Contacts | Authorizing Official | Update | Profile Change Request | Riley, Kevin
CFO
Firelands Regional Medical Center
4195577792 | Riley, Kevin
CFO
Firelands Regional Medical Center
4195577797 | 9/9/2024 3:39 PM |
Details | Last Recertification Date | Update | Recertification | 8/25/2023 11:10:50 AM | 8/14/2024 10:38:53 AM | 8/14/2024 10:38 AM |
Contacts | Primary Contact | Update | Profile Change Request | Horsfall II, Joseph T.
Pharmacy Director
Firelands Regional Medical Center
4195576942 | Posendek, Keith
Pharmacy Director
Firelands Regional Medical Center
4195576942 | 6/13/2024 2:18 PM |
Contacts | Primary Contact | Update | PC Change Request | Turner, Scott
340B Compliance Analyst
Firelands Regional Medical Center
4195575038 | Horsfall II, Joseph T.
Pharmacy Director
Firelands Regional Medical Center
4195576942 | 2/20/2024 7:39 AM |
Details | Last Recertification Date | Update | Recertification | 9/1/2022 10:36:43 AM | 8/25/2023 11:10:50 AM | 8/25/2023 11:10 AM |
Contacts | Authorizing Official | Update | Change Request | moore, Robert M
vice president
Firelands Regional Medical Center
4195575510 | Riley, Kevin
CFO
Firelands Regional Medical Center
4195577792 | 12/29/2022 12:21 PM |
Details | Last Recertification Date | Update | Recertification | 9/7/2021 11:08:57 AM | 9/1/2022 10:36:43 AM | 9/1/2022 10:36 AM |
Contacts | Primary Contact | Update | PC Change Request | Waller, David
Director, Pharmacy Services
Firelands Regional Medical Center
4195576942 | Turner, Scott
340B Compliance Analyst
Firelands Regional Medical Center
4195575038 | 6/28/2022 11:00 AM |
Contacts | Authorizing Official | Update | AO Change Request | Moncher, Daniel J.
Executive Vice President & CFO
Firelands Regional Medical Center
4195577793 | moore, Robert M
vice president
Firelands Regional Medical Center
4195575510 | 2/22/2022 9:18 AM |
Details | Last Recertification Date | Update | Recertification | 8/18/2020 9:54:45 AM | 9/7/2021 11:08:57 AM | 9/7/2021 11:08 AM |
Addresses | Main Address | Update | Change Request |
1221 Hayes Avenue
Suites B, F, J
Sandusky, OH 44870 |
1221 Hayes Avenue
Suites F
Sandusky, OH 44870 | 3/2/2021 11:50 AM |
Details | Last Recertification Date | Update | Recertification | 8/20/2019 9:58:10 AM | 8/18/2020 9:54:45 AM | 8/18/2020 9:54 AM |
Medicaid Billing | NPI: State | Update | Change Request | | OH | 8/16/2020 7:35 PM |
Details | Last Recertification Date | Update | Recertification | 8/16/2018 10:49:42 AM | 8/20/2019 9:58:10 AM | 8/20/2019 9:58 AM |
Addresses | Main Address | Update | Change Request |
1221 Hayes Avenue
Sandusky, OH 44870 |
1221 Hayes Avenue
Suites B, F, J
Sandusky, OH 44870 | 4/11/2019 10:40 AM |
Details | Last Recertification Date | Update | Recertification | 11/3/2017 10:19:47 AM | 8/16/2018 10:49:42 AM | 8/16/2018 10:49 AM |
Contacts | Primary Contact | Insert | Recertification | | Waller, David
Director, Pharmacy Services
Firelands Regional Medical Center
4195576942 | 11/3/2017 10:19 AM |
Details | Last Recertification Date | Update | Recertification | | 11/3/2017 10:19:47 AM | 11/3/2017 10:19 AM |
Contacts | Authorizing Official | Update | | Moncher, Daniel J.
Executive Vice President & CFO
4195577793 | Moncher, Daniel J.
Executive Vice President & CFO
Firelands Regional Medical Center
4195577793 | 9/19/2017 10:30 AM |
Contacts | Signed By | Update | | Moncher, Daniel J.
Executive Vice President & CFO
4195577793 | Moncher, Daniel J.
Executive Vice President & CFO
Firelands Regional Medical Center
4195577793 | 9/19/2017 10:30 AM |
Contacts | Authorizing Official | Insert | | | Moncher, Daniel J.
Executive Vice President & CFO
4195577793 | 3/23/2017 7:53 AM |
Contacts | Signed By | Insert | | | Moncher, Daniel J.
Executive Vice President & CFO
4195577793 | 3/23/2017 7:53 AM |
Addresses | Main Address | Insert | | |
1221 Hayes Avenue
Sandusky, OH 44870 | 11/1/2016 11:01 AM |
Dates | Participating Approval Date | Update | | | 11/1/2016 12:00:00 AM | 11/1/2016 10:59 AM |
Details | State | Update | | Pending | Active | 11/1/2016 10:59 AM |
Dates | Start Date | Update | | | 1/1/2017 12:00:00 AM | 11/1/2016 10:59 AM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_72626 | DSH360025F | 10/18/2016 1:06 PM |
Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_72626 | 10/7/2016 10:33 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 10/7/2016 10:33 AM |
Medicaid Billing | Medicaid: Number | Insert | | | 3293725 | 10/7/2016 10:33 AM |
Medicaid Billing | Medicaid: State | Insert | | | OH | 10/7/2016 10:33 AM |
Medicaid Billing | NPI: Number | Insert | | | 1801884655 | 10/7/2016 10:33 AM |
Details | Last Recertification Date | Insert | | | | 10/7/2016 10:33 AM |
Details | Grant Number | Insert | | | | 10/7/2016 10:33 AM |
Details | 340B ID | Insert | | | | 10/7/2016 10:33 AM |
Details | Is Authorizing Official EHB Data | Insert | | | | 10/7/2016 10:33 AM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/7/2016 10:33 AM |
Details | Medicare Provider Number | Insert | | | 360025 | 10/7/2016 10:33 AM |
Details | Entity Name | Insert | | | FIRELANDS REGIONAL MEDICAL CENTER | 10/7/2016 10:33 AM |
Details | Program Code | Insert | | | DSH | 10/7/2016 10:33 AM |
Details | Entity Subname | Insert | | | Center for Coordinated Care | 10/7/2016 10:33 AM |
Dates | Participating Approval Date | Insert | | | | 10/7/2016 10:33 AM |
Details | State | Insert | | | Pending | 10/7/2016 10:33 AM |
Dates | Registration Date | Insert | | | 10/7/2016 12:00:00 AM | 10/7/2016 10:33 AM |
Dates | Signed By Date | Insert | | | 10/7/2016 12:00:00 AM | 10/7/2016 10:33 AM |
Dates | Start Date | Insert | | | | 10/7/2016 10:33 AM |
Terminations | Termination Comments | Insert | | | | 10/7/2016 10:33 AM |
Terminations | Termination Date | Insert | | | | 10/7/2016 10:33 AM |
Terminations | Termination Effective Date | Insert | | | | 10/7/2016 10:33 AM |
Terminations | Termination Reason | Insert | | | | 10/7/2016 10:33 AM |