| Contacts | Primary Contact | Update | Recertification | McCullough, Mary
Administrative Manager
ChesPenn Health Services
6104853800-629 | Harris McGovern, Susan
President and CEO
ChesPenn Health Services
6104853800-632 | 2/20/2025 10:36 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2024 8:31:27 AM | 2/20/2025 10:36:32 AM | 2/20/2025 10:36 AM |
| Contacts | Authorizing Official | Update | Change Request | Harris McGovern, Susan
President and CEO
ChesPenn Health Services
6104853800-632 | Ruvolo, David
Compliance Officer
ChesPenn Health Services
6104853800-635 | 4/15/2024 10:00 AM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2023 10:40:36 AM | 1/31/2024 8:31:27 AM | 1/31/2024 8:31 AM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2022 8:44:59 AM | 2/2/2023 10:40:36 AM | 2/2/2023 10:40 AM |
| Contacts | Authorizing Official | Update | Change Request | Brink, Cindy
Compliance Officer
ChesPenn Health Services
6104853800-635 | Harris McGovern, Susan
President and CEO
ChesPenn Health Services
6104853800-632 | 1/6/2023 11:10 AM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2021 12:20:58 PM | 2/4/2022 8:44:59 AM | 2/4/2022 8:44 AM |
| Details | Last Recertification Date | Update | Recertification | 2/6/2020 2:04:31 PM | 2/16/2021 12:20:58 PM | 2/16/2021 12:20 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Brink, Cindy
Contracts and Compliance Manager
ChesPenn Health Services
6104853800-635 | Brink, Cindy
Compliance Officer
ChesPenn Health Services
6104853800-635 | 2/5/2021 2:04 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Lucas, Michael G.
CEO and President
ChesPenn Health Services
6104853800-630 | Brink, Cindy
Contracts and Compliance Manager
ChesPenn Health Services
6104853800-635 | 2/12/2020 11:23 AM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2019 8:21:31 AM | 2/6/2020 2:04:31 PM | 2/6/2020 2:04 PM |
| Details | Last Recertification Date | Update | Recertification | 3/5/2018 1:09:42 PM | 2/5/2019 8:21:31 AM | 2/5/2019 8:21 AM |
| Addresses | Main Address | Update | Recertification |
2600 W 9th St
Chester, PA 19013-2040 |
1510 Chester Pike, Suite 200
Eddystone, PA 19022 | 3/5/2018 1:09 PM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2017 12:00:00 AM | 3/5/2018 1:09:42 PM | 3/5/2018 1:09 PM |
| Contacts | Primary Contact | Update | | McCullough, Mary
Administrative Manager
6104853800-629 | McCullough, Mary
Administrative Manager
ChesPenn Health Services
6104853800-629 | 2/7/2018 2:59 PM |
| Contacts | Authorizing Official | Update | | Lucas, Michael G.
CEO and President
6104853800-630 | Lucas, Michael G.
CEO and President
ChesPenn Health Services
6104853800-630 | 2/7/2018 2:35 PM |
| Contacts | Authorizing Official | Insert | | | Lucas, Michael G.
CEO and President
6104853800-630 | 2/22/2017 1:05 PM |
| Contacts | Primary Contact | Update | | SMITH, ROBERT J.
EXECUTIVE DIRECTOR
6108761600-30 | McCullough, Mary
Administrative Manager
6104853800-629 | 2/21/2017 9:52 AM |
| Addresses | Main Address | Insert | | |
2600 W 9th St
Chester, PA 19013-2040 | 2/21/2017 8:42 AM |
| Details | Last Recertification Date | Update | | 2/17/2016 12:00:00 AM | 2/21/2017 12:00:00 AM | 2/21/2017 8:42 AM |
| Details | Last Recertification Date | Update | | 2/10/2015 12:00:00 AM | 2/17/2016 12:00:00 AM | 2/17/2016 11:13 AM |
| Details | Last Recertification Date | Update | | 3/19/2014 12:00:00 AM | 2/10/2015 12:00:00 AM | 2/10/2015 1:58 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/19/2014 12:00:00 AM | 3/19/2014 2:55 PM |
| Details | Entity Subname | Update | | ADMINISTRATIVE OFFICE | CHESPENN HEALTH SERVICES | 3/19/2014 2:55 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/4/2013 8:05 AM |
| Dates | Participating Approval Date | Update | | 12/17/2004 9:54:54 AM | 12/17/2004 12:00:00 AM | 1/31/2013 8:06 AM |
| Contacts | Primary Contact | Insert | | | SMITH, ROBERT J.
EXECUTIVE DIRECTOR
6108761600-30 | 8/11/2005 2:33 PM |
| Details | Last Recertification Date | Insert | | | | 12/17/2004 9:54 AM |
| Details | Grant Number | Insert | | | H80CS00738 | 12/17/2004 9:54 AM |
| Details | 340B ID | Insert | | | CH033930 | 12/17/2004 9:54 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 12/17/2004 9:54 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 12/17/2004 9:54 AM |
| Details | Medicare Provider Number | Insert | | | | 12/17/2004 9:54 AM |
| Details | Entity Name | Insert | | | CHESPENN HEALTH SERVICES | 12/17/2004 9:54 AM |
| Details | Program Code | Insert | | | CH | 12/17/2004 9:54 AM |
| Details | Entity Subname | Insert | | | ADMINISTRATIVE OFFICE | 12/17/2004 9:54 AM |
| Dates | Participating Approval Date | Insert | | | 12/17/2004 9:54:54 AM | 12/17/2004 9:54 AM |
| Details | State | Insert | | | Active | 12/17/2004 9:54 AM |
| Dates | Registration Date | Insert | | | 1/1/2003 12:00:00 AM | 12/17/2004 9:54 AM |
| Dates | Signed By Date | Insert | | | | 12/17/2004 9:54 AM |
| Dates | Start Date | Insert | | | 1/1/2003 12:00:00 AM | 12/17/2004 9:54 AM |
| Terminations | Termination Comments | Insert | | | | 12/17/2004 9:54 AM |
| Terminations | Termination Date | Insert | | | | 12/17/2004 9:54 AM |
| Terminations | Termination Effective Date | Insert | | | | 12/17/2004 9:54 AM |
| Terminations | Termination Reason | Insert | | | | 12/17/2004 9:54 AM |
| Details | Comments Public | Insert | | | 12/17/04 - ADMIN CORRECTION - REPLACES CH03393B | 12/17/2004 9:54 AM |