Covered Entity Details

DSH450102BV CHRISTUS MOTHER FRANCES HOSP-TYLER (Active) - information as of 6/2/2025 8:28:45 AM

Main Details

Name

CHRISTUS MOTHER FRANCES HOSP-TYLER

Subdivision Name

CHRISTUS MOTHER FRANCES HOSPITAL - Sleep Lab

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH450102BV

Medicare Provider Number

450102

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/11/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/1/2024

Last Recertification Date

Contacts

Authorizing Official

CHRISTUS Mother Frances Health System
Eric Garrison, CFO
(903) 606-4102

Primary Contact

Christus Mother Frances, Jacksonville
Joshua Ward, 340B Coordinator
(903) 606-7591

Addresses

Street Address

18780 I-20
RM #TC233 TC234
CANTON, TX 75103

Billing Address

CHRISTUS MOTHER FRANCES HOSP - TYLER
800 EAST DAWSON
TYLER, TX 75701

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	094108001,094108002,094108004,094108005	1679578439,1104406511

Shipping Addresses

Shipping Address 1

CHRISTUS MOTHER FRANCES HOSP - TYLER
800 EAST DAWSON
TYLER, TX 75701

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
DSH450102A	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Specialty Oncology Surgery	501 S. Saunders Avenue	Tyler	TX	Active
DSH450102AA	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Specialty	1505 S PALESTINE ST	ATHENS	TX	Terminated
DSH450102AB	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Wound Care	733 S FLEISHEL AVE	TYLER	TX	Active
DSH450102AC	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Endocrinology	1327 TROUP HWY	TYLER	TX	Active
DSH450102AD	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Douglas	520 DOUGLAS BLVD	TYLER	TX	Active
DSH450102AE	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Cardiac Diagnostics	1505 S PALESTINE ST	ATHENS	TX	Active
DSH450102AF	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Manhatton	3802 MANHATTON DR	Tyler	TX	Active
DSH450102AG	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	TMP ENDOSCOPY	1720 S. Beckham Avenue	Tyler	TX	Active
DSH450102AH	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Saunders	417 S SAUNDERS AVE	Tyler	TX	Active
DSH450102AJ	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Cardiac Diagnostics - Canton	18780 I-20	CANTON	TX	Active
DSH450102AK	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Louis and Peaches Owen Heart Hospital Clinic Services	703 S FLEISHEL AVE	Tyler	TX	Active
DSH450102AL	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Breast Center - Canton	18780 I-20	Canton	TX	Active
DSH450102AM	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Kilgore	1718 S HENDERSON BLVD	Kilgore	TX	Terminated
DSH450102AN	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Douglas	520 DOUGLAS BLVD	TYLER	TX	Active
DSH450102AP	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Neurology	910 E HOUSTON ST	TYLER	TX	Active
DSH450102AQ	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Imaging	1783 TROUP HWY	Tyler	TX	Active
DSH450102AR	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - General Surgery	910 E HOUSTON ST	TYLER	TX	Active
DSH450102AS	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - HealthPark Plaza	1327 TROUP HWY	TYLER	TX	Active
DSH450102AT	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Mother Frances Medical Arts Plaza - Tyler - Clinic Services	619 S FLEISHEL AVE	Tyler	TX	Active
DSH450102AU	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Mother Frances Medical Arts Plaza - Tyler - Clinic Services - Surgery	619 S FLEISHEL AVE	Tyler	TX	Active
DSH450102AV	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Louis and Peaches Owen Heart Hospital Clinic Services - Electrocardiology	703 S FLEISHEL AVE	Tyler	TX	Active
DSH450102AW	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Mother Frances HealthPark - Lake Palestine Clinic (Physical Medicine & Rehab)	20208 State Highway 155 S	Flint	TX	Active
DSH450102AX	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services	20208 STATE HIGHWAY 155 S	FLINT	TX	Active
DSH450102AY	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - North Park	910 E HOUSTON ST	TYLER	TX	Terminated
DSH450102AZ	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Sleep Center	120 E CHARNWOOD ST	TYLER	TX	Active
DSH450102B	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Chandler	803 HIGHWAY 31 E	CHANDLER	TX	Active
DSH450102BA	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Specialty - North Park Medical Plaza	910 E HOUSTON ST	Tyler	TX	Active
DSH450102BB	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Lindale - Diagnostic Radiology	3203 S MAIN ST	LINDALE	TX	Active
DSH450102BC	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Athens - Physical Therapy	1505 S PALESTINE ST	ATHENS	TX	Active
DSH450102BD	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Pain Management	910 E HOUSTON ST	Tyler	TX	Active
DSH450102BE	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CTC INFECTIOUS DISEASE CLINIC	704 S FLEISHEL AVE	Tyler	TX	Active
