| Details | Last Recertification Date | Update | Recertification | 9/5/2023 11:20:02 AM | 9/3/2024 1:19:57 PM | 9/3/2024 1:19 PM |
| Contacts | Primary Contact | Update | PC Change Request | Snelling, Jessica
Director of Finance
Enloe Medical Center
5303327009 | Thacker, Renee
Director, Finance
Enloe Medical Center
5303327386 | 8/27/2024 12:09 PM |
| Details | Last Recertification Date | Update | Recertification | 9/6/2022 12:19:04 PM | 9/5/2023 11:20:02 AM | 9/5/2023 11:20 AM |
| Details | Entity Subname | Update | Recertification | Enloe Hemotology Oncology Clinic | Enloe Hematology Oncology Clinic | 9/5/2023 11:20 AM |
| Addresses | Billing Address | Insert | Change Request | | Enloe Regional Cancer Center
265 Cohasset Rd Suite 160
Chico, CA 95926 | 8/7/2023 12:27 PM |
| Addresses | Shipping Address | Insert | Change Request | | Enloe Cancer Center Pharmacy
251 Cohasset Rd Suite 145
Chico, CA 95926 | 8/7/2023 12:27 PM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2021 11:14:26 AM | 9/6/2022 12:19:04 PM | 9/6/2022 12:19 PM |
| Details | Last Recertification Date | Update | Recertification | 9/3/2020 1:19:20 PM | 8/17/2021 11:14:26 AM | 8/17/2021 11:14 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 9/3/2020 1:19 PM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2019 6:36:46 AM | 9/3/2020 1:19:20 PM | 9/3/2020 1:19 PM |
| Contacts | Primary Contact | Update | Recertification | Woodward, Kevin
VP/Chief Financial Officer
Enloe Medical Center
5303326733 | Snelling, Jessica
Director of Finance
Enloe Medical Center
5303327009 | 8/31/2019 6:36 AM |
| Details | Last Recertification Date | Update | Recertification | 9/11/2018 12:27:46 PM | 8/31/2019 6:36:46 AM | 8/31/2019 6:36 AM |
| Contacts | Authorizing Official | Update | Change Request | Machula, Myron
VP/CFO
Enloe Medical Center
5303327357 | Woodward, Kevin
VP/Chief Financial Officer
Enloe Medical Center
5303326733 | 1/30/2019 10:49 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Woodward, Kevin
VP/Cheif Financial Officer
Enloe Medical Center
5303326733 | Woodward, Kevin
VP/Chief Financial Officer
Enloe Medical Center
5303326733 | 1/29/2019 12:50 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Woodward, Kevin
Director of Finance
Enloe Medical Center
5303326733 | Woodward, Kevin
VP/Cheif Financial Officer
Enloe Medical Center
5303326733 | 1/29/2019 12:50 PM |
| Details | Last Recertification Date | Update | Recertification | 11/17/2017 2:19:36 PM | 9/11/2018 12:27:46 PM | 9/11/2018 12:27 PM |
| Addresses | Main Address | Update | Recertification |
265 COHASSET RD
CHICO, CA 95926-2273 |
265 COHASSET RD
150, 170
CHICO, CA 95926-2273 | 11/17/2017 2:19 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1912949538 ( ) | | 11/17/2017 2:19 PM |
| Details | Last Recertification Date | Update | Recertification | | 11/17/2017 2:19:36 PM | 11/17/2017 2:19 PM |
| Details | Entity Subname | Update | Recertification | ENLOE MEDICAL CENTER / Hemotology Oncology | Enloe Hemotology Oncology Clinic | 11/17/2017 2:19 PM |
| Contacts | Authorizing Official | Update | | Machula, Myron
VP/CFO
5303327357 | Machula, Myron
VP/CFO
Enloe Medical Center
5303327357 | 10/6/2017 12:59 PM |
| Contacts | Signed By | Update | | Machula, Myron
VP/CFO
5303327357 | Machula, Myron
VP/CFO
Enloe Medical Center
5303327357 | 10/6/2017 12:59 PM |
| Contacts | Primary Contact | Update | | Woodward, Kevin
Director of Finance
5303326733 | Woodward, Kevin
Director of Finance
Enloe Medical Center
5303326733 | 10/5/2017 11:11 AM |
| Contacts | Primary Contact | Insert | | | Woodward, Kevin
Director of Finance
5303326733 | 6/9/2017 7:54 AM |
| Contacts | Authorizing Official | Insert | | | Machula, Myron
VP/CFO
5303327357 | 6/9/2017 7:54 AM |
| Contacts | Signed By | Insert | | | Machula, Myron
VP/CFO
5303327357 | 6/9/2017 7:54 AM |
| Addresses | Main Address | Insert | | |
