| Details | Last Recertification Date | Update | Recertification | 8/29/2023 12:05:46 PM | 8/12/2024 1:47:30 PM | 8/12/2024 1:47 PM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2022 5:05:55 PM | 8/29/2023 12:05:46 PM | 8/29/2023 12:05 PM |
| Details | Last Recertification Date | Update | Recertification | 8/27/2021 11:19:20 AM | 8/29/2022 5:05:55 PM | 8/29/2022 5:05 PM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2020 4:05:58 PM | 8/27/2021 11:19:20 AM | 8/27/2021 11:19 AM |
| Contacts | Primary Contact | Update | | Barker, Nick
PHARMACIST
Childress Regional Medical Center
9409379129 | Barker, Nick Patrick
PHARMACIST
Childress Regional Medical Center
9409379129 | 7/26/2021 7:53 AM |
| Contacts | Primary Contact | Update | Change Request | Stratton, Emilee
CFO
Childress Regional Medical Center
9409379181 | Barker, Nick
PHARMACIST
Childress Regional Medical Center
9409379129 | 7/23/2021 12:43 PM |
| Contacts | Authorizing Official | Update | Change Request | Latimer, Kevin
CEO
CHILDRESS REGIONAL MEDICAL CENTER
9409379178 | Stratton, Emilee
CFO
Childress Regional Medical Center
9409379181 | 7/23/2021 10:04 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1902995525 | 8/18/2020 4:05 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | TX | 8/18/2020 4:05 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1902995525 ( ) | | 8/18/2020 4:05 PM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2019 8:57:57 AM | 8/18/2020 4:05:58 PM | 8/18/2020 4:05 PM |
| Details | Last Recertification Date | Update | Recertification | 8/15/2018 5:08:27 PM | 8/31/2019 8:57:57 AM | 8/31/2019 8:57 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/21/2019 3:22 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 108081402 | 3/21/2019 3:22 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | TX | 3/21/2019 3:22 PM |
| Details | Last Recertification Date | Update | Recertification | 11/3/2017 7:55:09 AM | 8/15/2018 5:08:27 PM | 8/15/2018 5:08 PM |
| Contacts | Primary Contact | Update | Change Request | HENDERSON, JOHN
CEO
Childress Regional Medical Center
9409379178 | Stratton, Emilee
CFO
Childress Regional Medical Center
9409379181 | 4/2/2018 12:44 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Latimer, Kevin
CEO
CHILDRESS REGIONAL MEDICAL CENTER
9409379181 | Latimer, Kevin
CEO
CHILDRESS REGIONAL MEDICAL CENTER
9409379178 | 4/2/2018 12:38 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Latimer, Kevin
CFO
CHILDRESS REGIONAL MEDICAL CENTER
9409379181 | Latimer, Kevin
CEO
CHILDRESS REGIONAL MEDICAL CENTER
9409379181 | 4/2/2018 12:38 PM |
| Details | Last Recertification Date | Update | Recertification | 10/24/2017 11:16:46 AM | 11/3/2017 7:55:09 AM | 11/3/2017 7:55 AM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2016 12:00:00 AM | 10/24/2017 11:16:46 AM | 10/24/2017 11:16 AM |
| Details | Entity Name | Update | Change Request | CHILDRESS COUNTY HOSPITAL DISTRICT DBA CHILDRESS REGIONAL MEDICAL CENTER | CHILDRESS REGIONAL MEDICAL CENTER | 10/7/2017 3:18 PM |
| Contacts | Primary Contact | Update | | HENDERSON, JOHN
CEO
9409379178 | HENDERSON, JOHN
CEO
Childress Regional Medical Center
9409379178 | 10/7/2017 11:00 AM |
| Contacts | Authorizing Official | Update | | Latimer, Kevin
CFO
9409379181 | Latimer, Kevin
CFO
CHILDRESS REGIONAL MEDICAL CENTER
9409379181 | 10/7/2017 10:27 AM |
| Contacts | Authorizing Official | Insert | | | Latimer, Kevin
CFO
9409379181 | 4/7/2017 5:02 PM |
| Addresses | Main Address | Insert | | |
1001 US HWY 83 NORTH
CHILDRESS, TX 79201 | 8/17/2016 9:46 AM |
| Contacts | Primary Contact | Update | | Barker, Nick
PHARMACIST
9409379229 | HENDERSON, JOHN
CEO
9409379178 | 8/17/2016 9:46 AM |
| Details | Last Recertification Date | Update | | | 8/17/2016 12:00:00 AM | 8/17/2016 9:46 AM |
