| Details | State | Update | | To Be Terminated | Terminated | 1/1/2025 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | OPA Edit Termination Info | 1/1/2025 12:00:00 AM | 12/1/2024 12:00:00 AM | 12/11/2024 10:49 AM |
| Terminations | Termination Effective Date | Update | OPA Edit Termination Info | 1/1/2025 12:00:00 AM | 12/2/2024 12:00:00 AM | 12/11/2024 10:49 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | | 1/1/2025 12:00:00 AM | 10/21/2024 10:09 AM |
| Details | State | Update | Hospital Type Change Request | Active | To Be Terminated | 10/21/2024 10:09 AM |
| Terminations | Termination Date | Update | Hospital Type Change Request | | 1/1/2025 12:00:00 AM | 10/21/2024 10:09 AM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | | 1/1/2025 12:00:00 AM | 10/21/2024 10:09 AM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | | Change of covered entity type | 10/21/2024 10:09 AM |
| Contacts | Primary Contact | Update | Hospital Type Change Request | Vital, Kirk
Director Of Pharmacy
Christus Jaspeer Memorial
4093815616 | Vital, Kirk
Director Of Pharmacy
Christus Jaspeer Memorial
4093815616 | 10/4/2024 10:40 AM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2023 9:55:33 AM | 8/15/2024 3:09:58 PM | 8/15/2024 3:09 PM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2022 9:02:20 AM | 8/23/2023 9:55:33 AM | 8/23/2023 9:55 AM |
| Details | Last Recertification Date | Update | Recertification | 9/10/2021 1:55:27 PM | 8/26/2022 9:02:20 AM | 8/26/2022 9:02 AM |
| Details | Last Recertification Date | Update | Recertification | 9/10/2020 2:56:24 PM | 9/10/2021 1:55:27 PM | 9/10/2021 1:55 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | TX | 9/10/2020 2:56 PM |
| Details | Last Recertification Date | Update | Recertification | 9/15/2019 2:24:13 PM | 9/10/2020 2:56:24 PM | 9/10/2020 2:56 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Martin, Nikki
Assistant Administrator of Finance
CHRISTUS
4098997105 | Martin, Nikki
Regional Director, Finance
CHRISTUS
4098997105 | 9/1/2020 6:55 AM |
| Details | Last Recertification Date | Update | Recertification | 9/10/2018 10:26:33 AM | 9/15/2019 2:24:13 PM | 9/15/2019 2:24 PM |
| Details | Last Recertification Date | Update | Recertification | 12/4/2017 1:40:23 PM | 9/10/2018 10:26:33 AM | 9/10/2018 10:26 AM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2016 12:00:00 AM | 12/4/2017 1:40:23 PM | 12/4/2017 1:40 PM |
| Contacts | Primary Contact | Update | | Vital, Kirk
Director Of Pharmacy
4093815616 | Vital, Kirk
Director Of Pharmacy
Christus Jaspeer Memorial
4093815616 | 10/26/2017 11:41 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Martin, Nikki
Assistant Administrator of Finance
CHRISTUS
4099895181 | Martin, Nikki
Assistant Administrator of Finance
CHRISTUS
4098997105 | 9/27/2017 3:54 PM |
| Contacts | Authorizing Official | Update | | Martin, Nikki
Assistant Administrator of Finance
4099895181 | Martin, Nikki
Assistant Administrator of Finance
CHRISTUS
4099895181 | 9/27/2017 3:52 PM |
| Addresses | Main Address | Insert | | |
1275 MARVIN HANCOCK DRIVE
JASPER, TX 75951 | 8/23/2016 4:00 PM |
| Contacts | Primary Contact | Update | | Oke, Tommy
DIRECTOR OF PHARMACY
4093815616 | Vital, Kirk
Director Of Pharmacy
4093815616 | 8/23/2016 4:00 PM |
| Contacts | Authorizing Official | Insert | | | Martin, Nikki
Assistant Administrator of Finance
4099895181 | 8/23/2016 4:00 PM |
