Covered Entity Details

CAH451308-00 YOAKUM COUNTY HOSPITAL (Active) - information as of 6/6/2025 12:39:07 PM

Main Details

Name

YOAKUM COUNTY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

Rural

340B ID

CAH451308-00

Medicare Provider Number

451308

Additional Details

Current Program Status

Active

Registration Date

8/11/2010

Participating Start Date

8/12/2010

Participating Approval Date

8/12/2010

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Yoakum County Hospital
SUANN PARRISH, CFO
(806) 592-2121 Ext: 562

Primary Contact

Yoakum County Hospital
Crystal Zurita, Pharmacy Manager
(806) 592-2121 Ext: 122

Addresses

Street Address

412 MUSTANG AVE
DENVER CITY, TX 79323

Billing Address

YOAKUM COUNTY HOSPITAL
412 MUSTANG AVE
P.O BOX 1130
DENVER CITY, TX 79323

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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	Termination Date	Last Updated On
Contract Detail	DENVER CITY PHARMACY	TD HEALTHCARE, LLC	105 E BROADWAY ST	DENVER CITY	TX	79323-3225	12/03/2012	01/01/2013		03/28/2013
Contract Detail	LIBERTY DRUG		403 MUSTANG AVENUE	DENVER CITY	TX	79323	12/06/2012	01/01/2013		03/28/2013
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/10/2019	04/01/2019		04/01/2019
Contract Detail	WAL-MART PHARMACY 10-0626	2000 HOBBS HIGHWAY	P.O. BOX 1807	SEMINOLE	TX	79360	01/10/2019	04/01/2019		04/01/2019
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/16/2023	04/01/2023	01/05/2024	01/05/2024
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/05/2024	04/01/2024		04/01/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/05/2024	04/01/2024	01/12/2024	01/12/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH451308-01	Child	CAH	YOAKUM COUNTY HOSPITAL	WEST TEXAS MEDICAL CENTER	415 N AVENUE F	DENVER CITY	TX	Active
CAH451308-02	Child	CAH	YOAKUM COUNTY HOSPITAL	PLAINS CLINIC	703 AVE G	PLAINS	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/22/2023 4:16:28 PM	8/13/2024 8:24:28 AM	8/13/2024 8:24 AM
Details	Last Recertification Date	Update	Recertification	8/25/2022 11:26:02 AM	8/22/2023 4:16:28 PM	8/22/2023 4:16 PM
Contacts	Primary Contact	Update	Change Request	Pearson, Heather Pharmacy Manager Yoakum County Hospital 8065922121-122	Zurita, Crystal Pharmacy Manager Yoakum County Hospital 8065922121-122	10/12/2022 7:08 AM
Details	Last Recertification Date	Update	Recertification	8/23/2021 3:58:27 PM	8/25/2022 11:26:02 AM	8/25/2022 11:26 AM
Contacts	Primary Contact	Update	Change Request	Garcia, Jeannie Pharmacy Tech Yoakum County Hospital 8065922121-122	Pearson, Heather Pharmacy Manager Yoakum County Hospital 8065922121-122	4/20/2022 11:11 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 11:27:57 AM	8/23/2021 3:58:27 PM	8/23/2021 3:58 PM
Details	Last Recertification Date	Update	Recertification	9/2/2019 1:31:18 PM	9/3/2020 11:27:57 AM	9/3/2020 11:27 AM
Details	Last Recertification Date	Update	Recertification	8/15/2018 12:53:24 PM	9/2/2019 1:31:18 PM	9/2/2019 1:31 PM
Details	Last Recertification Date	Update	Recertification	11/9/2017 7:11:50 AM	8/15/2018 12:53:24 PM	8/15/2018 12:53 PM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/9/2017 7:11:50 AM	11/9/2017 7:11 AM
Contacts	Primary Contact	Update	Change Request	LUKER, GARY PHARMACIST 8326078511	Garcia, Jeannie Pharmacy Tech Yoakum County Hospital 8065922121-122	10/4/2017 4:47 PM
Contacts	Authorizing Official	Update		PARRISH, SUANN CFO 8065922121-562	PARRISH, SUANN CFO Yoakum County Hospital 8065922121-562	10/4/2017 4:39 PM
Addresses	Main Address	Insert			412 MUSTANG AVE DENVER CITY, TX 79323	8/15/2016 3:59 PM
Contacts	Primary Contact	Insert			LUKER, GARY PHARMACIST 8326078511	8/15/2016 3:59 PM
Contacts	Authorizing Official	Insert			PARRISH, SUANN CFO 8065922121-562	8/15/2016 3:59 PM
Details	Last Recertification Date	Update		8/7/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 3:59 PM
Details	Last Recertification Date	Update		8/14/2014 12:00:00 AM	8/7/2015 12:00:00 AM	8/7/2015 11:53 AM
Addresses	Billing Address	Insert			YOAKUM COUNTY HOSPITAL 412 MUSTANG AVE P.O BOX 1130 DENVER CITY, TX 79323	12/11/2014 6:35 AM
Details	Last Recertification Date	Update		8/19/2013 2:12:22 PM	8/14/2014 12:00:00 AM	8/14/2014 4:08 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/19/2013 2:12:22 PM	8/19/2013 2:12 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/1/2012 10:19 AM
Details	Last Recertification Date	Insert				8/12/2010 11:09 AM
Details	Grant Number	Insert				8/12/2010 11:09 AM
Details	340B ID	Insert			CAH451308-00	8/12/2010 11:09 AM
Details	Is Authorizing Official EHB Data	Insert				8/12/2010 11:09 AM
Dates	Last Date That 340B Drugs Purchased	Insert				8/12/2010 11:09 AM
Details	Medicare Provider Number	Insert			451308	8/12/2010 11:09 AM
Details	Entity Name	Insert			YOAKUM COUNTY HOSPITAL	8/12/2010 11:09 AM
Details	Program Code	Insert			CAH	8/12/2010 11:09 AM
Details	Entity Subname	Insert				8/12/2010 11:09 AM
Dates	Participating Approval Date	Insert			8/12/2010 12:00:00 AM	8/12/2010 11:09 AM
Details	State	Insert			Active	8/12/2010 11:09 AM
Dates	Registration Date	Insert			8/11/2010 12:00:00 AM	8/12/2010 11:09 AM
Dates	Signed By Date	Insert			8/6/2010 12:00:00 AM	8/12/2010 11:09 AM
Dates	Start Date	Insert			8/12/2010 12:00:00 AM	8/12/2010 11:09 AM
Terminations	Termination Comments	Insert				8/12/2010 11:09 AM
Terminations	Termination Date	Insert				8/12/2010 11:09 AM
Terminations	Termination Effective Date	Insert				8/12/2010 11:09 AM
Terminations	Termination Reason	Insert				8/12/2010 11:09 AM