Yes
CAH181315-01 | Child | CAH | FORT LOGAN HOSPITAL | Ephraim McDowell Garrard Clinic - Ephraim McDowell Garrard Clinic | 405 Danville Street | Lancaster | KY | Active |
CAH181315-02 | Child | CAH | FORT LOGAN HOSPITAL | Liberty Family Medical Center - Liberty Family Medical Center | 511 Middleburg Street | Liberty | KY | Active |
CAH181315-03 | Child | CAH | FORT LOGAN HOSPITAL | North Garrard Family Medical Center - North Garrard Family Medical Center | 510 Camp Dick Road | Lancaster | KY | Active |
CAH181315-04 | Child | CAH | FORT LOGAN HOSPITAL | Stanford Medical Park - Stanford Medical Park | 110 Metker Trail | Stanford | KY | Active |
CAH181315-05 | Child | CAH | FORT LOGAN HOSPITAL | RURAL HEALTH CLINIC - DANVILLE FAMILY PHYSICIANS | 109 DANIEL DR | DANVILLE | KY | Active |
CAH181315-06 | Child | CAH | FORT LOGAN HOSPITAL | EPHRAIM MCDOWELL INTERNAL MEDICINE - CLINIC - EPHRAIM MCDOWELL INTERNAL MEDICINE | 640 E LEXINGTON AVE | DANVILLE | KY | Active |
Contacts | Primary Contact | Update | Group Change Request | Haltom, Joan B
System Director of Pharmacy
Ephraim McDowell Health
8592391721 | Curtis, Megan N
340B Program Coordinator
Ephraim McDowell Health
8592391727 | 12/19/2024 8:58 AM |
Details | Last Recertification Date | Update | Recertification | 8/30/2023 10:33:30 PM | 8/13/2024 5:10:15 PM | 8/13/2024 5:10 PM |
Contacts | Primary Contact | Update | Group Change Request | Curtis, Megan N
340B Program Coordinator
Ephraim McDowell Health
8592391727 | Haltom, Joan B
System Director of Pharmacy
Ephraim McDowell Health
8592391721 | 7/24/2024 6:51 AM |
Contacts | Primary Contact | Update | Profile Change Request | Ballard, Megan N
340b Program Coordinator
Ephraim McDowell Health
8592391727 | Curtis, Megan N
340B Program Coordinator
Ephraim McDowell Health
8592391727 | 9/7/2023 1:20 PM |
Contacts | Authorizing Official | Update | Change Request | Dean, Jason
Administrator
Ephraim McDowell Fort Logan Hospital
6063654697 | Lynn, Lynne Warner
Hospital Administrator
Fort Logan Hospital/James B. Haggin Hospital
8592392329 | 9/7/2023 12:05 PM |
Details | Last Recertification Date | Update | Recertification | 8/30/2022 1:11:31 PM | 8/30/2023 10:33:30 PM | 8/30/2023 10:33 PM |
Details | Last Recertification Date | Update | Recertification | 8/17/2021 3:45:44 PM | 8/30/2022 1:11:31 PM | 8/30/2022 1:11 PM |
Contacts | Authorizing Official | Update | Change Request | Glass, Ina Louise
Administrator
Ephraim McDowell Fort Logan Hospital
6063654788 | Dean, Jason
Administrator
Ephraim McDowell Fort Logan Hospital
6063654697 | 12/14/2021 3:14 PM |
Details | Last Recertification Date | Update | Recertification | 8/28/2020 10:48:55 AM | 8/17/2021 3:45:44 PM | 8/17/2021 3:45 PM |
Medicaid Billing | NPI: State | Update | Recertification | | KY | 8/28/2020 10:48 AM |
Details | Last Recertification Date | Update | Recertification | | 8/28/2020 10:48:55 AM | 8/28/2020 10:48 AM |
Details | State | Update | | Approved | Active | 4/1/2020 12:05 AM |
Contacts | Signed By | Insert | New Registration | | Glass, Ina Louise
Administrator
Ephraim McDowell Fort Logan Hospital
6063654788 | 1/17/2020 12:40 PM |
Details | 340B ID | Update | New Registration | | CAH181315-05 | 1/17/2020 12:40 PM |
Details | Entity Subname | Update | New Registration | RURAL HEALTH CLINIC | RURAL HEALTH CLINIC - DANVILLE FAMILY PHYSICIANS | 1/17/2020 12:40 PM |
Dates | Participating Approval Date | Update | New Registration | | 1/17/2020 12:40:34 PM | 1/17/2020 12:40 PM |
Details | State | Update | New Registration | Pending | Approved | 1/17/2020 12:40 PM |
Dates | Signed By Date | Update | New Registration | | 1/15/2020 9:44:47 AM | 1/17/2020 12:40 PM |
Dates | Start Date | Update | New Registration | | 4/1/2020 12:00:00 AM | 1/17/2020 12:40 PM |
Addresses | Main Address | Insert | New Registration | |
109 DANIEL DR
DANVILLE, KY 40422-2527 | 1/13/2020 4:55 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 1/13/2020 4:55 PM |
Medicaid Billing | Medicaid: Number | Insert | New Registration | | 01000223 | 1/13/2020 4:55 PM |
Medicaid Billing | Medicaid: State | Insert | New Registration | | KY | 1/13/2020 4:55 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1417436221 | 1/13/2020 4:55 PM |
Contacts | Authorizing Official | Insert | New Registration | | Glass, Ina Louise
Administrator
Ephraim McDowell Fort Logan Hospital
6063654788 | 1/13/2020 4:55 PM |
Contacts | Primary Contact | Insert | New Registration | | Ballard, Megan N
340b Program Coordinator
Ephraim McDowell Health
8592391727 | 1/13/2020 4:55 PM |
Details | Last Recertification Date | Insert | New Registration | | | 1/13/2020 4:55 PM |
Details | Grant Number | Insert | New Registration | | | 1/13/2020 4:55 PM |
Details | 340B ID | Insert | New Registration | | | 1/13/2020 4:55 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 1/13/2020 4:55 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 1/13/2020 4:55 PM |
Details | Medicare Provider Number | Insert | New Registration | | 181315 | 1/13/2020 4:55 PM |
Details | Entity Name | Insert | New Registration | | FORT LOGAN HOSPITAL | 1/13/2020 4:55 PM |
Details | Program Code | Insert | New Registration | | CAH | 1/13/2020 4:55 PM |
Details | Entity Subname | Insert | New Registration | | RURAL HEALTH CLINIC | 1/13/2020 4:55 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 1/13/2020 4:55 PM |
Details | State | Insert | New Registration | | Pending | 1/13/2020 4:55 PM |
Dates | Registration Date | Insert | New Registration | | 1/13/2020 4:55:58 PM | 1/13/2020 4:55 PM |
Dates | Signed By Date | Insert | New Registration | | | 1/13/2020 4:55 PM |
Dates | Start Date | Insert | New Registration | | | 1/13/2020 4:55 PM |
Terminations | Termination Comments | Insert | New Registration | | | 1/13/2020 4:55 PM |
Terminations | Termination Date | Insert | New Registration | | | 1/13/2020 4:55 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 1/13/2020 4:55 PM |
Terminations | Termination Reason | Insert | New Registration | | | 1/13/2020 4:55 PM |