| Details | State | Update | | To Be Terminated | Terminated | 1/1/2024 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 8/16/2023 12:00:00 AM | 12/28/2023 3:31 PM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 12/28/2023 3:31 PM |
| Terminations | Termination Comments | Update | Termination Request | | We no longer need to use this location. We opened a near by clinic early location in 2023 (CH10291F) and replaced the need to keep this location open. We haven't seen a patient at this location since August 2023 and removed all drug, etc in September 2023. The building is now empty and we are just waiting for the lease to Expire April 2024. | 12/28/2023 3:31 PM |
| Terminations | Termination Date | Update | Termination Request | | 1/1/2024 12:00:00 AM | 12/28/2023 3:31 PM |
| Terminations | Termination Effective Date | Update | Termination Request | | 12/31/2023 12:00:00 AM | 12/28/2023 3:31 PM |
| Terminations | Termination Reason | Update | Termination Request | | Business decision by the Covered Entity | 12/28/2023 3:31 PM |
| Contacts | Authorizing Official | Update | Change Request | Porter, Signe
CFO
Klamath Health Partnership Inc
5418518110-2022 | Bland, Charles V.
Chief Financial Officer
Klamath Health Partnership, Inc.
8455416827 | 12/28/2023 9:47 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Porter, Signe
CFO
Klamath Heaalth Partnership Inc
5418518110-2022 | Porter, Signe
CFO
Klamath Health Partnership Inc
5418518110-2022 | 10/10/2023 6:40 AM |
| Contacts | Signed By | Update | Profile Change Request | Porter, Signe
CFO
Klamath Heaalth Partnership Inc
5418518110-2022 | Porter, Signe
CFO
Klamath Health Partnership Inc
5418518110-2022 | 10/10/2023 6:40 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Cox, Marcus
CPO
Klamath Health Partnership Inc
5418518110-8188 | Cox, Marcus
Chief Pharmacy Officer
Klamath Health Partnership, Inc
5418878188 | 10/10/2023 6:24 AM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2022 1:05:03 PM | 1/31/2023 2:35:12 PM | 1/31/2023 2:35 PM |
| Contacts | Primary Contact | Update | Recertification | Arguello, Teri
Finance Dept Manager
Klamath Health Partnership Inc
5418818110-2088 | Cox, Marcus
CPO
Klamath Health Partnership Inc
5418518110-8188 | 2/17/2022 1:05 PM |
| Details | Last Recertification Date | Update | Recertification | 2/26/2021 4:33:56 PM | 2/17/2022 1:05:03 PM | 2/17/2022 1:05 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1447644190 | 2/26/2021 4:33 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | OR | 2/26/2021 4:33 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1538155825 | 2/26/2021 4:33 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | OR | 2/26/2021 4:33 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1689023780 | 2/26/2021 4:33 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | OR | 2/26/2021 4:33 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1689023780 ( ) | | 2/26/2021 4:33 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1538155825 ( ) | | 2/26/2021 4:33 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1447644190 ( ) | | 2/26/2021 4:33 PM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2020 12:39:44 AM | 2/26/2021 4:33:56 PM | 2/26/2021 4:33 PM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2019 12:33:48 PM | 2/12/2020 12:39:44 AM | 2/12/2020 12:39 AM |
| Contacts | Primary Contact | Update | Recertification | Jackson, Staci
Finance Department Manager
Klamath Health Partnership
5418802088 | Arguello, Teri
Finance Dept Manager
Klamath Health Partnership Inc
5418818110-2088 | 2/5/2019 12:33 PM |
| Details | Last Recertification Date | Update | Recertification | 2/19/2018 1:31:01 PM | 2/5/2019 12:33:48 PM | 2/5/2019 12:33 PM |
| Details | Entity Name | Update | Recertification | KLAMATH HEALTH PARTNERS INC | KLAMATH HEALTH PARTNERSHIP INC | 2/5/2019 12:33 PM |
| Details | Last Recertification Date | Update | Recertification | 2/20/2017 12:00:00 AM | 2/19/2018 1:31:01 PM | 2/19/2018 1:31 PM |