| Details | Last Recertification Date | Update | | 8/17/2015 12:00:00 AM | 8/23/2016 12:00:00 AM | 8/23/2016 4:00 PM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 8/17/2015 6:06 PM |
| Details | Last Recertification Date | Update | | 8/14/2014 12:00:00 AM | 8/17/2015 12:00:00 AM | 8/17/2015 6:06 PM |
| Details | Last Recertification Date | Update | | 9/11/2013 12:00:00 AM | 8/14/2014 12:00:00 AM | 8/14/2014 3:14 PM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 9/11/2013 12:00:00 AM | 9/11/2013 10:52 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/14/2013 1:02 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 112706002 | 8/14/2013 1:02 PM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 8/14/2013 1:02 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/14/2013 1:02 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 112706001 | 8/14/2013 1:02 PM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 8/14/2013 1:02 PM |
| Contacts | Primary Contact | Update | | Oke, Tom
DIRECTOR OF PHARMACY
4093815616 | Oke, Tommy
DIRECTOR OF PHARMACY
4093815616 | 12/20/2012 4:12 PM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/17/2012 9:15 AM |
| Medicaid Billing | Medicaid: Number | Update | | DSH450573 | 112706003 | 3/21/2012 7:43 AM |
| Medicaid Billing | Medicaid: Number | Update | | 45-0573 | DSH450573 | 3/19/2012 1:23 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1598749707 | 3/19/2012 1:23 PM |
| Contacts | Primary Contact | Update | | BRENT, RALPH
DIRECTOR OF PHARMACY
4093841939 | Oke, Tom
DIRECTOR OF PHARMACY
4093815616 | 3/19/2012 1:23 PM |
| Contacts | Primary Contact | Insert | | | BRENT, RALPH
DIRECTOR OF PHARMACY
4093841939 | 6/15/2009 5:04 PM |
| Details | Last Recertification Date | Insert | | | | 6/15/2009 5:04 PM |
| Details | Grant Number | Insert | | | | 6/15/2009 5:04 PM |
| Details | 340B ID | Insert | | | DSH450573 | 6/15/2009 5:04 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 6/15/2009 5:04 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 6/15/2009 5:04 PM |
| Details | Medicare Provider Number | Insert | | | 450573 | 6/15/2009 5:04 PM |
| Details | Entity Name | Insert | | | CHRISTUS JASPER MEMORIAL HOSPITAL | 6/15/2009 5:04 PM |
| Details | Program Code | Insert | | | DSH | 6/15/2009 5:04 PM |
| Details | Entity Subname | Insert | | | | 6/15/2009 5:04 PM |
| Dates | Participating Approval Date | Insert | | | 7/15/2008 12:00:00 AM | 6/15/2009 5:04 PM |
| Details | State | Insert | | | Active | 6/15/2009 5:04 PM |
| Dates | Registration Date | Insert | | | 7/15/2008 12:00:00 AM | 6/15/2009 5:04 PM |
| Dates | Signed By Date | Insert | | | 8/13/2007 12:00:00 AM | 6/15/2009 5:04 PM |
| Dates | Start Date | Insert | | | 10/1/2004 12:00:00 AM | 6/15/2009 5:04 PM |
| Terminations | Termination Comments | Insert | | | | 6/15/2009 5:04 PM |
| Terminations | Termination Date | Insert | | | | 6/15/2009 5:04 PM |
| Terminations | Termination Effective Date | Insert | | | | 6/15/2009 5:04 PM |
| Terminations | Termination Reason | Insert | | | | 6/15/2009 5:04 PM |
| Details | Comments Public | Insert | | | 5/26/09- DOC RECD TO CONFIRM ELIG DSH ADJ % | 6/15/2009 5:04 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 7/15/2008 12:50 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 45-0573 | 7/15/2008 12:50 PM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 7/15/2008 12:50 PM |