Details | Last Recertification Date | Update | Recertification | 8/17/2023 12:03:18 PM | 8/19/2024 9:57:50 AM | 8/19/2024 9:57 AM |
Details | Last Recertification Date | Update | Recertification | 8/29/2022 8:28:52 AM | 8/17/2023 12:03:18 PM | 8/17/2023 12:03 PM |
Details | Last Recertification Date | Update | Recertification | 8/24/2021 8:26:50 AM | 8/29/2022 8:28:52 AM | 8/29/2022 8:28 AM |
Details | Last Recertification Date | Update | Recertification | 9/3/2020 10:51:14 AM | 8/24/2021 8:26:50 AM | 8/24/2021 8:26 AM |
Addresses | Main Address | Update | Change Request |
Route 30
Mayfield, NY 12117 |
2497 State Highway 30
Mayfield, NY 12117 | 12/8/2020 11:06 AM |
Details | Last Recertification Date | Update | Recertification | 9/6/2019 9:29:13 AM | 9/3/2020 10:51:14 AM | 9/3/2020 10:51 AM |
Details | Last Recertification Date | Update | Recertification | 8/31/2018 11:41:39 AM | 9/6/2019 9:29:13 AM | 9/6/2019 9:29 AM |
Contacts | Primary Contact | Update | Profile Change Request | Hammons, Brenda
Assistant to the CFO & CIO
Nathan Littauer Hospital
5187735485 | Hammons, Brenda
Pharmacy 340B Coordinator
Nathan Littauer Hospital
5187735582 | 1/9/2019 10:24 AM |
Details | Last Recertification Date | Update | Recertification | 11/22/2017 2:13:08 PM | 8/31/2018 11:41:39 AM | 8/31/2018 11:41 AM |
Addresses | Billing Address | Insert | Change Request | | Nathan Littauer Hospital
99 East State Street
Gloversville, NY 12078 | 7/17/2018 7:05 AM |
Addresses | Shipping Address | Insert | Change Request | | Nathan Littauer Hospital
99 East State Street
Gloversville, NY 12078 | 7/17/2018 7:05 AM |
Details | Last Recertification Date | Update | Recertification | 8/26/2016 12:00:00 AM | 11/22/2017 2:13:08 PM | 11/22/2017 2:13 PM |
Contacts | Authorizing Official | Update | | Ostrander, Michael
Vice President-Finance & CFO
5187735480 | Ostrander, Michael
Vice President-Finance & CFO
Nathan Littauer Hospital
5187735480 | 10/20/2017 2:08 PM |
Contacts | Signed By | Update | | Ostrander, Michael
Vice President-Finance & CFO
5187735480 | Ostrander, Michael
Vice President-Finance & CFO
Nathan Littauer Hospital
5187735480 | 10/20/2017 2:08 PM |
Contacts | Primary Contact | Update | | Hammons, Brenda
Assistant to the CFO & CIO
5187735485 | Hammons, Brenda
Assistant to the CFO & CIO
Nathan Littauer Hospital
5187735485 | 10/10/2017 2:28 PM |
Contacts | Authorizing Official | Insert | | | Ostrander, Michael
Vice President-Finance & CFO
5187735480 | 5/11/2017 7:17 AM |
Contacts | Signed By | Insert | | | Ostrander, Michael
Vice President-Finance & CFO
5187735480 | 5/11/2017 7:17 AM |
Contacts | Primary Contact | Insert | | | Hammons, Brenda
Assistant to the CFO & CIO
5187735485 | 5/11/2017 7:17 AM |
Addresses | Main Address | Insert | | |
Route 30
Mayfield, NY 12117 | 8/26/2016 2:27 PM |
Details | Last Recertification Date | Update | | 9/1/2015 12:00:00 AM | 8/26/2016 12:00:00 AM | 8/26/2016 2:27 PM |
Details | Last Recertification Date | Update | | | 9/1/2015 12:00:00 AM | 9/1/2015 11:07 AM |
Details | Entity Subname | Update | | Mayfield Primary Care Center - Internal Medicine / Internal Medicine | Mayfield Primary Care Center - Internal Medicine | 12/31/2014 3:51 PM |
Details | Entity Subname | Update | | Mayfield Primary Care Center - Internal Medicine | Mayfield Primary Care Center - Internal Medicine / Internal Medicine | 12/19/2014 2:16 PM |
Dates | Participating Approval Date | Update | | | 9/12/2014 12:00:00 AM | 9/12/2014 5:48 PM |
Details | State | Update | | Pending | Active | 9/12/2014 5:48 PM |
Dates | Start Date | Update | | | 10/1/2014 12:00:00 AM | 9/12/2014 5:48 PM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_45276 | DSH330276C | 9/11/2014 7:09 AM |
Details | Entity Subname | Update | | Mayfield Primary Care Center | Mayfield Primary Care Center - Internal Medicine | 9/11/2014 7:09 AM |
Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_45276 | 7/11/2014 11:35 AM |
Details | Last Recertification Date | Insert | | | | 7/11/2014 11:35 AM |
Details | Grant Number | Insert | | | | 7/11/2014 11:35 AM |
Details | 340B ID | Insert | | | | 7/11/2014 11:35 AM |
Details | Is Authorizing Official EHB Data | Insert | | | | 7/11/2014 11:35 AM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/11/2014 11:35 AM |
Details | Medicare Provider Number | Insert | | | 330276 | 7/11/2014 11:35 AM |
Details | Entity Name | Insert | | | NATHAN LITTAUER HOSPITAL | 7/11/2014 11:35 AM |
Details | Program Code | Insert | | | DSH | 7/11/2014 11:35 AM |
Details | Entity Subname | Insert | | | Mayfield Primary Care Center | 7/11/2014 11:35 AM |
Dates | Participating Approval Date | Insert | | | | 7/11/2014 11:35 AM |
Details | State | Insert | | | Pending | 7/11/2014 11:35 AM |
Dates | Registration Date | Insert | | | 7/11/2014 12:00:00 AM | 7/11/2014 11:35 AM |
Dates | Signed By Date | Insert | | | 7/11/2014 12:00:00 AM | 7/11/2014 11:35 AM |
Dates | Start Date | Insert | | | | 7/11/2014 11:35 AM |
Terminations | Termination Comments | Insert | | | | 7/11/2014 11:35 AM |
Terminations | Termination Date | Insert | | | | 7/11/2014 11:35 AM |
Terminations | Termination Effective Date | Insert | | | | 7/11/2014 11:35 AM |
Terminations | Termination Reason | Insert | | | | 7/11/2014 11:35 AM |