| Contacts | Authorizing Official | Update | Profile Change Request | Spencer, Laura M.
CEO
Rural Health Care, Inc. d/b/a Azalea Health
3863280108-3340 | Spencer, Laura M.
CEO
Rural Health Care, Inc. d/b/a Aza Health
3863280108-3340 | 2/26/2025 12:18 PM |
| Contacts | Signed By | Update | Profile Change Request | Spencer, Laura M.
CEO
Rural Health Care, Inc. d/b/a Azalea Health
3863280108-3340 | Spencer, Laura M.
CEO
Rural Health Care, Inc. d/b/a Aza Health
3863280108-3340 | 2/26/2025 12:18 PM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2024 1:21:17 PM | 2/14/2025 1:12:24 PM | 2/14/2025 1:12 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Waller, Shonda S
Chief Pharmacy Officer
Rural Health Care, Inc.
3863280558 | Waller, Shonda S
Chief Pharmacy Officer
Rural Health Care, Inc.
3863280108-3301 | 2/10/2025 9:46 AM |
| Contacts | Primary Contact | Update | Group Change Request | PEDERSON, LARRY W.
Chief Pharmacy Officer
Rural Health Care, Inc
3863280558 | Waller, Shonda S
Chief Pharmacy Officer
Rural Health Care, Inc.
3863280558 | 11/8/2024 6:16 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2023 4:27:12 PM | 2/5/2024 1:21:17 PM | 2/5/2024 1:21 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2022 2:15:41 PM | 2/1/2023 4:27:12 PM | 2/1/2023 4:27 PM |
| Addresses | Billing Address | Update | Recertification | Rural Health Care, Inc., DBA/Aza Health
PO Drawer 817
Palatka, FL 32178-0817 | Rural Health Care, Inc. D/B/A AZA HEALTH
PO Drawer 817
Palatka, FL 32178-0817 | 2/1/2022 2:15 PM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2021 5:03:40 PM | 2/1/2022 2:15:41 PM | 2/1/2022 2:15 PM |
| Details | Last Recertification Date | Update | Recertification | 2/10/2020 12:49:16 PM | 2/3/2021 5:03:40 PM | 2/3/2021 5:03 PM |
| Addresses | Billing Address | Insert | Recertification | | Rural Health Care, Inc., DBA/Aza Health
PO Drawer 817
Palatka, FL 32178-0817 | 2/10/2020 12:49 PM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2019 12:59:48 PM | 2/10/2020 12:49:16 PM | 2/10/2020 12:49 PM |
| Details | Entity Subname | Update | Recertification | Azalea Health | Aza Health | 2/10/2020 12:49 PM |
| Details | Last Recertification Date | Update | Recertification | 2/19/2018 3:28:31 PM | 2/14/2019 12:59:48 PM | 2/14/2019 12:59 PM |
| Contacts | Primary Contact | Update | Profile Change Request | PEDERSON, LARRY W.
VP / Chief Pharmacy Officer
Rural Health Care, Inc
3863280558 | PEDERSON, LARRY W.
Chief Pharmacy Officer
Rural Health Care, Inc
3863280558 | 2/13/2019 10:27 AM |
| Contacts | Primary Contact | Update | Recertification | Pederson, Larry W.
VP/Chief Pharmacy Officer
3863280558 | PEDERSON, LARRY W.
VP / Chief Pharmacy Officer
Rural Health Care, Inc
3863280558 | 2/19/2018 3:28 PM |
| Details | Last Recertification Date | Update | Recertification | | 2/19/2018 3:28:31 PM | 2/19/2018 3:28 PM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/19/2018 3:28 PM |
| Contacts | Authorizing Official | Update | | Spencer, Laura M.
CEO
3863280108-3340 | Spencer, Laura M.
CEO
Rural Health Care, Inc. d/b/a Azalea Health
3863280108-3340 | 2/19/2018 1:06 PM |
| Contacts | Signed By | Update | | Spencer, Laura M.
CEO
3863280108-3340 | Spencer, Laura M.
CEO
Rural Health Care, Inc. d/b/a Azalea Health
3863280108-3340 | 2/19/2018 1:06 PM |
| Addresses | Main Address | Insert | | |
250 State Road 207
St Augustine, FL 32084-0997 | 5/1/2017 5:33 PM |
| Contacts | Authorizing Official | Insert | | | Spencer, Laura M.
CEO
3863280108-3340 | 5/1/2017 5:33 PM |
| Contacts | Signed By | Insert | | | Spencer, Laura M.
CEO
3863280108-3340 | 5/1/2017 5:33 PM |
| Contacts | Primary Contact | Insert | | | Pederson, Larry W.
VP/Chief Pharmacy Officer
3863280558 | 5/1/2017 5:33 PM |
| Dates | Participating Approval Date | Update | | | 4/24/2017 12:00:00 AM | 4/24/2017 10:19 AM |
| Details | State | Update | | Pending | Active | 4/24/2017 10:19 AM |
| Dates | Start Date | Update | | | 7/1/2017 12:00:00 AM | 4/24/2017 10:19 AM |
| Details | 340B ID | Update | | ONLINE_REG_76816 | CH04034P | 4/17/2017 11:16 AM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_76816 | 4/13/2017 8:49 AM |
| Details | Last Recertification Date | Insert | | | | 4/13/2017 8:49 AM |
| Details | Grant Number | Insert | | | H80CS00081 | 4/13/2017 8:49 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 4/13/2017 8:49 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 4/13/2017 8:49 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/13/2017 8:49 AM |
| Details | Medicare Provider Number | Insert | | | | 4/13/2017 8:49 AM |
| Details | Entity Name | Insert | | | RURAL HEALTH CARE, INCORPORATED | 4/13/2017 8:49 AM |
| Details | Program Code | Insert | | | CH | 4/13/2017 8:49 AM |
| Details | Entity Subname | Insert | | | Azalea Health | 4/13/2017 8:49 AM |
| Dates | Participating Approval Date | Insert | | | | 4/13/2017 8:49 AM |
| Details | State | Insert | | | Pending | 4/13/2017 8:49 AM |
| Dates | Registration Date | Insert | | | 4/13/2017 12:00:00 AM | 4/13/2017 8:49 AM |
| Dates | Signed By Date | Insert | | | 4/13/2017 12:00:00 AM | 4/13/2017 8:49 AM |
| Dates | Start Date | Insert | | | | 4/13/2017 8:49 AM |
| Terminations | Termination Comments | Insert | | | | 4/13/2017 8:49 AM |
| Terminations | Termination Date | Insert | | | | 4/13/2017 8:49 AM |
| Terminations | Termination Effective Date | Insert | | | | 4/13/2017 8:49 AM |
| Terminations | Termination Reason | Insert | | | | 4/13/2017 8:49 AM |