DSH450102BF	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS ORTHOPEDICS AND SPORTS MEDICINE INSTITUTE - TYLER	8591 S BROADWAY AVE	Tyler	TX	Active
DSH450102BG	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	LINDALE TRINITY CLINIC - Cardiac Rehab	3203 S MAIN STREET	LINDALE	TX	Active
DSH450102BH	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	LINDALE TRINITY CLINIC - Emergency Care	3203 S MAIN STREET	LINDALE	TX	Active
DSH450102BJ	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	LINDALE TRINITY CLINIC - Cardiovascular Services	3203 S MAIN STREET	LINDALE	TX	Active
DSH450102BK	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS TRINITY MOTHER FRANCES ATHENS - Emergency Care	1509 S PALESTINE ST	ATHENS	TX	Active
DSH450102BL	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	THE CARDIOLOGY ASSOCIATES OF EAST TEXAS - Cardiology Clinic	1783 TROUP HIGHWAY	TYLER	TX	Active
DSH450102BM	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	THE CARDIOLOGY ASSOCIATES OF EAST TEXAS - Cardiac Catheterization	1783 TROUP HIGHWAY	TYLER	TX	Active
DSH450102BN	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS TRINITY MOTHER FRANCES NORTHPARK MEDICAL PLAZA - Infusion Services	910 E. HOUSTON ST	TYLER	TX	Active
DSH450102BP	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS TRINITY MOTHER FRANCES Herrington Ornelas Health Park - Physical Therapy	3593 E GRANDE BLVD	TYLER	TX	Active
DSH450102BQ	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS TRINITY MOTHER FRANCES Herrington Ornelas Health Park - Clinic	3593 E GRANDE BLVD	TYLER	TX	Active
DSH450102BR	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS TRINITY MOTHER FRANCES NORTHPARK MEDICAL PLAZA - Pain Management	910 E. HOUSTON ST	TYLER	TX	Active
DSH450102BS	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL – IMAGING - Nuclear Medicine	501 SAUNDERS AVE	TYLER	TX	Active
DSH450102BT	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - HVI - Cardiac Cath/Cardiology	1783 TROUP HWY	TYLER	TX	Terminated
DSH450102BU	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Infusion	910 E HOUSTON ST	Tyler	TX	Terminated
DSH450102BV	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Sleep Lab	18780 I-20	CANTON	TX	Active
DSH450102BW	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Nuclear Medicine	1327 TROUP HWY	Tyler	TX	Active
DSH450102BX	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Endoscopy	910 E HOUSTON ST	Tyler	TX	Active
DSH450102BZ	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Heart Failure Clinic	619 S FLEISHEL AVE	TYLER	TX	Active
DSH450102C	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Micro Surgery	8389 S BROADWAY AVE	TYLER	TX	Active
DSH450102CA	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Primary Care	3593 E GRANDE BLVD	TYLER	TX	Active
DSH450102CB	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Physical Therapy	1711 S HENDERSON BLVD	KILGORE	TX	Active
DSH450102CC	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Christus Heart & Vascular – EP	1783 TROUP HWY	TYLER	TX	Active
DSH450102CD	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS TRINITY CLINIC - Primary Care	700 S FLEISHEL AVE	TYLER	TX	Active
DSH450102CE	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Orthopedics & Sports Medicine Institute - Podiatry	8591 S. Broadway	Tyler	TX	Approved
DSH450102CF	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Orthopedics & Sports Medicine Institute - Orthopedics & Sports Medicine	8591 S. Broadway	Tyler	TX	Approved
DSH450102CG	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Clinic - Pulmonary	619 S. Fleishel	TYLER	TX	Approved
DSH450102CH	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Clinic - Neurosurgery	910 E. Houston	Tyler	TX	Approved
DSH450102D	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - HealthPark Plaza	1327 TROUP HWY	Tyler	TX	Active
DSH450102E	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Mother Frances Hospital - South Tyler Micro ECC	8389 S BROADWAY AVE	Tyler	TX	Active
DSH450102F	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Lindale	3203 S MAIN ST	LINDALE	TX	Active
DSH450102G	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Louis and Peaches Owen Heart Hospital - Cardiology	703 S FLEISHEL AVE	Tyler	TX	Active
DSH450102H	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Physical Medicine and Rehab - Canton	18780 I-20	Canton	TX	Active
DSH450102J	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services	733 S. Fleishel Ave	Tyler	TX	Active
DSH450102K	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL- South Tyler Imaging	8389 S BROADWAY AVE	TYLER	TX	Active
DSH450102L	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Cardiac Rehab - Canton	18780 I-20	Canton	TX	Active
DSH450102M	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Mother Frances Health Park - Lake Palestine Clinic	20208 State Highway 155 S	Flint	TX	Active
DSH450102N	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	TSQ OUTPATIENT SURGERY CENTER	415 S. Fleishel	Tyler	TX	Active
