/2014 8:25 AM |
| Dates | Participating Approval Date | Insert | | | | 4/3/2014 8:25 AM |
| Details | State | Insert | | | Pending | 4/3/2014 8:25 AM |
| Dates | Registration Date | Insert | | | 4/3/2014 12:00:00 AM | 4/3/2014 8:25 AM |
| Dates | Signed By Date | Insert | | | 4/3/2014 12:00:00 AM | 4/3/2014 8:25 AM |
| Dates | Start Date | Insert | | | | 4/3/2014 8:25 AM |
| Terminations | Termination Comments | Insert | | | | 4/3/2014 8:25 AM |
| Terminations | Termination Date | Insert | | | | 4/3/2014 8:25 AM |
| Terminations | Termination Effective Date | Insert | | | | 4/3/2014 8:25 AM |
| Terminations | Termination Reason | Insert | | | | 4/3/2014 8:25 AM |