No
Details | Last Recertification Date | Update | Recertification | 1/31/2024 12:11:09 PM | 2/10/2025 3:18:00 PM | 2/10/2025 3:18 PM |
Details | Last Recertification Date | Update | Recertification | 2/8/2023 12:17:57 PM | 1/31/2024 12:11:09 PM | 1/31/2024 12:11 PM |
Details | Last Recertification Date | Update | Recertification | 2/1/2022 4:23:34 PM | 2/8/2023 12:17:57 PM | 2/8/2023 12:17 PM |
Details | Last Recertification Date | Update | Recertification | 2/3/2021 9:50:48 AM | 2/1/2022 4:23:34 PM | 2/1/2022 4:23 PM |
Details | Last Recertification Date | Update | Recertification | | 2/3/2021 9:50:48 AM | 2/3/2021 9:50 AM |
Details | State | Update | | Approved | Active | 4/1/2020 12:05 AM |
Contacts | Signed By | Insert | New Registration | | DYER, DONNA
CEO
East Central Oklahoma Family Health Center, Inc,
4054523151-4101 | 2/28/2020 5:06 PM |
Details | 340B ID | Update | New Registration | | CHC10583-02 | 2/28/2020 5:06 PM |
Dates | Participating Approval Date | Update | New Registration | | 2/28/2020 5:06:10 PM | 2/28/2020 5:06 PM |
Details | State | Update | New Registration | Pending | Approved | 2/28/2020 5:06 PM |
Dates | Signed By Date | Update | New Registration | | 1/23/2020 10:11:59 AM | 2/28/2020 5:06 PM |
Dates | Start Date | Update | New Registration | | 4/1/2020 12:00:00 AM | 2/28/2020 5:06 PM |
Addresses | Main Address | Insert | New Registration | |
1102 W Main St
Henryetta, OK 74437-4232 | 1/23/2020 10:11 AM |
Addresses | Billing Address | Insert | New Registration | | East Central Oklahoma Family Health Center
120 E. Broadway
PO Box 236
Wetumka, OK 74883-0236 | 1/23/2020 10:11 AM |
Contacts | Primary Contact | Insert | New Registration | | Hicks, Denice
CFO
East Central Oklahoma Family Health Center, Inc
4054523151-4102 | 1/23/2020 10:11 AM |
Contacts | Authorizing Official | Insert | New Registration | | DYER, DONNA
CEO
East Central Oklahoma Family Health Center, Inc,
4054523151-4101 | 1/23/2020 10:11 AM |
Details | Last Recertification Date | Insert | New Registration | | | 1/23/2020 10:11 AM |
Details | Grant Number | Insert | New Registration | | H80CS10583 | 1/23/2020 10:11 AM |
Details | 340B ID | Insert | New Registration | | | 1/23/2020 10:11 AM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 1/23/2020 10:11 AM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 1/23/2020 10:11 AM |
Details | Medicare Provider Number | Insert | New Registration | | | 1/23/2020 10:11 AM |
Details | Entity Name | Insert | New Registration | | EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER INC | 1/23/2020 10:11 AM |
Details | Program Code | Insert | New Registration | | CH | 1/23/2020 10:11 AM |
Details | Entity Subname | Insert | New Registration | | ECO Family Health Center-Henryetta Behavioral Health Services | 1/23/2020 10:11 AM |
Dates | Participating Approval Date | Insert | New Registration | | | 1/23/2020 10:11 AM |
Details | State | Insert | New Registration | | Pending | 1/23/2020 10:11 AM |
Dates | Registration Date | Insert | New Registration | | 1/23/2020 10:11:57 AM | 1/23/2020 10:11 AM |
Dates | Signed By Date | Insert | New Registration | | | 1/23/2020 10:11 AM |
Dates | Start Date | Insert | New Registration | | | 1/23/2020 10:11 AM |
Terminations | Termination Comments | Insert | New Registration | | | 1/23/2020 10:11 AM |
Terminations | Termination Date | Insert | New Registration | | | 1/23/2020 10:11 AM |
Terminations | Termination Effective Date | Insert | New Registration | | | 1/23/2020 10:11 AM |
Terminations | Termination Reason | Insert | New Registration | | | 1/23/2020 10:11 AM |