Covered Entity Details

CH06126F EAST TEXAS COMMUNITY HEALTH SERVICES INC (Approved) - information as of 6/12/2025 9:43:32 PM

Main Details

Name

EAST TEXAS COMMUNITY HEALTH SERVICES INC

Subdivision Name

ETCHS LittleJacks Pediatrics

Type

HRSA-Funded Health Center

Site ID

BPS-H80-038704

340B ID

CH06126F

Grant Number

H80CS00793

Additional Details

Current Program Status

Approved

Registration Date

4/7/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/9/2025

Last Recertification Date

Contacts

Authorizing Official

East Texas Community Health Services, Inc.
Paige Murdock, CFO
(936) 560-5413 Ext: 1138

Primary Contact

East Texas Community Health Services, Inc.
Amelia Commander, COO
(936) 560-5413

Addresses

Street Address

4604 NE Stallings Dr
Nacogdoches, TX 75965-1608

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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?
No

Shipping Addresses

Same as Street Address

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.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH061260	Active	BPS-H80-008873	EAST TEXAS COMMUNITY HEALTH SERVICES, INC	Eastside Community Clinic #2	1309 S University Dr	Nacogdoches	TX
CH06126A	Active	BPS-H80-003865	EAST TEXAS COMMUNITY HEALTH SERVICES, INC	WESTSIDE COMMUNITY CLINIC	1210 Douglass Rd	Nacogdoches	TX
CH06126D	Active	BPS-H80-031745	East Texas Community Health Services, Inc.	Sayers Street Clinic	1717 Sayers Street	Lufkin	TX
CH06126E	Terminated	BPS-H80-024929	East Texas Community Health Services, Inc.	Lufkin Community Clinic - South	205 Shands Dr	Lufkin	TX
CH06126F	Approved	BPS-H80-038704	EAST TEXAS COMMUNITY HEALTH SERVICES INC	ETCHS LittleJacks Pediatrics	4604 NE Stallings Dr	Nacogdoches	TX
CH06126G	Approved	BPS-H80-032064	EAST TEXAS COMMUNITY HEALTH SERVICES INC	ETCHSI Mobile Unit	1309 S University Drive	Nacogdoches	TX
CH06126H	Approved	BPS-H80-004461	EAST TEXAS COMMUNITY HEALTH SERVICES INC	EAST TEXAS COMMUNITY HEALTH SERVICES	1401 S University Dr	Nacogdoches	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date
CH061260	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	01/01/2017
CH06126D	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2018
CH061260	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2018
CH06126D	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018
CH061260	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018
CH061260	WAL-MART PHARMACY 10-0163	4810 NORTH ST		NACOGDOCHES	TX	75965	01/01/2016

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Murdock, Paige CFO East Texas Community Health Services, Inc. 9365605413-1138	4/9/2025 1:46 PM
Details	340B ID	Update	New Registration		CH06126F	4/9/2025 1:46 PM
Dates	Participating Approval Date	Update	New Registration		4/9/2025 1:46:56 PM	4/9/2025 1:46 PM
Details	State	Update	New Registration	Pending	Approved	4/9/2025 1:46 PM
Dates	Signed By Date	Update	New Registration		4/7/2025 10:58:01 AM	4/9/2025 1:46 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/9/2025 1:46 PM
Addresses	Main Address	Insert	New Registration		4604 NE Stallings Dr Nacogdoches, TX 75965-1608	4/7/2025 10:58 AM
Contacts	Authorizing Official	Insert	New Registration		Murdock, Paige CFO East Texas Community Health Services, Inc. 9365605413-1138	4/7/2025 10:58 AM
Contacts	Primary Contact	Insert	New Registration		Commander, Amelia COO East Texas Community Health Services, Inc. 9365605413	4/7/2025 10:58 AM
Details	Assistance Received From Date	Insert	New Registration			4/7/2025 10:58 AM
Details	Assistance Received To Date	Insert	New Registration			4/7/2025 10:58 AM
Details	Last Recertification Date	Insert	New Registration			4/7/2025 10:58 AM
Details	Grant Number	Insert	New Registration		H80CS00793	4/7/2025 10:58 AM
Details	340B ID	Insert	New Registration			4/7/2025 10:58 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/7/2025 10:58 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/7/2025 10:58 AM
Details	Medicare Provider Number	Insert	New Registration			4/7/2025 10:58 AM
Details	Entity Name	Insert	New Registration		EAST TEXAS COMMUNITY HEALTH SERVICES INC	4/7/2025 10:58 AM
Details	NOFO Number	Insert	New Registration			4/7/2025 10:58 AM
Details	Program Code	Insert	New Registration		CH	4/7/2025 10:58 AM
Details	Entity Subname	Insert	New Registration		ETCHS LittleJacks Pediatrics	4/7/2025 10:58 AM
Dates	Participating Approval Date	Insert	New Registration			4/7/2025 10:58 AM
Details	State	Insert	New Registration		Pending	4/7/2025 10:58 AM
Dates	Registration Date	Insert	New Registration		4/7/2025 10:58:01 AM	4/7/2025 10:58 AM
Dates	Signed By Date	Insert	New Registration			4/7/2025 10:58 AM
Dates	Start Date	Insert	New Registration			4/7/2025 10:58 AM
Terminations	Termination Comments	Insert	New Registration			4/7/2025 10:58 AM
Terminations	Termination Date	Insert	New Registration			4/7/2025 10:58 AM
Terminations	Termination Effective Date	Insert	New Registration			4/7/2025 10:58 AM
Terminations	Termination Reason	Insert	New Registration			4/7/2025 10:58 AM

340B Drug Pricing Program Database