DSH450102P	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Mother Frances HealthPark - Lake Palestine Clinic- Cardiac Rehab	20208 State Highway 155 S	Flint	TX	Active
DSH450102Q	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Mother Frances Hospital - South Tyler Micro CT	8389 S BROADWAY AVE	Tyler	TX	Active
DSH450102R	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Emergency	18780 I-20	CANTON	TX	Active
DSH450102S	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Athens	1505 S PALESTINE ST	ATHENS	TX	Active
DSH450102T	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Gastroenterology	910 E HOUSTON ST	TYLER	TX	Active
DSH450102U	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Imaging - Canton	18780 I-20	Canton	TX	Active
DSH450102V	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Urology	910 E HOUSTON ST	TYLER	TX	Active
DSH450102W	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Clinic - Broadway Commons - Clinic Services	8288 S BROADWAY AVE	Tyler	TX	Active
DSH450102X	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Breast Center - North Park	910 E HOUSTON ST	TYLER	TX	Active
DSH450102Y	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Mother Frances Hospital - South Tyler Micro MRI	8389 S BROADWAY AVE	Tyler	TX	Active
DSH450102Z	Child	DSH	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Mother Frances Hospital - South Tyler Micro Ultrasound	8389 S BROADWAY AVE	Tyler	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Garrison, Eric CFO CHRISTUS Mother Frances Health System 9036064102	8/1/2024 8:22 AM
Details	340B ID	Update	New Registration		DSH450102BV	8/1/2024 8:22 AM
Details	Entity Subname	Update	New Registration	CHRISTUS MOTHER FRANCES HOSPITAL	CHRISTUS MOTHER FRANCES HOSPITAL - Sleep Lab	8/1/2024 8:22 AM
Dates	Participating Approval Date	Update	New Registration		8/1/2024 8:22:05 AM	8/1/2024 8:22 AM
Details	State	Update	New Registration	Pending	Approved	8/1/2024 8:22 AM
Dates	Signed By Date	Update	New Registration		7/11/2024 10:17:32 AM	8/1/2024 8:22 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/1/2024 8:22 AM
Addresses	Main Address	Insert	New Registration		18780 I-20 RM #TC233 TC234 CANTON, TX 75103	7/11/2024 10:17 AM
Addresses	Billing Address	Insert	New Registration		CHRISTUS MOTHER FRANCES HOSP - TYLER 800 EAST DAWSON TYLER, TX 75701	7/11/2024 10:17 AM
Addresses	Shipping Address	Insert	New Registration		CHRISTUS MOTHER FRANCES HOSP - TYLER 800 EAST DAWSON TYLER, TX 75701	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094108001	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094108002	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094108004	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094108005	7/11/2024 10:17 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	7/11/2024 10:17 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1679578439	7/11/2024 10:17 AM
Medicaid Billing	NPI: State	Insert	New Registration		TX	7/11/2024 10:17 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1104406511	7/11/2024 10:17 AM
Medicaid Billing	NPI: State	Insert	New Registration		TX	7/11/2024 10:17 AM
Contacts	Primary Contact	Insert	New Registration		Ward, Joshua 340B Coordinator Christus Mother Frances, Jacksonville 9036067591	7/11/2024 10:17 AM
Contacts	Authorizing Official	Insert	New Registration		Garrison, Eric CFO CHRISTUS Mother Frances Health System 9036064102	7/11/2024 10:17 AM
Details	Assistance Received From Date	Insert	New Registration			7/11/2024 10:17 AM
Details	Assistance Received To Date	Insert	New Registration			7/11/2024 10:17 AM
Details	Last Recertification Date	Insert	New Registration			7/11/2024 10:17 AM
Details	Grant Number	Insert	New Registration			7/11/2024 10:17 AM
Details	340B ID	Insert	New Registration			7/11/2024 10:17 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/11/2024 10:17 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/11/2024 10:17 AM
Details	Medicare Provider Number	Insert	New Registration		450102	7/11/2024 10:17 AM
Details	Entity Name	Insert	New Registration		CHRISTUS MOTHER FRANCES HOSP-TYLER	7/11/2024 10:17 AM
Details	NOFO Number	Insert	New Registration			7/11/2024 10:17 AM
Details	Program Code	Insert	New Registration		DSH	7/11/2024 10:17 AM
Details	Entity Subname	Insert	New Registration		CHRISTUS MOTHER FRANCES HOSPITAL	7/11/2024 10:17 AM
Dates	Participating Approval Date	Insert	New Registration			7/11/2024 10:17 AM
Details	State	Insert	New Registration		Pending	7/11/2024 10:17 AM
Dates	Registration Date	Insert	New Registration		7/11/2024 10:17:26 AM	7/11/2024 10:17 AM
Dates	Signed By Date	Insert	New Registration			7/11/2024 10:17 AM
Dates	Start Date	Insert	New Registration			7/11/2024 10:17 AM
Terminations	Termination Comments	Insert	New Registration			7/11/2024 10:17 AM
Terminations	Termination Date	Insert	New Registration			7/11/2024 10:17 AM
Terminations	Termination Effective Date	Insert	New Registration			7/11/2024 10:17 AM
Terminations	Termination Reason	Insert	New Registration			7/11/2024 10:17 AM