| Contacts | Authorizing Official | Update | Change Request | Antonson, Pete
CFO
Northwood Deaconess Health Center
7015876459 | McKenzie, Greta
CFO
Northwood Deaconess Health Center
7015876459 | 4/2/2025 1:58 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Antonson, Pete
CEO
Northwood Deaconess Health Center
7015876459 | Antonson, Pete
CFO
Northwood Deaconess Health Center
7015876459 | 3/18/2025 6:55 AM |
| Contacts | Signed By | Update | Profile Change Request | Antonson, Pete
CEO
Northwood Deaconess Health Center
7015876459 | Antonson, Pete
CFO
Northwood Deaconess Health Center
7015876459 | 3/18/2025 6:55 AM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2023 8:35:41 AM | 8/12/2024 9:45:45 AM | 8/12/2024 9:45 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2022 10:50:25 AM | 8/15/2023 8:35:41 AM | 8/15/2023 8:35 AM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2021 9:40:43 AM | 8/24/2022 10:50:25 AM | 8/24/2022 10:50 AM |
| Details | Last Recertification Date | Update | Recertification | 9/4/2020 11:26:32 AM | 8/18/2021 9:40:43 AM | 8/18/2021 9:40 AM |
| Contacts | Primary Contact | Update | Recertification | Schwartz, Tina
Business Office Manager
Northwood Deaconess Health Center
7015876454 | Metz, Jenny A
Pharmacy Manager
Northwood Deaconess Health Center
7015876480 | 9/4/2020 11:26 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2019 9:24:39 AM | 9/4/2020 11:26:32 AM | 9/4/2020 11:26 AM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2018 4:18:34 PM | 8/22/2019 9:24:39 AM | 8/22/2019 9:24 AM |
| Details | Last Recertification Date | Update | Recertification | 11/6/2017 11:00:02 AM | 8/15/2018 4:18:34 PM | 8/15/2018 4:18 PM |
| Details | Last Recertification Date | Update | Recertification | 8/10/2016 12:00:00 AM | 11/6/2017 11:00:02 AM | 11/6/2017 11:00 AM |
| Contacts | Primary Contact | Update | Recertification | Schwartz, Tina
Business Office Manager
7015876454 | Schwartz, Tina
Business Office Manager
Northwood Deaconess Health Center
7015876454 | 11/6/2017 10:59 AM |
| Contacts | Authorizing Official | Update | | Antonson, Pete
CEO
7015876459 | Antonson, Pete
CEO
Northwood Deaconess Health Center
7015876459 | 10/18/2017 10:52 AM |
| Contacts | Signed By | Update | | Antonson, Pete
CEO
7015876459 | Antonson, Pete
CEO
Northwood Deaconess Health Center
7015876459 | 10/18/2017 10:52 AM |
| Addresses | Main Address | Insert | | |
611 Towner Ave
Larimore, ND 58251 | 8/10/2016 1:29 PM |
| Contacts | Authorizing Official | Insert | | | Antonson, Pete
CEO
7015876459 | 8/10/2016 1:29 PM |
| Contacts | Signed By | Insert | | | Antonson, Pete
CEO
7015876459 | 8/10/2016 1:29 PM |
| Contacts | Primary Contact | Insert | | | Schwartz, Tina
Business Office Manager
7015876454 | 8/10/2016 1:29 PM |
| Details | Last Recertification Date | Update | | 8/10/2015 12:00:00 AM | 8/10/2016 12:00:00 AM | 8/10/2016 1:29 PM |
| Details | Last Recertification Date | Update | | | 8/10/2015 12:00:00 AM | 8/10/2015 11:48 AM |
| Addresses | Billing Address | Insert | | | Northwood Deaconess Health Center
PO Box 190
Northwood, ND 58267 | 5/19/2015 4:14 PM |
| Dates | Participating Approval Date | Update | | | 5/19/2015 12:00:00 AM | 5/19/2015 4:13 PM |
| Details | State | Update | | Pending | Active | 5/19/2015 4:13 PM |
| Dates | Start Date | Update | | | 7/1/2015 12:00:00 AM | 5/19/2015 4:13 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_50416 | CAH351312-01 | 4/6/2015 2:02 PM |
| Details | Entity Subname | Update | | Northwood Deaconess Health Center Clinic Larimore | Health Center Clinic Larimore | 4/6/2015 2:02 PM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_50416 | 4/2/2015 12:36 PM |
| Details | Last Recertification Date | Insert | | | | 4/2/2015 12:36 PM |
| Details | Grant Number | Insert | | | | 4/2/2015 12:36 PM |
| Details | 340B ID | Insert | | | | 4/2/2015 12:36 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/2/2015 12:36 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/2/2015 12:36 PM |
| Details | Medicare Provider Number | Insert | | | 351312 | 4/2/2015 12:36 PM |
| Details | Entity Name | Insert | | | NORTHWOOD DEACONESS HEALTH CENTER | 4/2/2015 12:36 PM |
| Details | Program Code | Insert | | | CAH | 4/2/2015 12:36 PM |
| Details | Entity Subname | Insert | | | Northwood Deaconess Health Center Clinic Larimore | 4/2/2015 12:36 PM |
| Dates | Participating Approval Date | Insert | | | | 4/2/2015 12:36 PM |
| Details | State | Insert | | | Pending | 4/2/2015 12:36 PM |
| Dates | Registration Date | Insert | | | 4/2/2015 12:00:00 AM | 4/2/2015 12:36 PM |
| Dates | Signed By Date | Insert | | | 4/2/2015 12:00:00 AM | 4/2/2015 12:36 PM |
| Dates | Start Date | Insert | | | | 4/2/2015 12:36 PM |
| Terminations | Termination Comments | Insert | | | | 4/2/2015 12:36 PM |
| Terminations | Termination Date | Insert | | | | 4/2/2015 12:36 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/2/2015 12:36 PM |
| Terminations | Termination Reason | Insert | | | | 4/2/2015 12:36 PM |