| Addresses | Shipping Address | Insert | Change Request | | CHRISTUS HOSPITAL-ORANGE Pharmacy
6901 MEDICAL CENTER DR
STE 100
ORANGE, TX 77630-1410 | 1/21/2025 7:25 AM |
| Addresses | Shipping Address | Insert | Change Request | | CHRISTUS HOSPITAL
2830 CALDER STREET
BEAUMONT, TX 77702-1048 | 1/21/2025 7:25 AM |
| Details | Last Recertification Date | Update | Recertification | 9/6/2023 4:41:00 PM | 8/23/2024 2:24:46 PM | 8/23/2024 2:24 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Kalathra, Santosh
Clinical/Operations Pharmacy Supervisor
CHRISTUS Health
4098997042 | Kalathra, Santosh
Director of Pharmacy
CHRISTUS Health
4092367042 | 8/20/2024 10:30 AM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2022 3:11:10 PM | 9/6/2023 4:41:00 PM | 9/6/2023 4:41 PM |
| Medicaid Billing | NPI: Number | Insert | Group Change Request | | 1679557888 | 1/5/2023 4:56 PM |
| Medicaid Billing | NPI: State | Insert | Group Change Request | | LA | 1/5/2023 4:56 PM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2021 11:18:50 AM | 9/1/2022 3:11:10 PM | 9/1/2022 3:11 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Group Change Request | | False | 5/20/2022 12:28 PM |
| Medicaid Billing | Medicaid: Number | Insert | Group Change Request | | 1732320 | 5/20/2022 12:28 PM |
| Medicaid Billing | Medicaid: State | Insert | Group Change Request | | LA | 5/20/2022 12:28 PM |
| Details | Last Recertification Date | Update | Recertification | | 8/16/2021 11:18:50 AM | 8/16/2021 11:18 AM |
| Details | State | Update | | Approved | Active | 5/25/2021 12:01 AM |
| Dates | Start Date | Update | OPA Edit | 7/1/2021 12:00:00 AM | 5/25/2021 12:00:00 AM | 5/21/2021 12:31 PM |
| Details | Comments Public | Insert | OPA Edit | | Participating from effective date: (04/01/2015) until terminated effective date: (01/01/2018), reinstatement effective date: (05/25/2021) | 5/21/2021 12:31 PM |
| Contacts | Primary Contact | Update | Change Request | Welch, Tommy
Director of Pharmacy
CHRISTUS Hospital
4098997042 | Kalathra, Santosh
Clinical/Operations Pharmacy Supervisor
CHRISTUS Health
4098997042 | 5/4/2021 9:24 AM |
| Medicaid Billing | NPI: State | Update | Hospital Type Change Request | | TX | 4/7/2021 1:24 PM |
| Contacts | Signed By | Insert | Hospital Type Change Request | | Trevino, Paul
CEO, CHRISTUS Health Southeast Texas
CHRISTUS Hospital
4098997102 | 4/7/2021 1:24 PM |
| Details | Last Recertification Date | Update | Hospital Type Change Request | 8/30/2016 12:00:00 AM | | 4/7/2021 1:24 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | 11/28/2017 12:00:00 AM | | 4/7/2021 1:24 PM |
| Dates | Participating Approval Date | Update | Hospital Type Change Request | 3/9/2009 12:00:00 AM | 4/7/2021 1:24:45 PM | 4/7/2021 1:24 PM |
| Details | State | Update | Hospital Type Change Request | Terminated | Approved | 4/7/2021 1:24 PM |
| Dates | Registration Date | Update | Hospital Type Change Request | 6/6/2006 12:00:00 AM | 4/6/2021 1:12:56 PM | 4/7/2021 1:24 PM |
| Dates | Signed By Date | Update | Hospital Type Change Request | 2/5/2009 12:00:00 AM | 4/6/2021 1:12:59 PM | 4/7/2021 1:24 PM |
| Dates | Start Date | Update | Hospital Type Change Request | 4/1/2015 12:00:00 AM | 7/1/2021 12:00:00 AM | 4/7/2021 1:24 PM |
| Terminations | Termination Date | Update | Hospital Type Change Request | 1/1/2018 12:00:00 AM | | 4/7/2021 1:24 PM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | 11/30/2017 12:00:00 AM | | 4/7/2021 1:24 PM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | DSH percentage below statutory minimum | | 4/7/2021 1:24 PM |
| Contacts | Authorizing Official | Update | Hospital Type Change Request | Trevino, Paul
Regional CEO
CHRISTUS Hospital
4098997102 | Trevino, Paul
CEO, CHRISTUS Health Southeast Texas
CHRISTUS Hospital
4098997102 | 7/13/2018 9:43 AM |
| Contacts | Primary Contact | Update | Hospital Type Change Request | Welch, Tommy
Director of Pharmacy
4098997042 | Welch, Tommy
Director of Pharmacy
CHRISTUS Hospital
4098997042 | 7/13/2018 9:43 AM |
| Details | State | Update | | To Be Terminated | Terminated | 1/1/2018 12:00 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 11/28/2017 12:00:00 AM | 11/29/2017 9:00 PM |
| Details | State | Update | Recertification | Active | To Be Terminated | 11/29/2017 9:00 PM |
| Terminations | Termination Date | Update | Recertification | | 1/1/2018 12:00:00 AM | 11/29/2017 9:00 PM |
| Terminations | Termination Effective Date | Update | Recertification | | 11/30/2017 12:00:00 AM | 11/29/2017 9:00 PM |