265 COHASSET RD
CHICO, CA 95926-2273 | 10/21/2016 11:30 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 10/17/2016 2:55 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | HSP40039F | 10/17/2016 2:55 PM |
| Medicaid Billing | Medicaid: State | Insert | | | CA | 10/17/2016 2:55 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1417901091 | 10/17/2016 2:55 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1912949538 | 10/17/2016 2:55 PM |
| Details | Last Recertification Date | Update | | 9/8/2016 12:00:00 AM | | 10/17/2016 2:55 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | 10/1/2016 12:00:00 AM | | 10/17/2016 2:55 PM |
| Dates | Participating Approval Date | Update | | 8/5/2015 12:00:00 AM | 10/17/2016 12:00:00 AM | 10/17/2016 2:55 PM |
| Details | State | Update | | Terminated | Active | 10/17/2016 2:55 PM |
| Dates | Registration Date | Update | | 7/12/2015 12:00:00 AM | 10/7/2016 12:00:00 AM | 10/17/2016 2:55 PM |
| Dates | Signed By Date | Update | | 7/12/2015 12:00:00 AM | 10/7/2016 12:00:00 AM | 10/17/2016 2:55 PM |
| Dates | Start Date | Update | | 10/1/2015 12:00:00 AM | 1/1/2017 12:00:00 AM | 10/17/2016 2:55 PM |
| Terminations | Termination Date | Update | | 10/1/2016 12:00:00 AM | | 10/17/2016 2:55 PM |
| Terminations | Termination Effective Date | Update | | 10/1/2016 12:00:00 AM | | 10/17/2016 2:55 PM |
| Terminations | Termination Reason | Update | | Failure to recertify | | 10/17/2016 2:55 PM |
| Details | Comments Public | Insert | | | Participated starting 10/1/2015, terminated 10/1/2016. Reinstated 1/1/2017. | 10/17/2016 2:55 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 10/1/2016 12:00:00 AM | 9/8/2016 10:14 AM |
| Details | State | Update | | Active | Terminated | 9/8/2016 10:14 AM |
| Terminations | Termination Date | Update | | | 10/1/2016 12:00:00 AM | 9/8/2016 10:14 AM |
| Terminations | Termination Effective Date | Update | | | 10/1/2016 12:00:00 AM | 9/8/2016 10:14 AM |
| Terminations | Termination Reason | Update | | | Failure to recertify | 9/8/2016 10:14 AM |
| Details | Last Recertification Date | Update | | | 9/8/2016 12:00:00 AM | 9/8/2016 10:02 AM |
| Dates | Participating Approval Date | Update | | | 8/5/2015 12:00:00 AM | 8/5/2015 1:59 PM |
| Details | State | Update | | Pending | Active | 8/5/2015 1:59 PM |
| Dates | Start Date | Update | | | 10/1/2015 12:00:00 AM | 8/5/2015 1:59 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_53161 | DSH050039C | 8/4/2015 1:50 PM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_53161 | 7/12/2015 2:00 PM |
| Details | Last Recertification Date | Insert | | | | 7/12/2015 2:00 PM |
| Details | Grant Number | Insert | | | | 7/12/2015 2:00 PM |
| Details | 340B ID | Insert | | | | 7/12/2015 2:00 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/12/2015 2:00 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/12/2015 2:00 PM |
| Details | Medicare Provider Number | Insert | | | 050039 | 7/12/2015 2:00 PM |
| Details | Entity Name | Insert | | | ENLOE MEDICAL CENTER | 7/12/2015 2:00 PM |
| Details | Program Code | Insert | | | DSH | 7/12/2015 2:00 PM |
| Details | Entity Subname | Insert | | | ENLOE MEDICAL CENTER / Hemotology Oncology | 7/12/2015 2:00 PM |
| Dates | Participating Approval Date | Insert | | | | 7/12/2015 2:00 PM |
| Details | State | Insert | | | Pending | 7/12/2015 2:00 PM |
| Dates | Registration Date | Insert | | | 7/12/2015 12:00:00 AM | 7/12/2015 2:00 PM |
| Dates | Signed By Date | Insert | | | 7/12/2015 12:00:00 AM | 7/12/2015 2:00 PM |
| Dates | Start Date | Insert | | | | 7/12/2015 2:00 PM |
| Terminations | Termination Comments | Insert | | | | 7/12/2015 2:00 PM |
| Terminations | Termination Date | Insert | | | | 7/12/2015 2:00 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/12/2015 2:00 PM |
| Terminations | Termination Reason | Insert | | | | 7/12/2015 2:00 PM |