| Details | State | Update | | To Be Terminated | Terminated | 1/1/2024 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | OPA Terminate | | 3/31/2023 12:00:00 AM | 10/3/2023 10:30 AM |
| Details | State | Update | OPA Terminate | Active | To Be Terminated | 10/3/2023 10:30 AM |
| Terminations | Termination Date | Update | OPA Terminate | | 1/1/2024 12:00:00 AM | 10/3/2023 10:30 AM |
| Terminations | Termination Effective Date | Update | OPA Terminate | | 3/31/2023 12:00:00 AM | 10/3/2023 10:30 AM |
| Terminations | Termination Reason | Update | OPA Terminate | | Other | 10/3/2023 10:30 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2022 11:32:40 AM | 2/23/2023 9:32:03 PM | 2/23/2023 9:32 PM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2021 12:11:38 AM | 2/1/2022 11:32:40 AM | 2/1/2022 11:32 AM |
| Contacts | Primary Contact | Update | Profile Change Request | faust, glenn andrew
pharmacist
BayClinicInc
8089300437 | faust, glenn andrew
pharmacist
BayClinicInc
8089300488 | 4/22/2021 4:01 PM |
| Contacts | Primary Contact | Update | Change Request | Hoskins, Michael
Pharmacist
Bay Clinic, Inc
8089300437 | faust, glenn andrew
pharmacist
BayClinicInc
8089300437 | 3/11/2021 6:23 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | HI | 2/17/2021 12:11 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | HI | 2/17/2021 12:11 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2020 5:44:47 AM | 2/17/2021 12:11:38 AM | 2/17/2021 12:11 AM |
| Contacts | Primary Contact | Update | Change Request | Ooka, Kenneth
Pharmacist
Bay Clinic, Inc.
8089300488 | Hoskins, Michael
Pharmacist
Bay Clinic, Inc
8089300437 | 2/25/2020 7:33 AM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2019 6:53:22 AM | 2/1/2020 5:44:47 AM | 2/1/2020 5:44 AM |
| Contacts | Authorizing Official | Update | Change Request | Wallace, Harold
CEO
Bay Clinic Inc
8089300449 | Alameda, Christian Kimo
Chief Executive Officer
Bay Clinic, Inc
8089304083 | 1/3/2020 9:44 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Ooka, Kenneth
Pharmacist
Bay Clinic, Inc.
8089300428 | Ooka, Kenneth
Pharmacist
Bay Clinic, Inc.
8089300488 | 11/1/2019 6:22 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Bells, Youlsau
Interim Chief Executive Officer
Bay Clinic Inc
8089300449 | Wallace, Harold
CEO
Bay Clinic Inc
8089300449 | 5/16/2019 5:50 PM |
| Contacts | Signed By | Update | Profile Change Request | Bells, Youlsau
Interim Chief Executive Officer
Bay Clinic Inc
8089300449 | Wallace, Harold
CEO
Bay Clinic Inc
8089300449 | 5/16/2019 5:50 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Wallace, Harold
Chief Executive Officer
Bay Clinic Inc
8089300449 | Bells, Youlsau
Interim Chief Executive Officer
Bay Clinic Inc
8089300449 | 5/15/2019 7:42 PM |
| Contacts | Signed By | Update | Profile Change Request | Wallace, Harold
Chief Executive Officer
Bay Clinic Inc
8089300449 | Bells, Youlsau
Interim Chief Executive Officer
Bay Clinic Inc
8089300449 | 5/15/2019 7:42 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1255812137 | 3/12/2019 4:39 PM |
| Addresses | Shipping Address | Insert | Recertification | | Bay Clinic Pharmacy
16-192 Pili Mua Street
Keaau, HI 96749 | 1/29/2019 6:53 AM |
| Contacts | Primary Contact | Update | Recertification | Roman, Claudia Marie
Director of Clinical Operations
Bay Clinic, Inc.
8089300430 | Ooka, Kenneth
Pharmacist
Bay Clinic, Inc.
8089300428 | 1/29/2019 6:53 AM |
| Details | Last Recertification Date | Update | Recertification | 3/6/2018 9:42:44 PM | 1/29/2019 6:53:22 AM | 1/29/2019 6:53 AM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 1/29/2019 6:53 AM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2017 12:00:00 AM | 3/6/2018 9:42:44 PM | 3/6/2018 9:42 PM |
| Contacts | Authorizing Official | Update | | Wallace, Harold
Chief Executive Officer
8089300449 | Wallace, Harold
Chief Executive Officer
Bay Clinic Inc
8089300449 | 3/6/2018 9:39 PM |
| Contacts | Signed By | Update | | Wallace, Harold
Chief Executive Officer
8089300449 | Wallace, Harold
Chief Executive Officer
Bay Clinic Inc
8089300449 | 3/6/2018 9:39 PM |
| Contacts | Primary Contact | Update | | Roman, Claudia
Director of Clinical Operations
8089300430 | Roman, Claudia Marie
Director of Clinical Operations
Bay Clinic, Inc.