| Terminations | Termination Reason | Update | Recertification | | DSH percentage below statutory minimum | 11/29/2017 9:00 PM |
| Contacts | Authorizing Official | Update | | Trevino, Paul
Regional CEO
4098997102 | Trevino, Paul
Regional CEO
CHRISTUS Hospital
4098997102 | 10/6/2017 9:36 AM |
| Contacts | Authorizing Official | Insert | | | Trevino, Paul
Regional CEO
4098997102 | 8/11/2017 3:29 PM |
| Contacts | Primary Contact | Update | | WELCH, TOMMY
DIRECTOR OF PHARMACY
4098997042 | Welch, Tommy
Director of Pharmacy
4098997042 | 8/2/2017 2:37 PM |
| Addresses | Main Address | Insert | | |
2830 CALDER STREET
BEAUMONT, TX 77702-1048 | 7/3/2017 12:04 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/31/2016 10:41 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 138296207 | 8/31/2016 10:41 AM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 8/31/2016 10:41 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/31/2016 10:41 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 138296206 | 8/31/2016 10:41 AM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 8/31/2016 10:41 AM |
| Details | Last Recertification Date | Update | | 8/18/2015 12:00:00 AM | 8/30/2016 12:00:00 AM | 8/31/2016 10:41 AM |
| Contacts | Primary Contact | Insert | | | WELCH, TOMMY
DIRECTOR OF PHARMACY
4098997042 | 8/18/2015 6:07 PM |
| Details | Last Recertification Date | Update | | | 8/18/2015 12:00:00 AM | 8/18/2015 6:07 PM |
| Dates | Start Date | Update | | 4/1/2014 12:00:00 AM | 4/1/2015 12:00:00 AM | 3/15/2015 7:49 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 3/12/2015 6:57 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 138296208 | 3/12/2015 6:57 PM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 3/12/2015 6:57 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1679557888 | 3/12/2015 6:57 PM |
| Details | Entity Subname | Update | | ST. ELIZABETH | | 3/12/2015 6:57 PM |
| Details | State | Update | | Terminated | Active | 3/12/2015 6:57 PM |
| Dates | Start Date | Update | | 4/1/2009 12:00:00 AM | 4/1/2014 12:00:00 AM | 3/12/2015 6:57 PM |
| Terminations | Termination Date | Update | | 7/1/2010 12:00:00 AM | | 3/12/2015 6:57 PM |
| Terminations | Termination Reason | Update | | DSH percentage below statutory minimum | | 3/12/2015 6:57 PM |
| Details | Comments Public | Insert | | | 3/12/15 participating 4/1/2009 thru 6/30/2010, not participating effective 7/1/10 due to DSH% falling below statutory minimum, reinstated effective 4/1/15 based on on-line registration submitted in Jan. 2015; Govt contract certifying official: Kyle Hayes, City Manager, City of Beaumont, 709-880-3770, khayes@ci.beaumont.tx.us; 4/1/09 REINSTATED PREV PART FROM 7/1/06 TO 3/31/08 NOT ELIGIBLE FROM 4/1/08 TO 3/31/09; 2/5/09- DOC RECD TO CONFIRM ELIG DSH ADJ % | 3/12/2015 6:57 PM |
| Details | Last Recertification Date | Insert | | | | 6/30/2010 7:41 PM |
| Details | Grant Number | Insert | | | | 6/30/2010 7:41 PM |
| Details | 340B ID | Insert | | | DSH450034 | 6/30/2010 7:41 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 6/30/2010 7:41 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 6/30/2010 7:41 PM |
| Details | Medicare Provider Number | Insert | | | 450034 | 6/30/2010 7:41 PM |
| Details | Entity Name | Insert | | | CHRISTUS HOSPITAL | 6/30/2010 7:41 PM |
| Details | Program Code | Insert | | | DSH | 6/30/2010 7:41 PM |
| Details | Entity Subname | Insert | | | ST. ELIZABETH | 6/30/2010 7:41 PM |
| Dates | Participating Approval Date | Insert | | | 3/9/2009 12:00:00 AM | 6/30/2010 7:41 PM |
| Details | State | Insert | | | Terminated | 6/30/2010 7:41 PM |
| Dates | Registration Date | Insert | | | 6/6/2006 12:00:00 AM | 6/30/2010 7:41 PM |
| Dates | Signed By Date | Insert | | | 2/5/2009 12:00:00 AM | 6/30/2010 7:41 PM |
| Dates | Start Date | Insert | | | 4/1/2009 12:00:00 AM | 6/30/2010 7:41 PM |
| Terminations | Termination Comments | Insert | | | | 6/30/2010 7:41 PM |
| Terminations | Termination Date | Insert | | | 7/1/2010 12:00:00 AM | 6/30/2010 7:41 PM |
| Terminations | Termination Effective Date | Insert | | | | 6/30/2010 7:41 PM |
| Terminations | Termination Reason | Insert | | | DSH percentage below statutory minimum | 6/30/2010 7:41 PM |
| Details | Comments Public | Insert | | | 4/1/09 REINSTATED PREV PART FROM 7/1/06 TO 3/31/08 NOT ELIGIBLE FROM 4/1/08 TO 3/31/09; 2/5/09- DOC RECD TO CONFIRM ELIG DSH ADJ % | 6/30/2010 7:41 PM |