| Details | Last Recertification Date | Update | Recertification | 1/30/2024 3:56:58 PM | 2/11/2025 9:56:15 AM | 2/11/2025 9:56 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Jordan, Amber
COO
Glenns Ferry Health Centers dba Desert Sage Health Center
2086967157 | Jordan, Amber
CEO
Glenns Ferry Health Centers dba Desert Sage Health Center
2086967157 | 2/11/2025 6:33 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Ferguson, Mary Ferguson
CEO
Glenns Ferry Health Centers, dba De
2086967216 | Jordan, Amber
COO
Glenns Ferry Health Centers dba Desert Sage Health Center
2086967157 | 12/4/2024 7:37 AM |
| Addresses | Billing Address | Update | Change Request | Desert Sage Health Centers
2280 American Legion Blvd.
Mountain Home, ID 83647-3142 | Desert Sage Health Centers
120 DESERT SAGE WAY
MOUNTAIN HOME, ID 83647-3142 | 3/2/2024 3:45 PM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2023 2:27:46 PM | 1/30/2024 3:56:58 PM | 1/30/2024 3:56 PM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2022 4:52:30 PM | 2/12/2023 2:27:46 PM | 2/12/2023 2:27 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Ferguson, Mary
CEO
Glenns Ferry Health Center
2083667416 | Ferguson, Mary Ferguson
CEO
Glenns Ferry Health Centers, dba De
2086967216 | 3/20/2022 9:14 AM |
| Contacts | Primary Contact | Update | Recertification | Wilson, Sharlet
Executive Assistant
Desert Sage Health Centers
2086967203 | Wilson, Sharlet K
Executive Assistant
GLENNS FERRY HEALTH CENTER dba Desert Sage Health Centers
2086967203 | 2/3/2022 4:52 PM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2021 8:02:31 PM | 2/3/2022 4:52:30 PM | 2/3/2022 4:52 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1972633949 | 2/3/2021 8:02 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | ID | 2/3/2021 8:02 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1972633949 ( ) | | 2/3/2021 8:02 PM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2020 1:48:34 PM | 2/3/2021 8:02:31 PM | 2/3/2021 8:02 PM |
| Details | Last Recertification Date | Update | Recertification | 2/11/2019 10:26:37 AM | 1/29/2020 1:48:34 PM | 1/29/2020 1:48 PM |
| Addresses | Main Address | Update | Change Request |
350 MAIN STREET
GRAND VIEW, ID 83624-0298 |
350 Main Street
GRAND VIEW, ID 83624 | 2/19/2019 10:35 AM |
| Addresses | Billing Address | Update | Change Request | Glenns Ferry Health Center
PO Box 266
Glenns Ferry, ID 83623 | Desert Sage Health Centers
2280 American Legion Blvd.
Mountain Home, ID 83647-3142 | 2/19/2019 10:35 AM |
| Details | Entity Subname | Update | Change Request | VALLEY HEALTH CENTER | DESERT SAGE HEALTH CENTERS | 2/19/2019 10:35 AM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2018 7:27:23 PM | 2/11/2019 10:26:37 AM | 2/11/2019 10:26 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Wilson, Sharlet
Administrative Assistant
Glenns Ferry Health Center
2083667416 | Wilson, Sharlet
Executive Assistant
Desert Sage Health Centers
2086967203 | 1/29/2019 1:46 PM |
| Details | Last Recertification Date | Update | Recertification | | 2/12/2018 7:27:23 PM | 2/12/2018 7:27 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 10/27/2017 4:31 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 002550600 | 10/27/2017 4:31 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | ID | 10/27/2017 4:31 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1972633949 | 10/27/2017 4:31 PM |
| Details | Is Authorizing Official EHB Data | Update | Change Request | False | | 10/27/2017 4:31 PM |
| Contacts | Authorizing Official | Update | | Ferguson, Mary
CEO
2083667416 | Ferguson, Mary
CEO
Glenns Ferry Health Center
2083667416 | 10/3/2017 1:37 PM |
| Contacts | Signed By | Update | | Ferguson, Mary
CEO
2083667416 | Ferguson, Mary
CEO
Glenns Ferry Health Center
2083667416 | 10/3/2017 1:37 PM |
| Contacts | Primary Contact | Update | | Wilson, Sharlet
Administrative Assistant
2083667416 | Wilson, Sharlet
Administrative Assistant
Glenns Ferry Health Center
2083667416 | 10/3/2017 1:36 PM |
| Addresses | Main Address | Insert | | |
350 MAIN STREET
GRAND VIEW, ID 83624-0298 | 3/16/2017 11:57 AM |
| Contacts | Authorizing Official | Insert | | | Ferguson, Mary
CEO
2083667416 | 3/16/2017 11:57 AM |
| Contacts | Signed By | Insert | | | Ferguson, Mary
CEO
2083667416 | 3/16/2017 11:57 AM |
| Contacts | Primary Contact | Insert | | | Wilson, Sharlet
Administrative Assistant
2083667416 | 3/16/2017 11:57 AM |
| Addresses | Billing Address | Insert | | | Glenns Ferry Health Center
PO Box 266
Glenns Ferry, ID 83623 | 1/11/2017 3:28 PM |
| Dates | Participating Approval Date | Update | | | 1/11/2017 12:00:00 AM | 1/11/2017 3:28 PM |
| Details | State | Update | | Pending | Active | 1/11/2017 3:28 PM |
| Dates | Start Date | Update | | | 4/1/2017 12:00:00 AM | 1/11/2017 3:28 PM |
| Details | 340B ID | Update | | ONLINE_REG_74263 | CH10161B | 1/11/2017 10:52 AM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_74263 | 1/9/2017 6:46 PM |
| Details | Last Recertification Date | Insert | | | | 1/9/2017 6:46 PM |
| Details | Grant Number | Insert | | | H80CS00473 | 1/9/2017 6:46 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/9/2017 6:46 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 1/9/2017 6:46 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/9/2017 6:46 PM |
| Details | Medicare Provider Number | Insert | | | | 1/9/2017 6:46 PM |
| Details | Entity Name | Insert | | | GLENNS FERRY HEALTH CENTER, INC. | 1/9/2017 6:46 PM |
| Details | Program Code | Insert | | | CH | 1/9/2017 6:46 PM |
| Details | Entity Subname | Insert | | | VALLEY HEALTH CENTER | 1/9/2017 6:46 PM |
| Dates | Participating Approval Date | Insert | | | | 1/9/2017 6:46 PM |
| Details | State | Insert | | | Pending | 1/9/2017 6:46 PM |
| Dates | Registration Date | Insert | | | 1/9/2017 12:00:00 AM | 1/9/2017 6:46 PM |
| Dates | Signed By Date | Insert | | | 1/9/2017 12:00:00 AM | 1/9/2017 6:46 PM |
| Dates | Start Date | Insert | | | | 1/9/2017 6:46 PM |
| Terminations | Termination Comments | Insert | | | | 1/9/2017 6:46 PM |
| Terminations | Termination Date | Insert | | | | 1/9/2017 6:46 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/9/2017 6:46 PM |
| Terminations | Termination Reason | Insert | | | | 1/9/2017 6:46 PM |