Covered Entity Details

DSH320004 CHRISTUS Southern New Mexico (Active) - information as of 5/14/2025 10:51:37 PM

Main Details

Name

CHRISTUS Southern New Mexico

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH320004

Medicare Provider Number

320004

Additional Details

Current Program Status

Active

Registration Date

12/14/2010

Participating Start Date

4/1/2015

Participating Approval Date

12/14/2010

Last Recertification Date

9/10/2024

Contacts

Authorizing Official

Otero County Hospital Association
Bashar Naser, CFO
(575) 443-7848 Ext: 5754437841

Primary Contact

Otero County Hospital Associaton
Cheri Christine Moore, Financial Analyst
(575) 443-7841

Addresses

Street Address

2669 SCENIC DR
ALAMOGORDO, NM 88310-8734

Billing Address

CHRISTUS Southern New Mexico
2669 SCENIC DR
Alamogordo, NM 88310-8734

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
3/12/15 hospital participating under this 340B ID from 1/1/2011 thru 6/30/2012, hospital changed to SCH entity type effective 7/1/12, changed back to DSH effective 4/1/15 based on on-line registration submitted in January 2015.	04/28/2015
3/12/15 hospital participating under this 340B ID from 1/1/2011 thru 6/30/2012, hospital changed to SCH entity type effective 7/1/12, changed back to DSH effective 4/1/15 based on on-line registration submitted in January 2015, Govt certifying official is Pamela Heltner, County Manager, County of Otero, 575-439-2621, pheltner@co.otero.nm.us	03/12/2015

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NM	00000018	1861450579

Shipping Addresses

Shipping Address 1

CHRISTUS Pharmacy
2669 SCENIC DR
ALAMOGORDO, NM 88310

Shipping Address 2

CHRISTUS Pharmacy Downtown
675 E Tenth ST
Alamogordo, NM 88310

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ALBERTSONS MARKET PHARMACY #681	1300 EAST 10TH STEET		ALAMOGORDO	NM	88310	04/17/2017	07/01/2017		04/17/2017
Contract Detail	ALBERTSONS MARKET PHARMACY #682	721 MECHEM DR. STE B		RUIDOSO	NM	88345	04/17/2017	07/01/2017	01/01/2024	01/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/17/2023	04/01/2023		04/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/17/2023	04/01/2023		04/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	01/17/2023	04/01/2023		04/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/15/2024	10/01/2024		10/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/15/2024	10/01/2024		10/01/2024
Contract Detail	CHRISTUS SPECIALTY PHARMACY	MOTHER FRANCES REGIONAL HEALTH CARE CTR	800 E DAWSON ST STE 100	TYLER	TX	75701-2036	10/16/2023	01/01/2024		01/01/2024
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/12/2018	04/01/2018		01/12/2018
Contract Detail	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	01/17/2023	04/01/2023		04/01/2023
Contract Detail	ICARE RX LLC	14447 COUNTRY WALK DR		MIAMI	FL	33186	10/15/2020	01/01/2021	07/08/2021	07/08/2021
Contract Detail	K MART PHARMACY #9119		3201 N WHITE SAND BLVD	ALAMOGORDO	NM	88310	04/15/2016	07/01/2016	01/12/2018	01/12/2018
Contract Detail	LOWE'S #55 PHARMACY	675 10TH ST		ALAMOGORDO	NM	88310-6769	10/15/2018	01/01/2019		01/01/2019
Contract Detail	PHYSICIAN'S RX PHARMACY, LLC	PHYSICIANS RX PHARMACY, LLC	9701 APOLLO DRIVE #400	LARGO	MD	20774	10/15/2020	01/01/2021	07/08/2021	07/08/2021
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/12/2018	04/01/2018	10/01/2022	10/11/2022
Contract Detail	PRXP OF CA LLC	PRXP OF CA LLC	4345 E LOWELL ST STE C & D	ONTARIO	CA	91761	10/15/2020	01/01/2021	07/08/2021	07/08/2021
Contract Detail	PRXP OF NEW YORK LLC	DBA BROADWAY FAMILY PHARMACY	601 AMSTERDAM AVE	NEW YORK	NY	10024	10/15/2020	01/01/2021	07/08/2021	07/08/2021
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	01/17/2023	04/01/2023		04/01/2023
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	01/17/2023	04/01/2023		04/01/2023
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	07/14/2020	10/01/2020	01/01/2024	01/01/2024
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	07/14/2020	10/01/2020	01/01/2024	01/01/2024
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	07/14/2020	10/01/2020	01/01/2024	01/01/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	03/26/2015	04/01/2015	08/05/2024	08/05/2024
Contract Detail	WAL-MART PHARMACY 10-1306	233 S NEW YORK AVENUE		ALAMOGORDO	NM	88310	03/26/2015	04/01/2015	08/05/2024	08/05/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	03/26/2015	04/01/2015	08/05/2024	08/05/2024
Contract Detail	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	07/08/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 11960	1256 EL PASEO ROAD	LAS CRUCES	NM	88001	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13927	3375 RINCONADA BLVD.	LAS CRUCES	NM	88011	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15603	122 NORTH GOLD AVENUE	DEMING	NM	88030	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07107	2300 E LOHMAN AVE	LAS CRUCES	NM	88001-8492	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREEN HASTINGS CO.	DBA: WALGREENS # 04650	138 SUDDERTH	RUIDOSO	NM	88345	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREEN HASTINGS CO.	DBA: WALGREENS # 01941	1200 S MAIN STREET	ROSWELL	NM	88203	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREEN HASTINGS CO.	DBA: WALGREENS # 09991	955 N WHITE SANDS BLVD	ALAMOGORDO	NM	88310-6925	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREEN HASTINGS CO.	DBA: WALGREENS # 05350	1835 N MAIN STREET	ROSWELL	NM	88201	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/12/2018	04/01/2018	12/06/2021	12/06/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/15/2024	10/01/2024	04/01/2025	04/01/2025
Contract Detail	WALMART PHARMACY 10-5726	2401 INDIAN WELLS ROAD		ALAMOGORDO	NM	88310	10/18/2016	01/01/2017	08/05/2024	08/05/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/15/2024	10/01/2024	04/01/2025	04/01/2025

