Details | Last Recertification Date | Update | Recertification | 1/31/2024 9:22:53 AM | 2/18/2025 1:04:09 AM | 2/18/2025 1:04 AM |
Details | Last Recertification Date | Update | Recertification | 2/3/2023 11:34:50 AM | 1/31/2024 9:22:53 AM | 1/31/2024 9:22 AM |
Details | Last Recertification Date | Update | Recertification | 2/3/2022 11:56:02 AM | 2/3/2023 11:34:50 AM | 2/3/2023 11:34 AM |
Contacts | Primary Contact | Update | PC Change Request | Lambert, Jade joseph
340B Administrator
Innis Community Health Center, Inc
2254923775-225 | Hooper, Tracy Lyn
340B Administrator
Innis Community Health Center, Inc.
2256185015 | 4/19/2022 9:28 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 4/12/2022 12:53 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 2208969 | 4/12/2022 12:53 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | LA | 4/12/2022 12:53 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1790456499 | 4/12/2022 12:53 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | LA | 4/12/2022 12:53 PM |
Details | Last Recertification Date | Update | Recertification | 2/8/2021 9:34:37 AM | 2/3/2022 11:56:02 AM | 2/3/2022 11:56 AM |
Addresses | Shipping Address | Insert | Change Request | | Arbor Family Pharmacy
6450 LA Hwy 1
Suite A
Batchelor, LA 70715 | 11/19/2021 1:03 PM |
Medicaid Billing | NPI: State | Update | Recertification | | LA | 2/8/2021 9:34 AM |
Details | Last Recertification Date | Update | Recertification | 2/9/2020 5:18:34 PM | 2/8/2021 9:34:37 AM | 2/8/2021 9:34 AM |
Details | Last Recertification Date | Update | Recertification | 1/28/2019 2:26:04 PM | 2/9/2020 5:18:34 PM | 2/9/2020 5:18 PM |
Addresses | Main Address | Update | Change Request |
8430 Pointe Coupee Rd
Morganza, LA 70759-3320 |
8430 Pointe Coupee Rd
New Roads, LA 70760 | 4/24/2019 7:23 AM |
Addresses | Main Address | Update | Change Request |
8366 Pointe Coupee Rd
Morganza, LA 70759-3320 |
8430 Pointe Coupee Rd
Morganza, LA 70759-3320 | 4/15/2019 10:03 AM |
Contacts | Authorizing Official | Update | Change Request | Peavy, Cindy Griffin
Executive Director
Innis Community Health Center, Inc
2254923775-201 | peavy, cindy
Executive Director
Innis Community Health Center, Inc.
2252359627 | 1/31/2019 11:15 AM |
Contacts | Primary Contact | Update | Recertification | Nelson, Rachel
Chief Operating Officer
Innis Community Health Center, Inc
2254923775-206 | Lambert, Jade joseph
340B Administrator
Innis Community Health Center, Inc
2254923775-225 | 1/28/2019 2:26 PM |
Details | Last Recertification Date | Update | Recertification | 2/9/2018 12:23:22 PM | 1/28/2019 2:26:04 PM | 1/28/2019 2:26 PM |
Details | Last Recertification Date | Update | Recertification | 2/16/2017 12:00:00 AM | 2/9/2018 12:23:22 PM | 2/9/2018 12:23 PM |
Contacts | Authorizing Official | Update | Profile Change Request | Peavy, Cindy griffin
Executive Director
Innis Community Health Center, Inc
2254923775-201 | Peavy, Cindy Griffin
Executive Director
Innis Community Health Center, Inc
2254923775-201 | 1/15/2018 4:50 PM |
Contacts | Signed By | Update | Profile Change Request | Peavy, Cindy griffin
Executive Director
Innis Community Health Center, Inc
2254923775-201 | Peavy, Cindy Griffin
Executive Director
Innis Community Health Center, Inc
2254923775-201 | 1/15/2018 4:50 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1821287202 | 1/15/2018 4:30 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1447555420 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1649372574 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1942524970 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1154542926 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1467781757 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1588099477 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1376944009 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1588077515 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1467874719 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1164817078 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1386671519 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1306399712 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1427090810 ( ) | | 1/15/2018 4:18 PM |
Medicaid Billing | NPI: Number | Delete | Change Request | 1912086984 ( ) | | 1/15/2018 4:18 PM |
Details | Is Authorizing Official EHB Data | Update | Change Request | False | | 1/15/2018 4:18 PM |
Contacts | Primary Contact | Update | New Registration | Nelson, Rachel
Chief Operating Officer
2254923775-206 | Nelson, Rachel
Chief Operating Officer
