Yes
SETON EDGAR B. DAVIS HOSPITAL
130 HAYS STREET
LULING, TX 78648-3207
| CAH451371-01 | Child | CAH | SETON EDGAR B. DAVIS HOSPITAL | SETON EDGAR B. DAVIS HOSPITAL SLEEP LAB | 725 S. HACKBERRY AVE. | LULING | TX | Terminated |
| CAH451371-02 | Child | CAH | SETON EDGAR B. DAVIS HOSPITAL | SETON EDGAR B. DAVIS HOSPITAL HERITAGE PROGRAM | 725 S. HACKBERRY AVE. | LULING | TX | Terminated |
| CAH451371-03 | Child | CAH | SETON EDGAR B. DAVIS HOSPITAL | SETON EDGAR B. DAVIS HOSPITAL OUTPATIENT LAB AND IMAGING | 300 S. COLORADO | LOCKHART | TX | Terminated |
| CAH451371-04 | Child | CAH | Ascension Seton d/b/a Ascension Seton Edgar B. Davis | SETON HEALTHCARE D/B/A SETON LOCKHART FAMILY HEALTH CENTER | 300 S. Colorado, Suite A, B, C, & D | LOCKHART | TX | Active |
| CAH451371-05 | Child | CAH | Ascension Seton d/b/a Ascension Seton Edgar B. Davis | SETON HEALTHCARE D/B/A SEBD CHILDREN'S CARE-A-VAN | 300 S. Colorado, Suite B | LOCKHART | TX | Active |
| CAH451371-06 | Child | CAH | Ascension Seton d/b/a Ascension Seton Edgar B. Davis | Lockhart Internal Med RHC - RURAL HEALTH CLINIC IV | 209 S Church St, Ste B | Lockhart | TX | Active |
| CAH451371-07 | Child | CAH | Ascension Seton d/b/a Ascension Seton Edgar B. Davis | Luling Family Med RHC - RURAL HEALTH CLINIC III | 130 Hays St, Ste B and D | Luling | TX | Active |
| CAH451371-08 | Child | CAH | Ascension Seton d/b/a Ascension Seton Edgar B. Davis | EBD Bastrop FM RHC - RURAL HEALTH CLINIC VI | 300 S Commerce St | Lockhart | TX | Active |
| CAH451371-09 | Child | CAH | Ascension Seton d/b/a Ascension Seton Edgar B. Davis | EBD Lockhart Clinic RHC - RURAL HEALTH CLINIC | 630 HWY 71 W | Bastrop | TX | Active |
| Contacts | Authorizing Official | Update | AO Change Request | Hartle, Christopher L.
President, North Group & South Group
5125025056 | Haynes, Apryl Renee
COO/CNO
Seton Edgar B. Davis Hospital
8308757041 | 11/28/2017 2:01 PM |
| Contacts | Primary Contact | Update | | Aziz, Shewan M.
Senior Network Director of Pharmacy
5123247303 | Aziz, Shewan M.
Senior Network Director of Pharmacy
Seton Healthcare Family
5123247303 | 10/24/2017 11:41 AM |
| Contacts | Authorizing Official | Update | | GALLAGHER, THOMAS E.
PRESIDENT & CEO
5123241903 | Hartle, Christopher L.
President, North Group & South Group
5125025056 | 9/11/2017 3:29 PM |
| Contacts | Primary Contact | Insert | | | Aziz, Shewan M.
Senior Network Director of Pharmacy
5123247303 | 5/24/2017 1:58 PM |
| Contacts | Authorizing Official | Insert | | | GALLAGHER, THOMAS E.
PRESIDENT & CEO
5123241903 | 11/8/2016 7:53 AM |
| Addresses | Main Address | Insert | | |
725 S. HACKBERRY AVE.
SUITE C
LULING, TX 78648-3200 | 6/23/2016 9:10 AM |
| Addresses | Billing Address | Insert | | | SETON EDGAR B. DAVIS HOSPITAL
P.O. BOX 33034
SAN ANTONIO, TX 78265-3034 | 6/23/2016 9:10 AM |
| Addresses | Shipping Address | Insert | | | SETON EDGAR B. DAVIS HOSPITAL
130 HAYS STREET
LULING, TX 78648-3207 | 6/23/2016 9:10 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 6/1/2010 12:00:00 AM | 6/23/2016 9:10 AM |
| Details | State | Update | | Active | Terminated | 6/23/2016 9:10 AM |
| Terminations | Termination Comments | Update | | | Unfortunately, we don't have any records indicating the exact date the site was closed. However, no drugs have been purchased for this site since before it was closed. | 6/23/2016 9:10 AM |
| Terminations | Termination Date | Update | | | 7/1/2016 12:00:00 AM | 6/23/2016 9:10 AM |
| Terminations | Termination Effective Date | Update | | | 6/1/2010 12:00:00 AM | 6/23/2016 9:10 AM |
| Terminations | Termination Reason | Update | | | Site closure | 6/23/2016 9:10 AM |
| Details | Last Recertification Date | Update | | 8/6/2014 12:00:00 AM | 8/11/2015 12:00:00 AM | 8/11/2015 7:54 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 12/1/2014 1:55 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 451371 | 12/1/2014 1:55 PM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 12/1/2014 1:55 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1356682298 | 12/1/2014 1:55 PM |
| Details | Last Recertification Date | Update | | 9/10/2013 10:41:02 AM | 8/6/2014 12:00:00 AM | 8/6/2014 9:30 AM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 9/10/2013 10:41:02 AM | 9/10/2013 10:41 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 6/1/2012 7:41 AM |
| Details | Last Recertification Date | Insert | | | | 8/19/2010 3:17 PM |
| Details | Grant Number | Insert | | | | 8/19/2010 3:17 PM |
| Details | 340B ID | Insert | | | CAH451371-01 | 8/19/2010 3:17 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/19/2010 3:17 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/19/2010 3:17 PM |
| Details | Medicare Provider Number | Insert | | | 451371 | 8/19/2010 3:17 PM |
| Details | Entity Name | Insert | | | SETON EDGAR B. DAVIS HOSPITAL | 8/19/2010 3:17 PM |
| Details | Program Code | Insert | | | CAH | 8/19/2010 3:17 PM |
| Details | Entity Subname | Insert | | | SETON EDGAR B. DAVIS HOSPITAL SLEEP LAB | 8/19/2010 3:17 PM |
| Dates | Participating Approval Date | Insert | | | 8/19/2010 12:00:00 AM | 8/19/2010 3:17 PM |
| Details | State | Insert | | | Active | 8/19/2010 3:17 PM |
| Dates | Registration Date | Insert | | | 8/19/2010 12:00:00 AM | 8/19/2010 3:17 PM |
| Dates | Signed By Date | Insert | | | 8/17/2010 12:00:00 AM | 8/19/2010 3:17 PM |
| Dates | Start Date | Insert | | | 8/19/2010 12:00:00 AM | 8/19/2010 3:17 PM |
| Terminations | Termination Comments | Insert | | | | 8/19/2010 3:17 PM |
| Terminations | Termination Date | Insert | | | | 8/19/2010 3:17 PM |
| Terminations | Termination Effective Date | Insert | | | | 8/19/2010 3:17 PM |
| Terminations | Termination Reason | Insert | | | | 8/19/2010 3:17 PM |