No
Details | Last Recertification Date | Update | Recertification | 2/9/2024 11:17:32 AM | 3/6/2025 9:36:10 AM | 3/6/2025 9:36 AM |
Contacts | Primary Contact | Update | AO Change Request | Rice, Jane
Compliance Officer
Community Health Connection, Inc.
9187104411 | Patrick, Kym
Chief Quality and Compliance Officer
Community Health Connection
9187104409 | 3/6/2025 8:22 AM |
Contacts | Authorizing Official | Update | AO Change Request | McCarthy, W James
Chief Executive Officer
community health connection
9186220641-117 | Neary, Kate
CEO
Community Health Connection
9186984492 | 3/6/2025 8:22 AM |
Details | Last Recertification Date | Update | Recertification | 2/20/2023 2:03:49 PM | 2/9/2024 11:17:32 AM | 2/9/2024 11:17 AM |
Details | Last Recertification Date | Update | Recertification | 2/9/2022 4:24:40 PM | 2/20/2023 2:03:49 PM | 2/20/2023 2:03 PM |
Details | Last Recertification Date | Update | Recertification | 2/22/2021 2:50:28 PM | 2/9/2022 4:24:40 PM | 2/9/2022 4:24 PM |
Medicaid Billing | Medicaid: Number | Delete | Recertification | 200082520C (OK) | | 2/22/2021 2:50 PM |
Medicaid Billing | NPI: Number | Delete | Recertification | 1700268844 ( ) | | 2/22/2021 2:50 PM |
Details | Last Recertification Date | Update | Recertification | 2/6/2020 3:59:34 PM | 2/22/2021 2:50:28 PM | 2/22/2021 2:50 PM |
Contacts | Authorizing Official | Update | Profile Change Request | McCarthy, James W.
Chief Executive Officer
community health connection
9186220641-117 | McCarthy, W James
Chief Executive Officer
community health connection
9186220641-117 | 2/6/2020 4:01 PM |
Contacts | Signed By | Update | Profile Change Request | McCarthy, James W.
Chief Executive Officer
community health connection
9186220641-117 | McCarthy, W James
Chief Executive Officer
community health connection
9186220641-117 | 2/6/2020 4:01 PM |
Details | Last Recertification Date | Update | Recertification | | 2/6/2020 3:59:34 PM | 2/6/2020 3:59 PM |
Details | State | Update | | Approved | Active | 1/1/2020 12:04 AM |
Contacts | Signed By | Insert | New Registration | | McCarthy, James W.
Chief Executive Officer
community health connection
9186220641-117 | 10/16/2019 11:27 AM |
Details | 340B ID | Update | New Registration | | CHC06446-02 | 10/16/2019 11:27 AM |
Dates | Participating Approval Date | Update | New Registration | | 10/16/2019 11:27:36 AM | 10/16/2019 11:27 AM |
Details | State | Update | New Registration | Pending | Approved | 10/16/2019 11:27 AM |
Dates | Signed By Date | Update | New Registration | | 10/14/2019 4:49:33 PM | 10/16/2019 11:27 AM |
Dates | Start Date | Update | New Registration | | 1/1/2020 12:00:00 AM | 10/16/2019 11:27 AM |
Addresses | Main Address | Insert | New Registration | |
13702 E 46th Pl
Tulsa, OK 74134-5919 | 10/9/2019 6:03 PM |
Addresses | Billing Address | Insert | New Registration | | Community Health Connection, Inc.
2321 East 3rd Street
Tulsa, OK 74104-1831 | 10/9/2019 6:03 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 10/9/2019 6:03 PM |
Medicaid Billing | Medicaid: Number | Insert | New Registration | | 200082520C | 10/9/2019 6:03 PM |
Medicaid Billing | Medicaid: State | Insert | New Registration | | OK | 10/9/2019 6:03 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1700268844 | 10/9/2019 6:03 PM |
Contacts | Primary Contact | Insert | New Registration | | Rice, Jane
Compliance Officer
Community Health Connection, Inc.
9187104411 | 10/9/2019 6:03 PM |
Contacts | Authorizing Official | Insert | New Registration | | McCarthy, James W.
Chief Executive Officer
community health connection
9186220641-117 | 10/9/2019 6:03 PM |
Details | Last Recertification Date | Insert | New Registration | | | 10/9/2019 6:03 PM |
Details | Grant Number | Insert | New Registration | | H80CS06446 | 10/9/2019 6:03 PM |
Details | 340B ID | Insert | New Registration | | | 10/9/2019 6:03 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/9/2019 6:03 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/9/2019 6:03 PM |
Details | Medicare Provider Number | Insert | New Registration | | | 10/9/2019 6:03 PM |
Details | Entity Name | Insert | New Registration | | Community Health Connection Inc | 10/9/2019 6:03 PM |
Details | Program Code | Insert | New Registration | | CH | 10/9/2019 6:03 PM |
Details | Entity Subname | Insert | New Registration | | Community Health Connection Rosa Parks Clinic | 10/9/2019 6:03 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 10/9/2019 6:03 PM |
Details | State | Insert | New Registration | | Pending | 10/9/2019 6:03 PM |
Dates | Registration Date | Insert | New Registration | | 10/9/2019 6:03:35 PM | 10/9/2019 6:03 PM |
Dates | Signed By Date | Insert | New Registration | | | 10/9/2019 6:03 PM |
Dates | Start Date | Insert | New Registration | | | 10/9/2019 6:03 PM |
Terminations | Termination Comments | Insert | New Registration | | | 10/9/2019 6:03 PM |
Terminations | Termination Date | Insert | New Registration | | | 10/9/2019 6:03 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 10/9/2019 6:03 PM |
Terminations | Termination Reason | Insert | New Registration | | | 10/9/2019 6:03 PM |