Innis Community Health Center, Inc
2254923775-206 | 10/5/2017 11:27 AM |
Contacts | Authorizing Official | Update | New Registration | Peavy, Cindy
Executive Director
Innis Community Health Center, Inc
2254923775-201 | Peavy, Cindy griffin
Executive Director
Innis Community Health Center, Inc
2254923775-201 | 10/5/2017 11:27 AM |
Contacts | Signed By | Update | New Registration | Peavy, Cindy
Executive Director
Innis Community Health Center, Inc
2254923775-201 | Peavy, Cindy griffin
Executive Director
Innis Community Health Center, Inc
2254923775-201 | 10/5/2017 11:27 AM |
Contacts | Authorizing Official | Update | | Peavy, Cindy
Executive Director
2254923775-201 | Peavy, Cindy
Executive Director
Innis Community Health Center, Inc
2254923775-201 | 9/25/2017 3:47 PM |
Contacts | Signed By | Update | | Peavy, Cindy
Executive Director
2254923775-201 | Peavy, Cindy
Executive Director
Innis Community Health Center, Inc
2254923775-201 | 9/25/2017 3:47 PM |
Addresses | Main Address | Insert | | |
8366 Pointe Coupee Rd
Morganza, LA 70759-3320 | 8/1/2017 2:41 PM |
Contacts | Primary Contact | Insert | | | Nelson, Rachel
Chief Operating Officer
2254923775-206 | 8/1/2017 2:41 PM |
Contacts | Authorizing Official | Insert | | | Peavy, Cindy
Executive Director
2254923775-201 | 8/1/2017 2:41 PM |
Contacts | Signed By | Insert | | | Peavy, Cindy
Executive Director
2254923775-201 | 8/1/2017 2:41 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/18/2017 2:03 PM |
Medicaid Billing | Medicaid: Number | Insert | | | 1034185 | 7/18/2017 2:03 PM |
Medicaid Billing | Medicaid: State | Insert | | | LA | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1447555420 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1649372574 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1942524970 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1154542926 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1467781757 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1588099477 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1376944009 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1588077515 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1467874719 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1164817078 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1386671519 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1306399712 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1427090810 | 7/18/2017 2:03 PM |
Medicaid Billing | NPI: Number | Insert | | | 1912086984 | 7/18/2017 2:03 PM |
Details | Last Recertification Date | Update | | 2/22/2016 12:00:00 AM | 2/16/2017 12:00:00 AM | 2/16/2017 12:24 PM |
Details | Last Recertification Date | Update | | 3/4/2015 12:00:00 AM | 2/22/2016 12:00:00 AM | 2/22/2016 11:18 AM |
Details | Last Recertification Date | Update | | | 3/4/2015 12:00:00 AM | 3/4/2015 8:40 AM |
Details | Is Authorizing Official EHB Data | Update | | | False | 3/4/2015 8:40 AM |
Details | 340B ID | Update | | ONLINE_REG | CH061068B | 4/17/2014 3:05 PM |
Dates | Participating Approval Date | Update | | | 4/17/2014 12:00:00 AM | 4/17/2014 3:05 PM |
Details | State | Update | | Pending | Active | 4/17/2014 3:05 PM |
Dates | Start Date | Update | | | 7/1/2014 12:00:00 AM | 4/17/2014 3:05 PM |
Details | Last Recertification Date | Insert | | | | 4/15/2014 2:43 PM |
Details | Grant Number | Insert | | | H80CS00855 | 4/15/2014 2:43 PM |
Details | 340B ID | Insert | | | ONLINE_REG | 4/15/2014 2:43 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 4/15/2014 2:43 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/15/2014 2:43 PM |
Details | Medicare Provider Number | Insert | | | | 4/15/2014 2:43 PM |
Details | Entity Name | Insert | | | INNIS COMMUNITY HEALTH CENTER, INC. | 4/15/2014 2:43 PM |
Details | Program Code | Insert | | | CH | 4/15/2014 2:43 PM |
Details | Entity Subname | Insert | | | Pointe Coupee Central School Based Clinic | 4/15/2014 2:43 PM |
Dates | Participating Approval Date | Insert | | | | 4/15/2014 2:43 PM |
Details | State | Insert | | | Pending | 4/15/2014 2:43 PM |
Dates | Registration Date | Insert | | | 4/15/2014 12:00:00 AM | 4/15/2014 2:43 PM |
Dates | Signed By Date | Insert | | | 4/15/2014 12:00:00 AM | 4/15/2014 2:43 PM |
Dates | Start Date | Insert | | | | 4/15/2014 2:43 PM |
Terminations | Termination Comments | Insert | | | | 4/15/2014 2:43 PM |
Terminations | Termination Date | Insert | | | | 4/15/2014 2:43 PM |
Terminations | Termination Effective Date | Insert | | | | 4/15/2014 2:43 PM |
Terminations | Termination Reason | Insert | | | | 4/15/2014 2:43 PM |