Covered Entity Details

DSH450801AT CHRISTUS ST MICHAEL (Active) - information as of 6/18/2025 1:15:43 AM

Main Details

Name

CHRISTUS ST MICHAEL

Subdivision Name

CHRISTUS St. Michael Outpatient Infusion - Oncology Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450801AT

Medicare Provider Number

450801

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/11/2024

Participating Start Date

4/1/2024

Participating Approval Date

3/5/2024

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

CHRISTUS St. Michael
Jason Adams, President
(903) 614-2001

Primary Contact

CHRISTUS St Michael
Carly Armstrong, Coordinator Pharmacy 340B Program
(903) 614-2929

Addresses

Street Address

2602 St. Michael Dr
Ste 249
Texarkana, TX 75503

Billing Address

CHRISTUS St. Michael Health System
2600 ST MICHAEL DRIVE
TEXARKANA, TX 75503

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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
TX	020976901,020976902,020976903,094644402,094353202	1295736734,1467591396,1689702334
LA	1733229	1295736734,1467591396,1689702334
AR	146008105	1295736734

Shipping Addresses

Shipping Address 1

CHRISTUS St. Michael Health System
2600 ST MICHAEL DRIVE
TEXARKANA, TX 75503

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH450801A	Child	DSH	CHRISTUS ST MICHAEL	W. Temple Cancer Treatment Center-Chemo	2604 ST MICHAEL DR	TEXARKANA	TX	Active
DSH450801AA	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Med Surg	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801AB	Child	DSH	CHRISTUS ST MICHAEL	Respiratory Therapy	1007 South William Street	Atlanta	TX	Active
DSH450801AC	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS ST MICHAEL OUTPATIENT INFU	2602 SAINT MICHAEL DR	TEXARKANA	TX	Active
DSH450801AD	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS St. Michael Oncology Clinic W - Clinic	5002 Cowhorn Creek Road	Texarkana	TX	Active
DSH450801AE	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS St. Michael Endocrinology Clinic - Endocrinology	2602 St. Michael Drive	Texarkana	TX	Active
DSH450801AF	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS St. Michael Pain Management Clinic	2604 St. Michael Drive	Texarkana	TX	Active
DSH450801AG	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS St. Michael Orthopedic Surgery Clinic	2602 St. Michael Drive	Texarkana	TX	Active
DSH450801AH	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS St. Michael Neurosurgery Clinic	2602 St. Michael Drive	Texarkana	TX	Active
DSH450801AJ	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS St. Michael Pulmonology and Sleep Medicine Clinic - Pulmonology, Sleep Medicine Clinic	2602 St. Michael Drive	Texarkana	TX	Terminated
DSH450801AK	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS St. Michael Cardiovascular and Thoracic Surgery Clinic	2604 St. Michael Drive	Texarkana	TX	Active
DSH450801AL	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS St. Michael Rheumatology Clinic - Rheumatology	5002 Cowhorn Creek	Texarkana	TX	Terminated
DSH450801AM	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS St. Michael Neurology Clinic	5002 Cowhorn Creek Rd.	Texarkana	TX	Active
DSH450801AN	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS ST MICHAEL NEUROSURGERY CLINIC - Neurosurgery	2604 SAINT MICHAEL DR	TEXARKANA	TX	Active
DSH450801AP	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS ST MICHAEL ONCOLOGY CLINIC	2602 SAINT MICHAEL DR	TEXARKANA	TX	Active
DSH450801AQ	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Non-Oncology Outpatient Infusion	1007 William St.	ATLANTA	TX	Active
DSH450801AR	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS HEALTH ARK-LA-TEX - W. Temple Cancer Treatment Center-Radiation	2604 SAINT MICHAEL DR, FL 1	TEXARKANA	TX	Active
DSH450801AS	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS HEALTH ARK-LA-TEX - CHRISTUS St. Michael Oncology Clinic W - Infusion	5002 COWHORN CREEK RD, STE 3205	TEXARKANA	TX	Active
DSH450801AT	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS St. Michael Outpatient Infusion - Oncology Clinic	2602 St. Michael Dr	Texarkana	TX	Active
DSH450801AU	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS HEALTH ARK-LA-TEX - CHRISTUS St. Michael Oncology Clinic - Infusion Services	2602 SAINT MICHAEL DR	TEXARKANA	TX	Active
DSH450801AV	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS HEALTH ARK-LA-TEX - W. Temple Cancer Treatment Center-Infusion	2604 SAINT MICHAEL DR, FL 1	TEXARKANA	TX	Active
