Covered Entity Details

STD975261 Josephine County Public Health (Active) - information as of 5/15/2025 1:47:59 AM

Main Details

Name

Josephine County Public Health

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD975261

Grant Number

NH25PS005149

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

Direct Funding (dollars received from CDC or an intermediate organization)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.

1/1/2024 - 12/31/2024

Additional Details

Current Program Status

Active

Registration Date

7/8/2019

Participating Start Date

10/1/2019

Participating Approval Date

9/4/2019

Last Recertification Date

5/8/2024

Notice of Funding Opportunity (NOFO) Number

PS19-1901

Contacts

Authorizing Official

Josephine County Public health
Janet Fredrickson, senior admin supervisor
(541) 474-5325

Primary Contact

Josephine County Public Health
Candus M Anderson, Public Health Clinic Provider - LPN
(541) 474-5325 Ext: 2226

Addresses

Street Address

715 NW Dimmick St
Grants Pass, OR 97526

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
OR	097519	1295737336

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Oconnor, Jenny Public Health Clinic Supervisor Josephine County Public health 5414745330	Fredrickson, Janet senior admin supervisor Josephine County Public health 5414745325	5/13/2025 12:06 PM
Details	Last Recertification Date	Update	Recertification	5/18/2023 5:16:19 PM	5/8/2024 6:39:23 PM	5/8/2024 6:39 PM
Details	Nature of Support: Support Received From Date	Update	Change Request	1/1/2023 12:00:00 AM	1/1/2024 12:00:00 AM	2/14/2024 6:27 PM
Details	Nature of Support: Support Received To Date	Update	Change Request	12/31/2023 12:00:00 AM	12/31/2024 12:00:00 AM	2/14/2024 6:27 PM
Details	Nature of Support: Support Received From Date	Update	Recertification	1/1/2022 12:00:00 AM	1/1/2023 12:00:00 AM	5/18/2023 5:16 PM
Details	Nature of Support: Support Received To Date	Update	Recertification	12/31/2022 12:00:00 AM	12/31/2023 12:00:00 AM	5/18/2023 5:16 PM
Details	Last Recertification Date	Update	Recertification	5/16/2022 10:07:19 AM	5/18/2023 5:16:19 PM	5/18/2023 5:16 PM
Contacts	Primary Contact	Update	New Registration	Anderson, Candus M Public Health Clinic Provider - RN Josephine County Public Health 5414745325-2226	Anderson, Candus M Public Health Clinic Provider - LPN Josephine County Public Health 5414745325-2226	2/21/2023 6:19 PM
Contacts	Primary Contact	Update	Change Request	Anderson, Candus Marae RN Josephine.County Public Health 5414745325-2226	Anderson, Candus M Public Health Clinic Provider - RN Josephine County Public Health 5414745325-2226	2/17/2023 7:17 AM
Details	Nature of Support: Support Received From Date	Update	Recertification	1/1/2021 12:00:00 AM	1/1/2022 12:00:00 AM	5/16/2022 10:07 AM
Details	Nature of Support: Support Received To Date	Update	Recertification	12/31/2021 12:00:00 AM	12/31/2022 12:00:00 AM	5/16/2022 10:07 AM
Details	Last Recertification Date	Update	Recertification	5/10/2021 9:04:51 AM	5/16/2022 10:07:19 AM	5/16/2022 10:07 AM
Contacts	Authorizing Official	Update	AO Change Request	Tiberio, Audrey Operations Manager Josephine County Public Health 5414745338	Oconnor, Jenny Public Health Clinic Supervisor Josephine County Public health 5414745330	5/12/2022 6:26 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	5/10/2021 9:04 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		097519	5/10/2021 9:04 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	5/10/2021 9:04 AM
Details	Nature Of Support	Delete	Recertification	In-Kind products or services (see note below; must have been purchased with section 318 funds) ()-()		5/10/2021 9:04 AM