| Details | Last Recertification Date | Update | | 8/5/2015 12:00:00 AM | | 3/15/2016 2:04 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | 8/21/2015 12:00:00 AM | | 3/15/2016 2:04 PM |
| Details | State | Update | | Terminated | Active | 3/15/2016 2:04 PM |
| Dates | Start Date | Update | | 12/6/2005 12:00:00 AM | 4/1/2016 12:00:00 AM | 3/15/2016 2:04 PM |
| Terminations | Termination Comments | Update | | Entity is registering as a SCH. | | 3/15/2016 2:04 PM |
| Terminations | Termination Date | Update | | 10/1/2015 12:00:00 AM | | 3/15/2016 2:04 PM |
| Terminations | Termination Effective Date | Update | | 8/21/2015 12:00:00 AM | | 3/15/2016 2:04 PM |
| Terminations | Termination Reason | Update | | Change of covered entity type | | 3/15/2016 2:04 PM |
| Details | Comments Public | Insert | | | 3/15/16 Participated as DSH450369A starting 12/6/2005, Terminated 10/1/2015 through 3/31/2016 due to change of entity type to SCH, Participated as SCH450369-01 10/1/2015 to 3/31/2016, reinstated as DSH effective on 4/1/2016 | 3/15/2016 2:04 PM |
| Contacts | Primary Contact | Update | | CALLOWAY, BAXTER
PHARMACIST
9409376371 | Barker, Nick
PHARMACIST
9409379229 | 8/21/2015 1:52 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 8/21/2015 12:00:00 AM | 8/21/2015 1:52 PM |
| Details | State | Update | | Active | Terminated | 8/21/2015 1:52 PM |
| Terminations | Termination Comments | Update | | | Entity is registering as a SCH. | 8/21/2015 1:52 PM |
| Terminations | Termination Date | Update | | | 10/1/2015 12:00:00 AM | 8/21/2015 1:52 PM |
| Terminations | Termination Effective Date | Update | | | 8/21/2015 12:00:00 AM | 8/21/2015 1:52 PM |
| Terminations | Termination Reason | Update | | | Change of covered entity type | 8/21/2015 1:52 PM |
| Details | Last Recertification Date | Update | | 8/26/2014 12:00:00 AM | 8/5/2015 12:00:00 AM | 8/5/2015 9:18 AM |
| Details | Last Recertification Date | Update | | 8/19/2013 9:18:01 AM | 8/26/2014 12:00:00 AM | 8/26/2014 10:49 AM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 8/19/2013 9:18:01 AM | 8/19/2013 9:18 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/29/2012 1:06 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1902995525 | 3/23/2012 3:57 PM |
| Details | Comments Public | Insert | | | 3/23/12 UPDATED MAIN ADD (WAS HIGHWAY 83 NORTH), ADDED NPI# | 3/23/2012 3:57 PM |
| Contacts | Primary Contact | Insert | | | CALLOWAY, BAXTER
PHARMACIST
9409376371 | 9/4/2008 4:42 PM |
| Details | Last Recertification Date | Insert | | | | 9/4/2008 4:42 PM |
| Details | Grant Number | Insert | | | | 9/4/2008 4:42 PM |
| Details | 340B ID | Insert | | | DSH450369A | 9/4/2008 4:42 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 9/4/2008 4:42 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 9/4/2008 4:42 PM |
| Details | Medicare Provider Number | Insert | | | 450369 | 9/4/2008 4:42 PM |
| Details | Entity Name | Insert | | | CHILDRESS COUNTY HOSPITAL DISTRICT DBA CHILDRESS REGIONAL MEDICAL CENTER | 9/4/2008 4:42 PM |
| Details | Program Code | Insert | | | DSH | 9/4/2008 4:42 PM |
| Details | Entity Subname | Insert | | | FOX RURAL HEALTH CLINIC | 9/4/2008 4:42 PM |
| Dates | Participating Approval Date | Insert | | | 12/6/2005 12:00:00 AM | 9/4/2008 4:42 PM |
| Details | State | Insert | | | Active | 9/4/2008 4:42 PM |
| Dates | Registration Date | Insert | | | 12/6/2005 12:00:00 AM | 9/4/2008 4:42 PM |
| Dates | Signed By Date | Insert | | | 11/30/2005 12:00:00 AM | 9/4/2008 4:42 PM |
| Dates | Start Date | Insert | | | 12/6/2005 12:00:00 AM | 9/4/2008 4:42 PM |
| Terminations | Termination Comments | Insert | | | | 9/4/2008 4:42 PM |
| Terminations | Termination Date | Insert | | | | 9/4/2008 4:42 PM |
| Terminations | Termination Effective Date | Insert | | | | 9/4/2008 4:42 PM |
| Terminations | Termination Reason | Insert | | | | 9/4/2008 4:42 PM |