| Contacts | Authorizing Official | Update | Change Request | Hess, Cory
President HH - CFV VP
Harnett Health System
9107667100 | Tart, Michael
President
Harnett Health System
9107667102 | 12/30/2024 1:40 PM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2023 4:13:00 PM | 8/14/2024 9:18:53 AM | 8/14/2024 9:18 AM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2022 12:43:09 PM | 8/15/2023 4:13:00 PM | 8/15/2023 4:13 PM |
| Contacts | Primary Contact | Update | Change Request | Pope, Amy
Pharmacy Director
Harnett Health System
9108921000-4096 | Pope, Amy
Pharmacy Manager
Harnett Health System
9107667074 | 6/22/2023 7:54 AM |
| Contacts | Authorizing Official | Update | Change Request | Lang, Jessica
Chief Financial Officer
Harnett Health System
9108921000-4016 | Hess, Cory
President HH - CFV VP
Harnett Health System
9107667100 | 9/29/2022 11:23 AM |
| Details | Last Recertification Date | Update | Recertification | 8/27/2021 8:55:54 AM | 9/7/2022 12:43:09 PM | 9/7/2022 12:43 PM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2020 10:15:35 AM | 8/27/2021 8:55:54 AM | 8/27/2021 8:55 AM |
| Contacts | Authorizing Official | Update | Change Request | Jones, Mike
VP Support Services
Harnett Health
9108921000-3003 | Lang, Jessica
Chief Financial Officer
Harnett Health System
9108921000-4016 | 6/16/2021 7:49 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 8/25/2020 10:15 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 3400071 | 8/25/2020 10:15 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | NC | 8/25/2020 10:15 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | NC | 8/25/2020 10:15 AM |
| Details | Last Recertification Date | Update | Recertification | 8/27/2019 8:37:24 AM | 8/25/2020 10:15:35 AM | 8/25/2020 10:15 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2018 10:38:38 AM | 8/27/2019 8:37:24 AM | 8/27/2019 8:37 AM |
| Details | Last Recertification Date | Update | Recertification | 11/9/2017 10:16:52 AM | 8/21/2018 10:38:38 AM | 8/21/2018 10:38 AM |
| Details | Last Recertification Date | Update | Recertification | 10/25/2017 10:07:39 AM | 11/9/2017 10:16:52 AM | 11/9/2017 10:16 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2016 12:00:00 AM | 10/25/2017 10:07:39 AM | 10/25/2017 10:07 AM |
| Contacts | Authorizing Official | Update | | Jones, Mike
VP Support Services
9108921000-3003 | Jones, Mike
VP Support Services
Harnett Health
9108921000-3003 | 10/24/2017 10:15 AM |
| Contacts | Primary Contact | Update | | Pope, Amy
Pharmacy Director
9108921000-4096 | Pope, Amy
Pharmacy Director
Harnett Health System
9108921000-4096 | 9/19/2017 8:21 AM |
| Contacts | Signed By | Insert | | | Allen, Vicki
VP Patient Care Services, CNO
9108921000-4104 | 4/28/2017 8:03 AM |
| Contacts | Primary Contact | Update | | Holmes, Alyce
Pharmacy Director
9108921000-4094 | Pope, Amy
Pharmacy Director
9108921000-4096 | 8/22/2016 11:39 AM |
| Contacts | Authorizing Official | Insert | | | Jones, Mike
VP Support Services
9108921000-3003 | 8/22/2016 11:39 AM |
| Addresses | Main Address | Insert | | |
215 Brightwater Drive
Lillington, NC 27546 | 8/22/2016 11:39 AM |
| Details | Last Recertification Date | Update | | 8/13/2015 12:00:00 AM | 8/22/2016 12:00:00 AM | 8/22/2016 11:39 AM |
| Details | Last Recertification Date | Update | | 8/7/2014 12:00:00 AM | 8/13/2015 12:00:00 AM | 8/13/2015 3:39 PM |
| Contacts | Primary Contact | Insert | | | Holmes, Alyce
Pharmacy Director
9108921000-4094 | 8/13/2015 3:39 PM |
| Addresses | Billing Address | Insert | | | Harnett Health System
215 Brightwater Drive
Att: Pharmacy Department
Lillington, NC 27546 | 12/30/2014 8:08 AM |
| Addresses | Shipping Address | Insert | | | Harnett Health System
215 Brightwater Drive
Att: Pharmacy Department
Lillington, NC 27546 | 12/30/2014 8:08 AM |
| Details | Last Recertification Date | Update | | | 8/7/2014 12:00:00 AM | 8/7/2014 2:19 PM |
| Dates | Participating Approval Date | Update | | | 5/29/2014 12:00:00 AM | 5/29/2014 10:39 AM |
| Details | State | Update | | Pending | Active | 5/29/2014 10:39 AM |
| Dates | Start Date | Update | | | 7/1/2014 12:00:00 AM | 5/29/2014 10:39 AM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | DSH340071T | 4/14/2014 2:25 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1922144757 | 4/10/2014 6:16 PM |
| Details | Last Recertification Date | Insert | | | | 4/10/2014 6:16 PM |
| Details | Grant Number | Insert | | | | 4/10/2014 6:16 PM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 4/10/2014 6:16 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/10/2014 6:16 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/10/2014 6:16 PM |
| Details | Medicare Provider Number | Insert | | | 340071 | 4/10/2014 6:16 PM |
| Details | Entity Name | Insert | | | HARNETT HEALTH SYSTEM, INC. | 4/10/2014 6:16 PM |
| Details | Program Code | Insert | | | DSH | 4/10/2014 6:16 PM |
| Details | Entity Subname | Insert | | | Outpatient Surgery (Recovery Room) | 4/10/2014 6:16 PM |
| Dates | Participating Approval Date | Insert | | | | 4/10/2014 6:16 PM |
| Details | State | Insert | | | Pending | 4/10/2014 6:16 PM |
| Dates | Registration Date | Insert | | | 4/10/2014 12:00:00 AM | 4/10/2014 6:16 PM |
| Dates | Signed By Date | Insert | | | 4/10/2014 12:00:00 AM | 4/10/2014 6:16 PM |
| Dates | Start Date | Insert | | | | 4/10/2014 6:16 PM |
| Terminations | Termination Comments | Insert | | | | 4/10/2014 6:16 PM |
| Terminations | Termination Date | Insert | | | | 4/10/2014 6:16 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/10/2014 6:16 PM |
| Terminations | Termination Reason | Insert | | | | 4/10/2014 6:16 PM |