Details | Last Recertification Date | Update | Recertification | 2/22/2024 2:44:08 PM | 3/4/2025 1:30:33 PM | 3/4/2025 1:30 PM |
Contacts | Primary Contact | Update | Profile Change Request | Graybeal, Monica
Director of Pharmacy
Dirne (dba Heritage Health)
2082920303 | Graybeal, Monica
Director of Pharmacy
Dirne Health Centers, Inc
2082920662 | 3/4/2025 12:57 PM |
Details | Last Recertification Date | Update | Recertification | 2/22/2023 1:06:24 PM | 2/22/2024 2:44:08 PM | 2/22/2024 2:44 PM |
Details | Entity Name | Update | Recertification | DIRNE HEALTH CENTERS, INC. | Dirne Health Centers, Inc. | 2/22/2024 2:44 PM |
Addresses | Billing Address | Update | Recertification | Heritage Health
PO BOX 3648
Coeur d'Alene, ID 83816 | Dirne Health Centers, Inc.
PO Box 1387
Hayden, ID 83835 | 2/22/2023 1:06 PM |
Details | Last Recertification Date | Update | Recertification | 2/1/2022 1:32:48 PM | 2/22/2023 1:06:24 PM | 2/22/2023 1:06 PM |
Contacts | Primary Contact | Update | PC Change Request | Hampe, Mark
Chief Financial Officer
Dirne Health Centers, Inc DBA Heritage Health
2082920134 | Graybeal, Monica
Director of Pharmacy
Dirne (dba Heritage Health)
2082920303 | 8/12/2022 10:32 AM |
Details | Last Recertification Date | Update | Recertification | 2/3/2021 3:13:49 AM | 2/1/2022 1:32:48 PM | 2/1/2022 1:32 PM |
Details | Last Recertification Date | Update | Recertification | 1/27/2020 2:57:38 PM | 2/3/2021 3:13:49 AM | 2/3/2021 3:13 AM |
Details | Last Recertification Date | Update | Recertification | 1/30/2019 4:21:41 PM | 1/27/2020 2:57:38 PM | 1/27/2020 2:57 PM |
Contacts | Primary Contact | Update | Recertification | Potter, Benjamin
CFO
Heritage Health
2086205255 | Hampe, Mark
Chief Financial Officer
Dirne Health Centers, Inc DBA Heritage Health
2082920134 | 1/30/2019 4:21 PM |
Details | Last Recertification Date | Update | Recertification | 2/13/2018 1:07:16 AM | 1/30/2019 4:21:41 PM | 1/30/2019 4:21 PM |
Contacts | Primary Contact | Update | Recertification | Potter, Ben
CFO
Dirne Health Centers Inc DBA Heritage Health
2082620252 | Potter, Benjamin
CFO
Heritage Health
2086205255 | 2/13/2018 1:07 AM |
Details | Last Recertification Date | Update | Recertification | 2/8/2017 12:00:00 AM | 2/13/2018 1:07:16 AM | 2/13/2018 1:07 AM |
Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/13/2018 1:07 AM |
Contacts | Primary Contact | Update | Recertification | Gaby, Ben
CFO
2082920240 | Potter, Ben
CFO
Dirne Health Centers Inc DBA Heritage Health
2082620252 | 2/13/2018 1:04 AM |
Contacts | Authorizing Official | Update | New Registration | Baker, Michael
CEO
2082920256 | Baker, Michael
CEO
Heritage Health
2082920256 | 10/4/2017 12:41 PM |
Contacts | Signed By | Update | New Registration | Baker, Michael
CEO
2082920256 | Baker, Michael
CEO
Heritage Health
2082920256 | 10/4/2017 12:41 PM |
Addresses | Main Address | Insert | | |
925 E POLSTON AVE
POST FALLS, ID 83854-9049 | 2/8/2017 12:20 PM |
Contacts | Authorizing Official | Insert | | | Baker, Michael
CEO
2082920256 | 2/8/2017 12:20 PM |
Contacts | Signed By | Insert | | | Baker, Michael
CEO
2082920256 | 2/8/2017 12:20 PM |
Contacts | Primary Contact | Insert | | | Gaby, Ben
CFO
2082920240 | 2/8/2017 12:20 PM |
Details | Last Recertification Date | Update | | 2/23/2016 12:00:00 AM | 2/8/2017 12:00:00 AM | 2/8/2017 12:20 PM |
Details | Last Recertification Date | Update | | | 2/23/2016 12:00:00 AM | 2/23/2016 7:55 AM |
Dates | Participating Approval Date | Update | | | 10/16/2015 12:00:00 AM | 10/16/2015 5:51 PM |
Details | State | Update | | Pending | Active | 10/16/2015 5:51 PM |
Dates | Start Date | Update | | | 1/1/2016 12:00:00 AM | 10/16/2015 5:51 PM |
Addresses | Billing Address | Insert | | | Heritage Health
PO BOX 3648
Coeur d'Alene, ID 83816 | 10/16/2015 5:50 PM |
Details | 340B ID | Update | | ONLINE_REG_54617 | CH10817N | 10/7/2015 8:10 PM |
Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_54617 | 10/6/2015 7:01 PM |
Details | Last Recertification Date | Insert | | | | 10/6/2015 7:01 PM |
Details | Grant Number | Insert | | | H80CS02331 | 10/6/2015 7:01 PM |
Details | 340B ID | Insert | | | ONLINE_REG | 10/6/2015 7:01 PM |
Details | Is Authorizing Official EHB Data | Insert | | | False | 10/6/2015 7:01 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/6/2015 7:01 PM |
Details | Medicare Provider Number | Insert | | | | 10/6/2015 7:01 PM |
Details | Entity Name | Insert | | | DIRNE HEALTH CENTERS, INC. | 10/6/2015 7:01 PM |
Details | Program Code | Insert | | | CH | 10/6/2015 7:01 PM |
Details | Entity Subname | Insert | | | Heritage Health Post Falls | 10/6/2015 7:01 PM |
Dates | Participating Approval Date | Insert | | | | 10/6/2015 7:01 PM |
Details | State | Insert | | | Pending | 10/6/2015 7:01 PM |
Dates | Registration Date | Insert | | | 10/6/2015 12:00:00 AM | 10/6/2015 7:01 PM |
Dates | Signed By Date | Insert | | | 10/6/2015 12:00:00 AM | 10/6/2015 7:01 PM |
Dates | Start Date | Insert | | | | 10/6/2015 7:01 PM |
Terminations | Termination Comments | Insert | | | | 10/6/2015 7:01 PM |
Terminations | Termination Date | Insert | | | | 10/6/2015 7:01 PM |
Terminations | Termination Effective Date | Insert | | | | 10/6/2015 7:01 PM |
Terminations | Termination Reason | Insert | | | | 10/6/2015 7:01 PM |