Yes
MO | 600400717,507276004 | 1134134745,1003824293 |
Details | Last Recertification Date | Update | Recertification | 1/29/2024 2:36:56 PM | 2/10/2025 10:45:37 AM | 2/10/2025 10:45 AM |
Details | Last Recertification Date | Update | Recertification | 2/3/2023 9:43:01 AM | 1/29/2024 2:36:56 PM | 1/29/2024 2:36 PM |
Contacts | Primary Contact | Update | Profile Change Request | Holmes, Kendra
VP/COO
Affinia Healthcare
3146584868 | Holmes, Kendra
President CEO
Affinia Healthcare
3147797530 | 1/29/2024 9:23 AM |
Details | Last Recertification Date | Update | Recertification | 2/1/2022 5:41:31 PM | 2/3/2023 9:43:01 AM | 2/3/2023 9:43 AM |
Contacts | Authorizing Official | Update | AO Change Request | Voss, Janet
VP and CFO
Affinia Healthcare
3148148571 | O'Connor, Leslie S
CFO
Affinia Healthcare
6183435786 | 2/2/2023 2:07 PM |
Details | Last Recertification Date | Update | Recertification | 2/3/2021 5:00:21 PM | 2/1/2022 5:41:31 PM | 2/1/2022 5:41 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/3/2021 5:00 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 600400717 | 2/3/2021 5:00 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | MO | 2/3/2021 5:00 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/3/2021 5:00 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 507276004 | 2/3/2021 5:00 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | MO | 2/3/2021 5:00 PM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1003824293 | 2/3/2021 5:00 PM |
Medicaid Billing | NPI: State | Insert | Recertification | | MO | 2/3/2021 5:00 PM |
Medicaid Billing | NPI: State | Update | Recertification | | MO | 2/3/2021 5:00 PM |
Details | Last Recertification Date | Update | Recertification | 1/28/2020 11:46:33 AM | 2/3/2021 5:00:21 PM | 2/3/2021 5:00 PM |
Details | Last Recertification Date | Update | Recertification | 1/29/2019 8:12:35 AM | 1/28/2020 11:46:33 AM | 1/28/2020 11:46 AM |
Details | Entity Subname | Update | Recertification | 2200 Lemp | 2220 Lemp | 1/28/2020 11:46 AM |
Details | Last Recertification Date | Update | Recertification | 2/19/2018 11:24:00 AM | 1/29/2019 8:12:35 AM | 1/29/2019 8:12 AM |
Contacts | Primary Contact | Update | Recertification | Holmes, Kendra
Director of Pharmacy
3148148638 | Holmes, Kendra
VP/COO
Affinia Healthcare
3146584868 | 2/19/2018 11:24 AM |
Details | Last Recertification Date | Update | Recertification | 2/14/2017 12:00:00 AM | 2/19/2018 11:24:00 AM | 2/19/2018 11:24 AM |
Contacts | Authorizing Official | Update | | Voss, Janet
VP and CFO
3148148571 | Voss, Janet
VP and CFO
Affinia Healthcare
3148148571 | 2/7/2018 11:38 AM |
Addresses | Main Address | Insert | | |
2220 Lemp Ave.
Saint Louis, MO 63104-2700 | 2/21/2017 3:44 PM |
Contacts | Authorizing Official | Update | | GRAM, RICHARD
EXECUTIVE DIRECTOR
3145399510 | Voss, Janet
VP and CFO
3148148571 | 2/21/2017 3:44 PM |
Contacts | Primary Contact | Update | | APPOO, VILLIE
ASSOCIATE EXECUTIVE DIRECTOR
3145399509 | Holmes, Kendra
Director of Pharmacy
3148148638 | 2/21/2017 3:44 PM |
Medicaid Billing | NPI: Number | Insert | | | 1134134745 | 2/21/2017 3:43 PM |
Details | Last Recertification Date | Update | | 2/26/2016 12:00:00 AM | 2/14/2017 12:00:00 AM | 2/21/2017 3:43 PM |
Details | Entity Subname | Update | | GRACE HILL HADLEY | 2200 Lemp | 3/17/2016 8:23 AM |
Details | Last Recertification Date | Update | | 1/28/2015 12:00:00 AM | 2/26/2016 12:00:00 AM | 3/3/2016 2:52 PM |
Details | Entity Name | Update | | GRACE HILL HEALTH CENTER INC | Affinia Healthcare | 5/28/2015 7:56 AM |
Details | Last Recertification Date | Update | | 2/10/2014 12:00:00 AM | 1/28/2015 12:00:00 AM | 1/28/2015 2:45 PM |
Details | Entity Name | Update | | GRACE HILL NEIGHBORHOOD HEALTH CENTERS, INC. | GRACE HILL HEALTH CENTER INC | 3/31/2014 4:25 PM |
Details | Entity Subname | Update | | | GRACE HILL HADLEY | 3/31/2014 4:25 PM |
Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 2/10/2014 12:00:00 AM | 2/10/2014 11:17 AM |
Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/15/2013 10:01 AM |
Contacts | Authorizing Official | Insert | | | GRAM, RICHARD
EXECUTIVE DIRECTOR
3145399510 | 11/7/2006 1:49 PM |
Contacts | Primary Contact | Insert | | | APPOO, VILLIE
ASSOCIATE EXECUTIVE DIRECTOR
3145399509 | 11/17/2005 2:43 PM |
Details | Last Recertification Date | Insert | | | | 11/17/2005 2:37 PM |
Details | Grant Number | Insert | | | H80CS00415 | 11/17/2005 2:37 PM |
Details | 340B ID | Insert | | | CH071190 | 11/17/2005 2:37 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 11/17/2005 2:37 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 11/17/2005 2:37 PM |
Details | Medicare Provider Number | Insert | | | | 11/17/2005 2:37 PM |
Details | Entity Name | Insert | | | GRACE HILL NEIGHBORHOOD HEALTH CENTERS, INC. | 11/17/2005 2:37 PM |
Details | Program Code | Insert | | | CH | 11/17/2005 2:37 PM |
Details | Entity Subname | Insert | | | | 11/17/2005 2:37 PM |
Dates | Participating Approval Date | Insert | | | 2/9/2005 12:00:00 AM | 11/17/2005 2:37 PM |
Details | State | Insert | | | Active | 11/17/2005 2:37 PM |
Dates | Registration Date | Insert | | | 12/1/1992 12:00:00 AM | 11/17/2005 2:37 PM |
Dates | Signed By Date | Insert | | | | 11/17/2005 2:37 PM |
Dates | Start Date | Insert | | | 12/1/1992 12:00:00 AM | 11/17/2005 2:37 PM |
Terminations | Termination Comments | Insert | | | | 11/17/2005 2:37 PM |
Terminations | Termination Date | Insert | | | | 11/17/2005 2:37 PM |
Terminations | Termination Effective Date | Insert | | | | 11/17/2005 2:37 PM |
Terminations | Termination Reason | Insert | | | | 11/17/2005 2:37 PM |