DSH450801AW	Child	DSH	CHRISTUS ST MICHAEL	CTC VASCULAR SURGERY - Vascular Surgery	5002 COWHORN CREEK RD	TEXARKANA	TX	Active
DSH450801AX	Child	DSH	CHRISTUS ST MICHAEL	NST/MFM - Maternal Fetal Medicine CLINIC	2602 SAINT MICHAEL DR	TEXARKANA	TX	Active
DSH450801AY	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS TRINITY CLINIC-CARDIOLOGY - Cardiology	2604 SAINT MICHAEL DR	TEXARKANA	TX	Active
DSH450801B	Child	DSH	CHRISTUS ST MICHAEL	W. Temple Cancer Treatment Center-Rad Therapy	2604 ST MICHAEL DR	TEXARKANA	TX	Active
DSH450801C	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS ST MICHAEL OUTPATIENT IMAG	2500 ST MICHAEL DR	TEXARKANA	TX	Active
DSH450801D	Child	DSH	CHRISTUS ST MICHAEL	Senior Health Center	2604 SAINT MICHAEL DRIVE, STE 239	TEXARKANA	TX	Terminated
DSH450801E	Child	DSH	CHRISTUS ST MICHAEL	CHRISTUS ST MICHAEL SLEEP LAB	2604 ST MICHAEL DR	TEXARKANA	TX	Active
DSH450801F	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Emergency	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801G	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Surgery General	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Terminated
DSH450801H	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Lab General	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801J	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Hematology	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801K	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Microbiology	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801L	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Chemistry	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801M	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - TOT Therapy	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801N	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Reference Lab	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801P	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Blood Bank	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801Q	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Wound Care	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Terminated
DSH450801R	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Neurophysiology	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Terminated
DSH450801S	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Radiology Diag	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801T	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Sleep Lab	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801U	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Mammography	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801V	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Ultrasound	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801W	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - MRI	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801X	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Cat Scanner	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801Y	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Resp Thrpy	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active
DSH450801Z	Child	DSH	CHRISTUS ST MICHAEL	Atlanta - Phys Thrpy	1007 SOUTH WILLIAMS STREET	ATLANTA	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Dates	Last Date That 340B Drugs Purchased	Update	OPA Cancel Termination Request	1/1/2025 12:00:00 AM		11/12/2024 10:52 AM
Details	State	Update	OPA Cancel Termination Request	To Be Terminated	Active	11/12/2024 10:52 AM
Terminations	Termination Date	Update	OPA Cancel Termination Request	1/1/2025 12:00:00 AM		11/12/2024 10:52 AM
Terminations	Termination Effective Date	Update	OPA Cancel Termination Request	1/1/2025 12:00:00 AM		11/12/2024 10:52 AM
Terminations	Termination Reason	Update	OPA Cancel Termination Request	Change of covered entity type		11/12/2024 10:52 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	10/23/2024 10:34 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	10/23/2024 10:34 AM
Terminations	Termination Date	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	10/23/2024 10:34 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	10/23/2024 10:34 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	10/23/2024 10:34 AM
Contacts	Primary Contact	Update	Profile Change Request	Armstrong, Carly Pharmacy Buyer Senior CHRISTUS St Michael 9036142929	Armstrong, Carly Coordinator Pharmacy 340B Program CHRISTUS St Michael 9036142929	8/15/2024 10:49 AM
