Details | Last Recertification Date | Update | Recertification | 8/17/2023 3:13:49 PM | 8/22/2024 7:51:41 AM | 8/22/2024 7:51 AM |
Details | Last Recertification Date | Update | Recertification | 8/30/2022 10:30:51 AM | 8/17/2023 3:13:49 PM | 8/17/2023 3:13 PM |
Details | Last Recertification Date | Update | Recertification | 8/23/2021 11:08:05 AM | 8/30/2022 10:30:51 AM | 8/30/2022 10:30 AM |
Details | Last Recertification Date | Update | Recertification | 9/4/2020 11:24:32 AM | 8/23/2021 11:08:05 AM | 8/23/2021 11:08 AM |
Contacts | Primary Contact | Update | Change Request | Pastian, Andre Rene
CNO
Boulder City Hospital
7022934111-6512 | Waddington, Roger Kent
Pharmacy Manager
Boulder City Hospital
7022934111-1517 | 7/19/2021 7:32 AM |
Contacts | Primary Contact | Update | Change Request | West, Stephanie
Pharmacy Manager
Boulder City Hospital
7022945708 | Pastian, Andre Rene
CNO
Boulder City Hospital
7022934111-6512 | 1/25/2021 10:35 AM |
Contacts | Authorizing Official | Update | Profile Change Request | Lewis, Douglas B.
CFO
Boulder City Hospital
7022945709 | Lewis, Douglas B.
CFO
Boulder City Hospital
7022934111-6509 | 1/7/2021 12:49 PM |
Contacts | Signed By | Update | Profile Change Request | Lewis, Douglas B.
CFO
Boulder City Hospital
7022945709 | Lewis, Douglas B.
CFO
Boulder City Hospital
7022934111-6509 | 1/7/2021 12:49 PM |
Details | Last Recertification Date | Update | Recertification | 8/26/2019 10:19:39 AM | 9/4/2020 11:24:32 AM | 9/4/2020 11:24 AM |
Details | Last Recertification Date | Update | Recertification | 8/27/2018 9:13:16 AM | 8/26/2019 10:19:39 AM | 8/26/2019 10:19 AM |
Contacts | Primary Contact | Update | Change Request | Belete, Frey
Controller
Boulder City Hospital
7022945711 | West, Stephanie
Pharmacy Manager
Boulder City Hospital
7022945708 | 8/29/2018 4:48 PM |
Details | Last Recertification Date | Update | Recertification | 11/15/2017 1:10:20 PM | 8/27/2018 9:13:16 AM | 8/27/2018 9:13 AM |
Medicaid Billing | Medicaid: Number | Delete | Recertification | 1102839 (NV) | | 11/15/2017 1:10 PM |
Medicaid Billing | NPI: Number | Delete | Recertification | 1881739613 ( ) | | 11/15/2017 1:10 PM |
Contacts | Primary Contact | Update | Recertification | Lewis, Douglas B.
CFO
7022945709 | Belete, Frey
Controller
Boulder City Hospital
7022945711 | 11/15/2017 1:10 PM |
Details | Last Recertification Date | Update | Recertification | 8/15/2016 12:00:00 AM | 11/15/2017 1:10:20 PM | 11/15/2017 1:10 PM |
Contacts | Authorizing Official | Update | | Lewis, Douglas B.
CFO
7022945709 | Lewis, Douglas B.
CFO
Boulder City Hospital
7022945709 | 10/30/2017 5:16 PM |
Contacts | Signed By | Update | | Lewis, Douglas B.
CFO
7022945709 | Lewis, Douglas B.
CFO
Boulder City Hospital
7022945709 | 10/30/2017 5:16 PM |
Addresses | Main Address | Insert | | |
901 ADAMS BLVD
BOULDER CITY, NV 89005-2247 | 8/15/2016 6:47 PM |
Contacts | Authorizing Official | Insert | | | Lewis, Douglas B.
CFO
7022945709 | 8/15/2016 6:47 PM |
Contacts | Primary Contact | Insert | | | Lewis, Douglas B.
CFO
7022945709 | 8/15/2016 6:47 PM |
Contacts | Signed By | Insert | | | Lewis, Douglas B.
CFO
7022945709 | 8/15/2016 6:47 PM |
Details | Last Recertification Date | Update | | | 8/15/2016 12:00:00 AM | 8/15/2016 6:47 PM |
Dates | Participating Approval Date | Update | | | 8/7/2015 12:00:00 AM | 8/7/2015 10:50 AM |
Details | State | Update | | Pending | Active | 8/7/2015 10:50 AM |
Dates | Start Date | Update | | | 10/1/2015 12:00:00 AM | 8/7/2015 10:50 AM |
Details | 340B ID | Update | | ONLINE_REG_54072 | CAH291309-00 | 8/7/2015 10:15 AM |
Details | 340B ID | Update | | | ONLINE_REG_54072 | 7/20/2015 5:19 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/20/2015 5:19 PM |
Medicaid Billing | Medicaid: Number | Insert | | | 1102839 | 7/20/2015 5:19 PM |
Medicaid Billing | Medicaid: State | Insert | | | NV | 7/20/2015 5:19 PM |
Medicaid Billing | NPI: Number | Insert | | | 1881739613 | 7/20/2015 5:19 PM |
Details | Last Recertification Date | Insert | | | | 7/20/2015 5:19 PM |
Details | Grant Number | Insert | | | | 7/20/2015 5:19 PM |
Details | 340B ID | Insert | | | | 7/20/2015 5:19 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 7/20/2015 5:19 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/20/2015 5:19 PM |
Details | Medicare Provider Number | Insert | | | 291309 | 7/20/2015 5:19 PM |
Details | Entity Name | Insert | | | BOULDER CITY HOSPITAL | 7/20/2015 5:19 PM |
Details | Program Code | Insert | | | CAH | 7/20/2015 5:19 PM |
Details | Entity Subname | Insert | | | | 7/20/2015 5:19 PM |
Dates | Participating Approval Date | Insert | | | | 7/20/2015 5:19 PM |
Details | State | Insert | | | Pending | 7/20/2015 5:19 PM |
Dates | Registration Date | Insert | | | 7/20/2015 12:00:00 AM | 7/20/2015 5:19 PM |
Dates | Signed By Date | Insert | | | 7/20/2015 12:00:00 AM | 7/20/2015 5:19 PM |
Dates | Start Date | Insert | | | | 7/20/2015 5:19 PM |
Terminations | Termination Comments | Insert | | | | 7/20/2015 5:19 PM |
Terminations | Termination Date | Insert | | | | 7/20/2015 5:19 PM |
Terminations | Termination Effective Date | Insert | | | | 7/20/2015 5:19 PM |
Terminations | Termination Reason | Insert | | | | 7/20/2015 5:19 PM |