| Contacts | Primary Contact | Update | Change Request | Porter, Signe
CFO
Klamath Heaalth Partnership Inc
5418518110-2022 | Jackson, Staci
Finance Department Manager
Klamath Health Partnership
5418802088 | 1/30/2018 6:10 PM |
| Details | Is Authorizing Official EHB Data | Update | Change Request | False | | 1/30/2018 6:10 PM |
| Contacts | Authorizing Official | Update | | Porter, Signe
CFO
5418518110-2022 | Porter, Signe
CFO
Klamath Heaalth Partnership Inc
5418518110-2022 | 10/2/2017 11:42 PM |
| Contacts | Primary Contact | Update | | Porter, Signe
CFO
5418518110-2022 | Porter, Signe
CFO
Klamath Heaalth Partnership Inc
5418518110-2022 | 10/2/2017 11:42 PM |
| Contacts | Signed By | Update | | Porter, Signe
CFO
5418518110-2022 | Porter, Signe
CFO
Klamath Heaalth Partnership Inc
5418518110-2022 | 10/2/2017 11:42 PM |
| Contacts | Authorizing Official | Insert | | | Porter, Signe
CFO
5418518110-2022 | 7/13/2017 12:41 PM |
| Contacts | Primary Contact | Insert | | | Porter, Signe
CFO
5418518110-2022 | 7/13/2017 12:41 PM |
| Contacts | Signed By | Insert | | | Porter, Signe
CFO
5418518110-2022 | 7/13/2017 12:41 PM |
| Addresses | Main Address | Insert | | |
2684 CAMPUS DR
KLAMATH FALLS, OR 97601-1105 | 2/20/2017 3:49 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 2/20/2017 3:49 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 500719898 | 2/20/2017 3:49 PM |
| Medicaid Billing | Medicaid: State | Insert | | | OR | 2/20/2017 3:49 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 2/20/2017 3:49 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 170061 | 2/20/2017 3:49 PM |
| Medicaid Billing | Medicaid: State | Insert | | | OR | 2/20/2017 3:49 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1689023780 | 2/20/2017 3:49 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1538155825 | 2/20/2017 3:49 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1447644190 | 2/20/2017 3:49 PM |
| Details | Last Recertification Date | Update | | | 2/20/2017 12:00:00 AM | 2/20/2017 3:49 PM |
| Addresses | Billing Address | Insert | | | Klamath Health Partnership Inc
2074 S. 6th Street
Klamath Falls, OR 97601 | 2/16/2016 5:53 PM |
| Dates | Participating Approval Date | Update | | | 2/16/2016 12:00:00 AM | 2/16/2016 5:53 PM |
| Details | State | Update | | Pending | Active | 2/16/2016 5:53 PM |
| Dates | Start Date | Update | | | 4/1/2016 12:00:00 AM | 2/16/2016 5:53 PM |
| Details | 340B ID | Update | | CH051070S | CH10291C | 2/12/2016 2:23 PM |
| Details | 340B ID | Update | | ONLINE_REG_56910 | CH051070S | 1/28/2016 8:25 AM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_56910 | 1/8/2016 11:18 AM |
| Details | Last Recertification Date | Insert | | | | 1/8/2016 11:18 AM |
| Details | Grant Number | Insert | | | H80CS00233 | 1/8/2016 11:18 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/8/2016 11:18 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 1/8/2016 11:18 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/8/2016 11:18 AM |
| Details | Medicare Provider Number | Insert | | | | 1/8/2016 11:18 AM |
| Details | Entity Name | Insert | | | KLAMATH HEALTH PARTNERS INC | 1/8/2016 11:18 AM |
| Details | Program Code | Insert | | | CH | 1/8/2016 11:18 AM |
| Details | Entity Subname | Insert | | | Klamath Open Door - Campus Clinic | 1/8/2016 11:18 AM |
| Dates | Participating Approval Date | Insert | | | | 1/8/2016 11:18 AM |
| Details | State | Insert | | | Pending | 1/8/2016 11:18 AM |
| Dates | Registration Date | Insert | | | 1/8/2016 12:00:00 AM | 1/8/2016 11:18 AM |
| Dates | Signed By Date | Insert | | | 1/8/2016 12:00:00 AM | 1/8/2016 11:18 AM |
| Dates | Start Date | Insert | | | | 1/8/2016 11:18 AM |
| Terminations | Termination Comments | Insert | | | | 1/8/2016 11:18 AM |
| Terminations | Termination Date | Insert | | | | 1/8/2016 11:18 AM |
| Terminations | Termination Effective Date | Insert | | | | 1/8/2016 11:18 AM |
| Terminations | Termination Reason | Insert | | | | 1/8/2016 11:18 AM |