| Details | Last Recertification Date | Update | Recertification | 8/30/2023 4:05:16 PM | 8/28/2024 10:48:31 AM | 8/28/2024 10:48 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Morgan, Samantha
Regional Manager, 340B Program
CommonSpirit Health
3036737380 | Morgan, Samantha
System Manager, 340B Mountain Region
CommonSpirit Health
3036737380 | 8/20/2024 1:07 PM |
| Contacts | Authorizing Official | Update | Change Request | Travis, Carol
CFO
Centura Health
7206271230 | Travis, Carol
CFO and VP of Finance
CommonSpirit Health
7206271230 | 7/26/2024 1:03 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Morgan, Samantha
Director, Enterprise 340B Program
Centura Health
3036737380 | Morgan, Samantha
Regional Manager, 340B Program
CommonSpirit Health
3036737380 | 7/25/2024 4:28 PM |
| Contacts | Authorizing Official | Update | Change Request | Hatfield, Chad E
Chief Executive Officer
Longmont United Hospital
3036515025 | Travis, Carol
CFO
Centura Health
7206271230 | 5/14/2024 12:25 PM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2022 10:09:30 AM | 8/30/2023 4:05:16 PM | 8/30/2023 4:05 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Morgan, Samantha
340B Program Manager
Centura Health
3036737380 | Morgan, Samantha
Director, Enterprise 340B Program
Centura Health
3036737380 | 5/25/2023 12:41 PM |
| Contacts | Primary Contact | Update | Change Request | Ives, John D
Director of Pharmacy
Longmont United Hospital
3036515116 | Morgan, Samantha
340B Program Manager
Centura Health
3036737380 | 4/18/2023 6:46 AM |
| Contacts | Authorizing Official | Update | Change Request | Thomson, Chris M
Group VP and Physician Executive; interim CEO
Centura Health; Longmont United Hospital
4344017827 | Hatfield, Chad E
Chief Executive Officer
Longmont United Hospital
3036515025 | 9/29/2022 7:07 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2021 10:20:45 AM | 8/29/2022 10:09:30 AM | 8/29/2022 10:09 AM |
| Details | Entity Name | Update | Recertification | LONGMONT UNITED HOSPITAL | CENTURA LONGMONT UNITED HOSPITAL | 8/29/2022 10:09 AM |
| Contacts | Authorizing Official | Update | Change Request | Olson, Kristi
Chief Executive Officer
St. Thomas More Hospital
7192852039 | Thomson, Chris M
Group VP and Physician Executive; interim CEO
Centura Health; Longmont United Hospital
4344017827 | 5/17/2022 8:27 AM |
| Contacts | Primary Contact | Update | Change Request | Ives, John
Director of Pharmacy
Longmont United Hospital
3036515116 | Ives, John D
Director of Pharmacy
Longmont United Hospital
3036515116 | 5/2/2022 4:44 PM |
| Contacts | Authorizing Official | Update | Change Request | Johnson, Christina
CEO
Longmont United Hospital
3036515025 | Olson, Kristi
Chief Executive Officer
St. Thomas More Hospital
7192852039 | 1/11/2022 8:42 AM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2020 9:48:32 AM | 8/24/2021 10:20:45 AM | 8/24/2021 10:20 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 8/25/2020 9:48 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 05003009 | 8/25/2020 9:48 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | CO | 8/25/2020 9:48 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | CO | 8/25/2020 9:48 AM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2019 7:19:08 AM | 8/25/2020 9:48:32 AM | 8/25/2020 9:48 AM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2018 11:30:09 AM | 8/28/2019 7:19:08 AM | 8/28/2019 7:19 AM |