8089300430 | 2/9/2018 4:54 PM |
| Contacts | Authorizing Official | Insert | | | Wallace, Harold
Chief Executive Officer
8089300449 | 4/29/2017 7:52 PM |
| Contacts | Signed By | Insert | | | Wallace, Harold
Chief Executive Officer
8089300449 | 4/29/2017 7:52 PM |
| Addresses | Main Address | Insert | | |
15-2866 Pahoa Village Rd, Bldg C
Pahoa, HI 96778-7720 | 2/16/2017 5:56 PM |
| Contacts | Primary Contact | Update | | Needham, Patricia
Director of Operations
8089614084 | Roman, Claudia
Director of Clinical Operations
8089300430 | 2/16/2017 5:56 PM |
| Details | Last Recertification Date | Update | | 2/23/2016 12:00:00 AM | 2/16/2017 12:00:00 AM | 2/16/2017 5:55 PM |
| Addresses | Billing Address | Insert | | | Bay Clinic, Inc.
450 Kilauea Ave., Ste. 105
Hilo, HI 96720 | 1/24/2017 7:03 AM |
| Contacts | Primary Contact | Update | | Dundas, Charles
Medical Director
8089300458 | Needham, Patricia
Director of Operations
8089614084 | 1/24/2017 7:03 AM |
| Details | Last Recertification Date | Update | | 2/12/2015 12:00:00 AM | 2/23/2016 12:00:00 AM | 2/23/2016 6:36 PM |
| Contacts | Primary Contact | Update | | Uyehara, Harmony
Director of Clinical Operations
8089343211 | Dundas, Charles
Medical Director
8089300458 | 2/23/2016 6:36 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 2/12/2015 11:03 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 646937 | 2/12/2015 11:03 AM |
| Medicaid Billing | Medicaid: State | Insert | | | HI | 2/12/2015 11:03 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1952548638 | 2/12/2015 11:03 AM |
| Details | Last Recertification Date | Update | | | 2/12/2015 12:00:00 AM | 2/12/2015 11:03 AM |
| Contacts | Primary Contact | Insert | | | Uyehara, Harmony
Director of Clinical Operations
8089343211 | 11/14/2014 1:20 PM |
| Dates | Participating Approval Date | Update | | | 7/21/2014 12:00:00 AM | 7/21/2014 12:29 PM |
| Details | State | Update | | Pending | Active | 7/21/2014 12:29 PM |
| Dates | Start Date | Update | | | 10/1/2014 12:00:00 AM | 7/21/2014 12:29 PM |
| Details | 340B ID | Update | | ONLINE_REG_44268 | CH09188E | 7/21/2014 11:22 AM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_44268 | 7/2/2014 10:24 PM |
| Details | Last Recertification Date | Insert | | | | 7/2/2014 10:24 PM |
| Details | Grant Number | Insert | | | H80CS00837 | 7/2/2014 10:24 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 7/2/2014 10:24 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 7/2/2014 10:24 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/2/2014 10:24 PM |
| Details | Medicare Provider Number | Insert | | | | 7/2/2014 10:24 PM |
| Details | Entity Name | Insert | | | BAY CLINIC, INC. | 7/2/2014 10:24 PM |
| Details | Program Code | Insert | | | CH | 7/2/2014 10:24 PM |
| Details | Entity Subname | Insert | | | Bay Clinic Mobile Health | 7/2/2014 10:24 PM |
| Dates | Participating Approval Date | Insert | | | | 7/2/2014 10:24 PM |
| Details | State | Insert | | | Pending | 7/2/2014 10:24 PM |
| Dates | Registration Date | Insert | | | 7/2/2014 12:00:00 AM | 7/2/2014 10:24 PM |
| Dates | Signed By Date | Insert | | | 7/2/2014 12:00:00 AM | 7/2/2014 10:24 PM |
| Dates | Start Date | Insert | | | | 7/2/2014 10:24 PM |
| Terminations | Termination Comments | Insert | | | | 7/2/2014 10:24 PM |
| Terminations | Termination Date | Insert | | | | 7/2/2014 10:24 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/2/2014 10:24 PM |
| Terminations | Termination Reason | Insert | | | | 7/2/2014 10:24 PM |