Details	Last Recertification Date	Update	Recertification		8/14/2024 4:18:11 PM	8/14/2024 4:18 PM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Adams, Jason President CHRISTUS St. Michael 9036142001	3/5/2024 4:24 PM
Details	340B ID	Update	New Registration		DSH450801AT	3/5/2024 4:24 PM
Details	Entity Subname	Update	New Registration	CHRISTUS St. Michael Outpatient Infusion	CHRISTUS St. Michael Outpatient Infusion - Oncology Clinic	3/5/2024 4:24 PM
Dates	Participating Approval Date	Update	New Registration		3/5/2024 4:24:03 PM	3/5/2024 4:24 PM
Details	State	Update	New Registration	Pending	Approved	3/5/2024 4:24 PM
Dates	Signed By Date	Update	New Registration		2/5/2024 12:01:41 PM	3/5/2024 4:24 PM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	3/5/2024 4:24 PM
Addresses	Main Address	Insert	New Registration		2602 St. Michael Dr Ste 249 Texarkana, TX 75503	1/11/2024 5:26 PM
Addresses	Billing Address	Insert	New Registration		CHRISTUS St. Michael Health System 2600 ST MICHAEL DRIVE TEXARKANA, TX 75503	1/11/2024 5:26 PM
Addresses	Shipping Address	Insert	New Registration		CHRISTUS St. Michael Health System 2600 ST MICHAEL DRIVE TEXARKANA, TX 75503	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		020976901	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		020976902	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		020976903	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094644402	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094353202	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1733229	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		146008105	1/11/2024 5:26 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AR	1/11/2024 5:26 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1295736734	1/11/2024 5:26 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	1/11/2024 5:26 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467591396	1/11/2024 5:26 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	1/11/2024 5:26 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1689702334	1/11/2024 5:26 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	1/11/2024 5:26 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1295736734	1/11/2024 5:26 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	1/11/2024 5:26 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467591396	1/11/2024 5:26 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	1/11/2024 5:26 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1689702334	1/11/2024 5:26 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	1/11/2024 5:26 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1295736734	1/11/2024 5:26 PM
Medicaid Billing	NPI: State	Insert	New Registration		AR	1/11/2024 5:26 PM
Contacts	Authorizing Official	Insert	New Registration		Adams, Jason President CHRISTUS St. Michael 9036142001	1/11/2024 5:26 PM
Contacts	Primary Contact	Insert	New Registration		Armstrong, Carly Pharmacy Buyer Senior CHRISTUS St Michael 9036142929	1/11/2024 5:26 PM
Details	Assistance Received From Date	Insert	New Registration			1/11/2024 5:26 PM
Details	Assistance Received To Date	Insert	New Registration			1/11/2024 5:26 PM
Details	Last Recertification Date	Insert	New Registration			1/11/2024 5:26 PM
Details	Grant Number	Insert	New Registration			1/11/2024 5:26 PM
Details	340B ID	Insert	New Registration			1/11/2024 5:26 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/11/2024 5:26 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/11/2024 5:26 PM
Details	Medicare Provider Number	Insert	New Registration		450801	1/11/2024 5:26 PM
Details	Entity Name	Insert	New Registration		CHRISTUS ST MICHAEL	1/11/2024 5:26 PM
Details	NOFO Number	Insert	New Registration			1/11/2024 5:26 PM
Details	Program Code	Insert	New Registration		DSH	1/11/2024 5:26 PM
Details	Entity Subname	Insert	New Registration		CHRISTUS St. Michael Outpatient Infusion	1/11/2024 5:26 PM
Dates	Participating Approval Date	Insert	New Registration			1/11/2024 5:26 PM
Details	State	Insert	New Registration		Pending	1/11/2024 5:26 PM
Dates	Registration Date	Insert	New Registration		1/11/2024 5:26:09 PM	1/11/2024 5:26 PM
Dates	Signed By Date	Insert	New Registration			1/11/2024 5:26 PM
Dates	Start Date	Insert	New Registration			1/11/2024 5:26 PM
Terminations	Termination Comments	Insert	New Registration			1/11/2024 5:26 PM
Terminations	Termination Date	Insert	New Registration			1/11/2024 5:26 PM
Terminations	Termination Effective Date	Insert	New Registration			1/11/2024 5:26 PM
Terminations	Termination Reason	Insert	New Registration			1/11/2024 5:26 PM