340B Drug Pricing Program Database


DSH450104 GUADALUPE REGIONAL MEDICAL CENTER (Active) - information as of 4/28/2025 1:44:18 AM

Main Details
GUADALUPE REGIONAL MEDICAL CENTER
Disproportionate Share Hospital
No
DSH450104
450104


Additional Details
Active
7/11/2008
10/1/2004
7/11/2008
9/4/2024

Contacts

Guadalupe Regional Medical Center
Kody Bryan Gann, Chief Financial Officer
(830) 401-7721

Guadalupe Regional Medical Center
Scott Mozisek, Director of Pharmacy
(830) 379-2411

Addresses

1215 E. COURT
SEGUIN, TX 78155

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
2/1/06 UPDATED ENTITY NAME (WAS GUADALUPE VALLEY HOSPITAL)01/22/2010
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
TX1384117091720088123
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 07784 110 S KING ST
SEGUINTX7815501/13/201404/01/2014 06/28/201606/28/2016
Contract DetailHEB PHARMACY #7161340 E. COURT ST
SEGUINTX7815511/05/201211/05/2012 06/28/201606/28/2016
Contract DetailPARKER'S CITY PHARMACY1005 E COURT ST
SEGUINTX78155-584307/06/201107/08/2011 12/01/201610/26/2017
Contract DetailWAL-MART PHARMACY 10-0901550 S. 123 BYPASS
SEGUINTX7815506/22/201206/22/2012 06/28/201606/28/2016
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH450104AChildDSHGUADALUPE REGIONAL MEDICAL CENTERGuadalupe Clinic for Chronic Disease Care1350 Ashby, Suite BSeguinTXActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/29/2023 5:59:39 PM9/4/2024 7:44:58 AM9/4/2024 7:44 AM
DetailsLast Recertification DateUpdateRecertification9/12/2022 12:55:15 PM8/29/2023 5:59:39 PM8/29/2023 5:59 PM
DetailsLast Recertification DateUpdateRecertification9/9/2021 8:34:15 PM9/12/2022 12:55:15 PM9/12/2022 12:55 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False2/15/2022 7:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1384117092/15/2022 7:17 PM
Medicaid BillingMedicaid: StateInsertChange Request TX2/15/2022 7:17 PM
Medicaid BillingNPI: NumberInsertChange Request 17200881232/15/2022 7:17 PM
Medicaid BillingNPI: StateInsertChange Request TX2/15/2022 7:17 PM
DetailsLast Recertification DateUpdateRecertification8/18/2020 7:18:24 AM9/9/2021 8:34:15 PM9/9/2021 8:34 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestGann, Kody Bryan VP of Finance Guadalupe Regional Medical Center 8304017721Gann, Kody Bryan Chief Financial Officer Guadalupe Regional Medical Center 83040177218/13/2021 2:40 PM
ContactsAuthorizing OfficialUpdateAO Change RequestWALLACE, PENNY CFO Guadalupe Regional Medical Center 8303792411Gann, Kody Bryan VP of Finance Guadalupe Regional Medical Center 83040177218/19/2020 2:47 PM
DetailsLast Recertification DateUpdateRecertification8/19/2019 10:21:10 AM8/18/2020 7:18:24 AM8/18/2020 7:18 AM
DetailsLast Recertification DateUpdateRecertification8/15/2018 1:41:42 PM8/19/2019 10:21:10 AM8/19/2019 10:21 AM
DetailsLast Recertification DateUpdateRecertification11/3/2017 1:13:15 PM8/15/2018 1:41:42 PM8/15/2018 1:41 PM
ContactsPrimary ContactUpdateRecertificationHICKS, LARRY DIRECTOR OF PHARMACY 8304017868Mozisek, Scott Director of Pharmacy Guadalupe Regional Medical Center 830379241111/3/2017 1:13 PM
DetailsLast Recertification DateUpdateRecertification8/10/2016 12:00:00 AM11/3/2017 1:13:15 PM11/3/2017 1:13 PM
ContactsAuthorizing OfficialUpdate WALLACE, PENNY CFO 8303792411WALLACE, PENNY CFO Guadalupe Regional Medical Center 830379241110/13/2017 1:06 PM
AddressesMain AddressInsert   1215 E. COURT SEGUIN, TX 781558/10/2016 4:13 PM
ContactsPrimary ContactInsert  HICKS, LARRY DIRECTOR OF PHARMACY 83040178688/10/2016 4:13 PM
ContactsAuthorizing OfficialInsert  WALLACE, PENNY CFO 83037924118/10/2016 4:13 PM
DetailsLast Recertification DateUpdate 8/5/2015 12:00:00 AM8/10/2016 12:00:00 AM8/10/2016 4:13 PM
DetailsLast Recertification DateUpdate 8/11/2014 12:00:00 AM8/5/2015 12:00:00 AM8/5/2015 9:17 AM
DetailsLast Recertification DateUpdate 9/6/2013 12:00:00 AM8/11/2014 12:00:00 AM8/11/2014 10:15 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/6/2013 12:00:00 AM9/6/2013 1:38 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/18/2012 12:17 PM
DetailsLast Recertification DateInsert   1/22/2010 4:09 PM
DetailsGrant NumberInsert   1/22/2010 4:09 PM
Details340B IDInsert  DSH4501041/22/2010 4:09 PM
DetailsIs Authorizing Official EHB DataInsert   1/22/2010 4:09 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/22/2010 4:09 PM
DetailsMedicare Provider NumberInsert  4501041/22/2010 4:09 PM
DetailsEntity NameInsert  GUADALUPE REGIONAL MEDICAL CENTER1/22/2010 4:09 PM
DetailsProgram CodeInsert  DSH1/22/2010 4:09 PM
DetailsEntity SubnameInsert   1/22/2010 4:09 PM
DatesParticipating Approval DateInsert  7/11/2008 12:00:00 AM1/22/2010 4:09 PM
DetailsStateInsert  Active1/22/2010 4:09 PM
DatesRegistration DateInsert  7/11/2008 12:00:00 AM1/22/2010 4:09 PM
DatesSigned By DateInsert  8/13/2007 12:00:00 AM1/22/2010 4:09 PM
DatesStart DateInsert  10/1/2004 12:00:00 AM1/22/2010 4:09 PM
TerminationsTermination CommentsInsert   1/22/2010 4:09 PM
TerminationsTermination DateInsert   1/22/2010 4:09 PM
TerminationsTermination Effective DateInsert   1/22/2010 4:09 PM
TerminationsTermination ReasonInsert   1/22/2010 4:09 PM
DetailsComments PublicInsert  2/1/06 UPDATED ENTITY NAME (WAS GUADALUPE VALLEY HOSPITAL)1/22/2010 4:09 PM