| Details | Last Recertification Date | Update | Recertification | 8/31/2023 7:44:27 PM | 9/3/2024 1:06:33 PM | 9/3/2024 1:06 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 12:25:48 PM | 8/31/2023 7:44:27 PM | 8/31/2023 7:44 PM |
| Addresses | Billing Address | Insert | Change Request | | Enloe Regional Cancer Center
265 Cohasset Rd Suite 160
Chico, CA 95926 | 8/7/2023 12:26 PM |
| Addresses | Shipping Address | Insert | Change Request | | Enloe Cancer Center Pharmacy
251 Cohasset Rd Suite 145
Chico, CA 95926 | 8/7/2023 12:26 PM |
| Addresses | Main Address | Update | Change Request |
265 COHASSET RD
CHICO, CA 95926-2273 |
265 COHASSET RD Suite 140
CHICO, CA 95926-2273 | 8/7/2023 12:26 PM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2021 11:13:06 AM | 9/6/2022 12:25:48 PM | 9/6/2022 12:25 PM |
| Details | Last Recertification Date | Update | Recertification | 9/3/2020 1:18:26 PM | 8/17/2021 11:13:06 AM | 8/17/2021 11:13 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 9/3/2020 1:18 PM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2019 6:37:01 AM | 9/3/2020 1:18:26 PM | 9/3/2020 1:18 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 6:37 AM |
| Details | Last Recertification Date | Update | Recertification | 9/11/2018 12:24:10 PM | 8/31/2019 6:37:01 AM | 8/31/2019 6:37 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 12:50:32 PM | 9/11/2018 12:24:10 PM | 9/11/2018 12:24 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1912949538 ( ) | | 11/17/2017 12:50 PM |
| Details | Last Recertification Date | Update | Recertification | | 11/17/2017 12:50:32 PM | 11/17/2017 12:50 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 |
| Dates | Participating Approval Date | Update | | | 10/17/2016 12:00:00 AM | 10/17/2016 2:41 PM |
| Details | State | Update | | Pending | Active | 10/17/2016 2:41 PM |
| Dates | Start Date | Update | | | 1/1/2017 12:00:00 AM | 10/17/2016 2:41 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_73041 | DSH050039S | 10/14/2016 7:31 AM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_73041 | 10/13/2016 11:22 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 10/13/2016 11:22 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | HSP40039F | 10/13/2016 11:22 AM |
| Medicaid Billing | Medicaid: State | Insert | | | CA | 10/13/2016 11:22 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1417901091 | 10/13/2016 11:22 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1912949538 | 10/13/2016 11:22 AM |
| Details | Last Recertification Date | Insert | | | | 10/13/2016 11:22 AM |
| Details | Grant Number | Insert | | | | 10/13/2016 11:22 AM |
| Details | 340B ID | Insert | | | | 10/13/2016 11:22 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/13/2016 11:22 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/13/2016 11:22 AM |
| Details | Medicare Provider Number | Insert | | | 050039 | 10/13/2016 11:22 AM |
| Details | Entity Name | Insert | | | ENLOE MEDICAL CENTER | 10/13/2016 11:22 AM |
| Details | Program Code | Insert | | | DSH | 10/13/2016 11:22 AM |
| Details | Entity Subname | Insert | | | ENLOE MEDICAL CENTER / Enloe Radiation Oncology Clinic | 10/13/2016 11:22 AM |
| Dates | Participating Approval Date | Insert | | | | 10/13/2016 11:22 AM |
| Details | State | Insert | | | Pending | 10/13/2016 11:22 AM |
| Dates | Registration Date | Insert | | | 10/13/2016 12:00:00 AM | 10/13/2016 11:22 AM |
| Dates | Signed By Date | Insert | | | 10/13/2016 12:00:00 AM | 10/13/2016 11:22 AM |
| Dates | Start Date | Insert | | | | 10/13/2016 11:22 AM |
| Terminations | Termination Comments | Insert | | | | 10/13/2016 11:22 AM |
| Terminations | Termination Date | Insert | | | | 10/13/2016 11:22 AM |
| Terminations | Termination Effective Date | Insert | | | | 10/13/2016 11:22 AM |
| Terminations | Termination Reason | Insert | | | | 10/13/2016 11:22 AM |