| Contacts | Authorizing Official | Update | Change Request | Frank, Daniel
Chief Financial Officer
Longmont United Hospital
3036515488 | Johnson, Christina
CEO
Longmont United Hospital
3036515025 | 1/9/2019 11:48 AM |
| Details | Last Recertification Date | Update | Recertification | 11/3/2017 10:41:01 AM | 8/15/2018 11:30:09 AM | 8/15/2018 11:30 AM |
| Details | Last Recertification Date | Update | Recertification | 10/24/2017 12:35:32 PM | 11/3/2017 10:41:01 AM | 11/3/2017 10:41 AM |
| Details | Last Recertification Date | Update | Recertification | | 10/24/2017 12:35:32 PM | 10/24/2017 12:35 PM |
| Contacts | Authorizing Official | Update | | Frank, Daniel
Chief Financial Officer
3036515488 | Frank, Daniel
Chief Financial Officer
Longmont United Hospital
3036515488 | 10/10/2017 10:36 AM |
| Contacts | Signed By | Update | | Frank, Daniel
Chief Financial Officer
3036515488 | Frank, Daniel
Chief Financial Officer
Longmont United Hospital
3036515488 | 10/10/2017 10:36 AM |
| Contacts | Primary Contact | Update | | Ives, John
Director of Pharmacy
3036515116 | Ives, John
Director of Pharmacy
Longmont United Hospital
3036515116 | 10/10/2017 10:26 AM |
| Addresses | Main Address | Insert | | |
1950 WEST MOUNTAIN VIEW AVENUE
LONGMONT, CO 80501-3129 | 6/13/2017 10:45 AM |
| Addresses | Billing Address | Insert | | | Centura Health
PO Box 372660
Denver, CO 80237 | 6/13/2017 10:45 AM |
| Contacts | Primary Contact | Insert | | | Ives, John
Director of Pharmacy
3036515116 | 6/13/2017 10:45 AM |
| Contacts | Authorizing Official | Insert | | | Frank, Daniel
Chief Financial Officer
3036515488 | 6/13/2017 10:45 AM |
| Contacts | Signed By | Insert | | | Frank, Daniel
Chief Financial Officer
3036515488 | 6/13/2017 10:45 AM |
| Dates | Participating Approval Date | Update | | | 4/7/2017 12:00:00 AM | 4/7/2017 1:47 PM |
| Details | State | Update | | Pending | Active | 4/7/2017 1:47 PM |
| Dates | Start Date | Update | | | 7/1/2017 12:00:00 AM | 4/7/2017 1:47 PM |
| Details | 340B ID | Update | | ONLINE_REG_75893 | DSH060003 | 4/5/2017 10:02 AM |
| Details | 340B ID | Update | | | ONLINE_REG_75893 | 4/4/2017 2:02 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1366465866 | 4/4/2017 2:02 PM |
| Details | Last Recertification Date | Insert | | | | 4/4/2017 2:02 PM |
| Details | Grant Number | Insert | | | | 4/4/2017 2:02 PM |
| Details | 340B ID | Insert | | | | 4/4/2017 2:02 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/4/2017 2:02 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/4/2017 2:02 PM |
| Details | Medicare Provider Number | Insert | | | 060003 | 4/4/2017 2:02 PM |
| Details | Entity Name | Insert | | | LONGMONT UNITED HOSPITAL | 4/4/2017 2:02 PM |
| Details | Program Code | Insert | | | DSH | 4/4/2017 2:02 PM |
| Details | Entity Subname | Insert | | | | 4/4/2017 2:02 PM |
| Dates | Participating Approval Date | Insert | | | | 4/4/2017 2:02 PM |
| Details | State | Insert | | | Pending | 4/4/2017 2:02 PM |
| Dates | Registration Date | Insert | | | 4/4/2017 12:00:00 AM | 4/4/2017 2:02 PM |
| Dates | Signed By Date | Insert | | | 4/4/2017 12:00:00 AM | 4/4/2017 2:02 PM |
| Dates | Start Date | Insert | | | | 4/4/2017 2:02 PM |
| Terminations | Termination Comments | Insert | | | | 4/4/2017 2:02 PM |
| Terminations | Termination Date | Insert | | | | 4/4/2017 2:02 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/4/2017 2:02 PM |
| Terminations | Termination Reason | Insert | | | | 4/4/2017 2:02 PM |