Details	Nature of Support: In Kind Support Description	Insert	Recertification			5/10/2021 9:04 AM
Details	Nature Of Support	Insert	Recertification		Direct Funding (dollars received from CDC or an intermediate organization)	5/10/2021 9:04 AM
Details	Nature of Support: Support Received From Date	Insert	Recertification		1/1/2021 12:00:00 AM	5/10/2021 9:04 AM
Details	Nature of Support: Support Received To Date	Insert	Recertification		12/31/2021 12:00:00 AM	5/10/2021 9:04 AM
Medicaid Billing	NPI: State	Update	Recertification		OR	5/10/2021 9:04 AM
Details	Last Recertification Date	Update	Recertification	5/12/2020 11:05:13 AM	5/10/2021 9:04:51 AM	5/10/2021 9:04 AM
Details	NOFO Number	Update	Recertification		PS19-1901	5/10/2021 9:04 AM
Details	Last Recertification Date	Update	Recertification		5/12/2020 11:05:13 AM	5/12/2020 11:05 AM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Contacts	Signed By	Insert	New Registration		Tiberio, Audrey Operations Manager Josephine County Public Health 5414745338	9/4/2019 3:51 PM
Details	340B ID	Update	New Registration		STD975261	9/4/2019 3:51 PM
Dates	Participating Approval Date	Update	New Registration		9/4/2019 3:51:20 PM	9/4/2019 3:51 PM
Details	State	Update	New Registration	Pending	Approved	9/4/2019 3:51 PM
Dates	Signed By Date	Update	New Registration		7/8/2019 4:59:03 PM	9/4/2019 3:51 PM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	9/4/2019 3:51 PM
Contacts	Primary Contact	Update		Anderson, Candus RN Josephine.County Public Health 5414745325-2226	Anderson, Candus Marae RN Josephine.County Public Health 5414745325-2226	7/8/2019 7:32 PM
Addresses	Main Address	Insert	New Registration		715 NW Dimmick St Grants Pass, OR 97526	7/8/2019 4:59 PM
Details	Nature Of Support	Insert	New Registration		In-Kind products or services (see note below; must have been purchased with section 318 funds)	7/8/2019 4:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1295737336	7/8/2019 4:59 PM
Contacts	Authorizing Official	Insert	New Registration		Tiberio, Audrey Operations Manager Josephine County Public Health 5414745338	7/8/2019 4:59 PM
Contacts	Primary Contact	Insert	New Registration		Anderson, Candus RN Josephine.County Public Health 5414745325-2226	7/8/2019 4:59 PM
Details	Last Recertification Date	Insert	New Registration			7/8/2019 4:59 PM
Details	Grant Number	Insert	New Registration		NH25PS005149	7/8/2019 4:59 PM
Details	340B ID	Insert	New Registration			7/8/2019 4:59 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/8/2019 4:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/8/2019 4:59 PM
Details	Medicare Provider Number	Insert	New Registration			7/8/2019 4:59 PM
Details	Entity Name	Insert	New Registration		Josephine County Public Health	7/8/2019 4:59 PM
Details	Program Code	Insert	New Registration		STD	7/8/2019 4:59 PM
Details	Entity Subname	Insert	New Registration			7/8/2019 4:59 PM
Dates	Participating Approval Date	Insert	New Registration			7/8/2019 4:59 PM
Details	State	Insert	New Registration		Pending	7/8/2019 4:59 PM
Dates	Registration Date	Insert	New Registration		7/8/2019 4:59:01 PM	7/8/2019 4:59 PM
Dates	Signed By Date	Insert	New Registration			7/8/2019 4:59 PM
Dates	Start Date	Insert	New Registration			7/8/2019 4:59 PM
Terminations	Termination Comments	Insert	New Registration			7/8/2019 4:59 PM
Terminations	Termination Date	Insert	New Registration			7/8/2019 4:59 PM
Terminations	Termination Effective Date	Insert	New Registration			7/8/2019 4:59 PM
Terminations	Termination Reason	Insert	New Registration			7/8/2019 4:59 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History