Yes
Sandhills Medical Foundation, Inc. - Ruby
290 Market Street
Ruby, SC 29741
| Details | Last Recertification Date | Update | Recertification | 2/19/2024 1:32:44 AM | 2/26/2025 12:26:38 PM | 2/26/2025 12:26 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Wardlaw, Ernest Stan
Chief Executive Officer
Sandhills Medical Foundation, Inc.
8039006612 | Cantave, Delgado
CEO
Sandhills Medical Foundation, Inc
8039006469 | 2/25/2025 11:02 AM |
| Details | Last Recertification Date | Update | Recertification | 2/20/2023 11:43:05 AM | 2/19/2024 1:32:44 AM | 2/19/2024 1:32 AM |
| Contacts | Authorizing Official | Update | Group Change Request | Roberts, David
Chief Executive Officer
Sandhills Medical Foundation, Inc.
8433356454 | Wardlaw, Ernest Stan
Chief Executive Officer
Sandhills Medical Foundation, Inc.
8039006612 | 11/16/2023 11:51 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2022 7:19:05 AM | 2/20/2023 11:43:05 AM | 2/20/2023 11:43 AM |
| Contacts | Authorizing Official | Update | Group Change Request | Dixon, Christopher W.
CEO
Sandhills Medical Foundation, Inc
8433356754 | Roberts, David
Chief Executive Officer
Sandhills Medical Foundation, Inc.
8433356454 | 8/12/2022 10:39 AM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2021 2:41:37 PM | 1/31/2022 7:19:05 AM | 1/31/2022 7:19 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | SC | 2/13/2021 2:41 PM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2020 1:37:43 AM | 2/13/2021 2:41:37 PM | 2/13/2021 2:41 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2019 8:58:31 AM | 1/31/2020 1:37:43 AM | 1/31/2020 1:37 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 4/23/2019 12:48 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | FQC230 | 4/23/2019 12:48 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | SC | 4/23/2019 12:48 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1922584481 | 4/23/2019 12:48 PM |
| Details | Last Recertification Date | Update | Recertification | | 2/1/2019 8:58:31 AM | 2/1/2019 8:58 AM |
| Details | State | Update | | Approved | Active | 10/1/2018 12:05 AM |
| Addresses | Main Address | Update | OPA Edit |
CH04505G
Ruby, SC 29741 |
290 Market St
Ruby, SC 29741 | 9/5/2018 10:21 AM |
| Addresses | Main Address | Update | OPA Edit |
Ruby, SC 29741 |
CH04505G
Ruby, SC 29741 | 9/5/2018 10:20 AM |
| Contacts | Signed By | Insert | New Registration | | Dixon, Christopher W.
CEO
Sandhills Medical Foundation, Inc
8433356754 | 9/5/2018 10:18 AM |
| Details | 340B ID | Update | New Registration | | CH04505G | 9/5/2018 10:18 AM |
| Dates | Participating Approval Date | Update | New Registration | | 9/5/2018 10:18:31 AM | 9/5/2018 10:18 AM |
| Details | State | Update | New Registration | Pending | Approved | 9/5/2018 10:18 AM |
| Dates | Signed By Date | Update | New Registration | | 8/17/2018 12:22:02 AM | 9/5/2018 10:18 AM |
| Dates | Start Date | Update | New Registration | | 10/1/2018 12:00:00 AM | 9/5/2018 10:18 AM |
| Addresses | Main Address | Insert | New Registration | |
Ruby, SC 29741 | 8/17/2018 12:22 AM |
| Addresses | Billing Address | Insert | New Registration | | Sandhills Medical Foundation, Inc.
645 S Seventh Street
PO Box 366
McBee, SC 29101-0366 | 8/17/2018 12:22 AM |
| Addresses | Shipping Address | Insert | New Registration | | Sandhills Medical Foundation, Inc. - Ruby
290 Market Street
Ruby, SC 29741 | 8/17/2018 12:22 AM |
| Contacts | Primary Contact | Insert | New Registration | | Rollings, Erin
DIRECTOR OF PHARMACY
Sandhills Medical Foundation, Inc.
8034385537 | 8/17/2018 12:22 AM |
| Contacts | Authorizing Official | Insert | New Registration | | Dixon, Christopher W.
CEO
Sandhills Medical Foundation, Inc
8433356754 | 8/17/2018 12:22 AM |
| Details | Last Recertification Date | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Details | Grant Number | Insert | New Registration | | H80CS00501 | 8/17/2018 12:22 AM |
| Details | 340B ID | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Details | Medicare Provider Number | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Details | Entity Name | Insert | New Registration | | SANDHILLS MEDICAL FOUNDATION | 8/17/2018 12:22 AM |
| Details | Program Code | Insert | New Registration | | CH | 8/17/2018 12:22 AM |
| Details | Entity Subname | Insert | New Registration | | Sandhills Medical Foundation - Ruby | 8/17/2018 12:22 AM |
| Dates | Participating Approval Date | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Details | State | Insert | New Registration | | Pending | 8/17/2018 12:22 AM |
| Dates | Registration Date | Insert | New Registration | | 8/17/2018 12:22:00 AM | 8/17/2018 12:22 AM |
| Dates | Signed By Date | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Dates | Start Date | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Terminations | Termination Comments | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Terminations | Termination Date | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 8/17/2018 12:22 AM |
| Terminations | Termination Reason | Insert | New Registration | | | 8/17/2018 12:22 AM |