| Contacts | Primary Contact | Update | Group Change Request | CURRIE, TONY
DIR OF PHARMACY
Adams Memorial
2607242145-12604 | Wheeler, Dane
CFO
Adams Memorial Hospital
2607242145 | 4/14/2025 6:28 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2023 2:12:33 PM | 8/19/2024 11:32:52 AM | 8/19/2024 11:32 AM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2022 12:52:20 PM | 8/24/2023 2:12:33 PM | 8/24/2023 2:12 PM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2021 10:02:06 AM | 8/29/2022 12:52:20 PM | 8/29/2022 12:52 PM |
| Addresses | Shipping Address | Delete | Change Request | ADAMS COUNTY MEMORIAL HOSPITAL
1100 MERCER AVE
DECATUR, IN 46733 | | 10/8/2021 8:33 AM |
| Addresses | Main Address | Update | Change Request |
200 NORTH CIRCLE DR
DECATUR, IN 46733 |
1100 Mercer Ave
Decatur, IN 46733 | 10/8/2021 8:33 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2020 1:16:25 PM | 8/16/2021 10:02:06 AM | 8/16/2021 10:02 AM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2019 1:48:02 PM | 8/24/2020 1:16:25 PM | 8/24/2020 1:16 PM |
| Contacts | Authorizing Official | Update | New Registration | Smith, Scott
Executive Director
Adams Memorial Hospital
2607242145 | Smith, Scott
Executive Director
Adams Memorial Hospital
2607242145-11002 | 4/7/2020 12:42 PM |
| Contacts | Authorizing Official | Update | AO Change Request | EIDAM, JO-ELLEN
CEO
AHN
2607242145-11001 | Smith, Scott
Executive Director
Adams Memorial Hospital
2607242145 | 9/4/2019 10:35 AM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2018 8:20:06 AM | 8/19/2019 1:48:02 PM | 8/19/2019 1:48 PM |
| Details | Last Recertification Date | Update | Recertification | 11/9/2017 9:45:08 AM | 8/15/2018 8:20:06 AM | 8/15/2018 8:20 AM |
| Details | Last Recertification Date | Update | Recertification | 10/26/2017 10:21:36 AM | 11/9/2017 9:45:08 AM | 11/9/2017 9:45 AM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2016 12:00:00 AM | 10/26/2017 10:21:36 AM | 10/26/2017 10:21 AM |
| Contacts | Authorizing Official | Update | | EIDAM, JO-ELLEN
CEO
2607242145-11001 | EIDAM, JO-ELLEN
CEO
AHN
2607242145-11001 | 10/11/2017 10:21 AM |
| Contacts | Primary Contact | Update | | CURRIE, TONY
DIR OF PHARMACY
2607242145-12604 | CURRIE, TONY
DIR OF PHARMACY
Adams Memorial
2607242145-12604 | 9/20/2017 3:27 PM |
| Contacts | Authorizing Official | Update | | EIDAM, JO-ELLEN
CEO
2607242145-11001 | EIDAM, JO-ELLEN
CEO
2607242145-11001 | 9/11/2017 3:29 PM |
| Contacts | Signed By | Insert | | | EIDAM, JO-ELLEN
CEO
2607242145-1400 | 8/15/2016 11:11 AM |
| Contacts | Authorizing Official | Insert | | | EIDAM, JO-ELLEN
CEO
2607242145-11001 | 8/15/2016 11:11 AM |
| Contacts | Primary Contact | Update | | CURRIE, TONY
DIR OF PHARMACY
2607242145-2604 | CURRIE, TONY
DIR OF PHARMACY
2607242145-12604 | 8/15/2016 11:11 AM |
| Addresses | Main Address | Insert | | |
200 NORTH CIRCLE DR
DECATUR, IN 46733 | 8/15/2016 11:10 AM |
| Details | Last Recertification Date | Update | | 8/13/2015 12:00:00 AM | 8/15/2016 12:00:00 AM | 8/15/2016 11:10 AM |
| Contacts | Primary Contact | Insert | | | CURRIE, TONY
DIR OF PHARMACY
2607242145-2604 | 8/31/2015 10:58 AM |
| Details | Last Recertification Date | Update | | | 8/13/2015 12:00:00 AM | 8/13/2015 9:19 AM |
| Details | Entity Subname | Update | | ADAMS MEMORIAL ORTHOPEDICS / ORTHOPEDICS | ORTHOPEDICS | 12/31/2014 3:51 PM |
| Details | Entity Subname | Update | | ADAMS MEMORIAL ORTHOPEDICS | ADAMS MEMORIAL ORTHOPEDICS / ORTHOPEDICS | 12/19/2014 2:16 PM |
| Addresses | Billing Address | Insert | | | ADAMS COUNTY MEMORIAL HOSPITAL
1100 MERCER AVE
DECATUR, IN 46733 | 9/4/2014 6:03 PM |
| Addresses | Shipping Address | Insert | | | ADAMS COUNTY MEMORIAL HOSPITAL
1100 MERCER AVE
DECATUR, IN 46733 | 9/4/2014 6:03 PM |
| Dates | Participating Approval Date | Update | | | 9/4/2014 12:00:00 AM | 9/4/2014 6:03 PM |
| Details | State | Update | | Pending | Active | 9/4/2014 6:03 PM |
| Dates | Start Date | Update | | | 10/1/2014 12:00:00 AM | 9/4/2014 6:03 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_45965 | CAH151330-03 | 8/19/2014 9:53 AM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_45965 | 7/15/2014 1:11 PM |
| Details | Last Recertification Date | Insert | | | | 7/15/2014 1:11 PM |
| Details | Grant Number | Insert | | | | 7/15/2014 1:11 PM |
| Details | 340B ID | Insert | | | | 7/15/2014 1:11 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/15/2014 1:11 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/15/2014 1:11 PM |
| Details | Medicare Provider Number | Insert | | | 151330 | 7/15/2014 1:11 PM |
| Details | Entity Name | Insert | | | ADAMS COUNTY MEMORIAL HOSPITAL DBA ADAMS MEMORIAL HOSPITAL | 7/15/2014 1:11 PM |
| Details | Program Code | Insert | | | CAH | 7/15/2014 1:11 PM |
| Details | Entity Subname | Insert | | | ADAMS MEMORIAL ORTHOPEDICS | 7/15/2014 1:11 PM |
| Dates | Participating Approval Date | Insert | | | | 7/15/2014 1:11 PM |
| Details | State | Insert | | | Pending | 7/15/2014 1:11 PM |
| Dates | Registration Date | Insert | | | 7/15/2014 12:00:00 AM | 7/15/2014 1:11 PM |
| Dates | Signed By Date | Insert | | | 7/15/2014 12:00:00 AM | 7/15/2014 1:11 PM |
| Dates | Start Date | Insert | | | | 7/15/2014 1:11 PM |
| Terminations | Termination Comments | Insert | | | | 7/15/2014 1:11 PM |
| Terminations | Termination Date | Insert | | | | 7/15/2014 1:11 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/15/2014 1:11 PM |
| Terminations | Termination Reason | Insert | | | | 7/15/2014 1:11 PM |