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH320004A	Child	DSH	GERALD CHAMPION REGIONAL MEDICAL CTR	AMBULATORY SURGERY CENTER	2351 25TH STREET	ALAMOGORDO	NM	Terminated
DSH320004AA	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Pulmonology	2559 Medical Drive	Alamogordo	NM	Active
DSH320004AB	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Urgent Care	250 East 1st Street	Alamogordo	NM	Active
DSH320004AC	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Sleep Center	2474 Indian Wells Road	Alamogordo	NM	Active
DSH320004AD	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Sleep and Behavioral Medicine Ruidoso	101 5th Street	Ruidoso	NM	Active
DSH320004AE	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Osteo Clinic	2559 Medical Drive	Alamogordo	NM	Active
DSH320004AF	Child	DSH	GERALD CHAMPION REGIONAL MEDICAL CTR	Pediatrics of Alamogordo - Pediatrics of Alamogordo Downtown	1212 9th Street	Alamogordo	NM	Terminated
DSH320004AG	Child	DSH	GERALD CHAMPION REGIONAL MEDICAL CTR	Champion Pain Management - Alamogordo	2474 Indian Wells Road	Alamogordo	NM	Terminated
DSH320004AH	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Family Medicine Ruidoso	101 5th Street	Ruidoso	NM	Active
DSH320004AJ	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Pain Management Roswell	400 North Pennsylvania Avenue	Roswell	NM	Active
DSH320004AK	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Pain Management Alamogordo	2559 Medical Drive	Alamogordo	NM	Active
DSH320004AL	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Neurology and Diagnostics	2050 North Scenic Drive	Alamogordo	NM	Active
DSH320004B	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Family Medicine Tenth Street	1401 10TH STREET	ALAMOGORDO	NM	Active
DSH320004C	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Cancer Center	2559 Medical Drive	Alamogordo	NM	Active
DSH320004D	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Endocrinology	2579 North Scenic Drive	Alamogordo	NM	Active
DSH320004E	Child	DSH	GERALD CHAMPION REGIONAL MEDICAL CTR	Family Practice of Alamogordo	1315 12th Street	Alamogordo	NM	Terminated
DSH320004F	Child	DSH	GERALD CHAMPION REGIONAL MEDICAL CTR	General & Vascular Surgery	1212 9th Street, Suite C	Alamogordo	NM	Terminated
DSH320004G	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Internal Medicine Ninth Street	1101 9th Street	Alamogordo	NM	Active
DSH320004H	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Surgical Associates	2559 Medical Drive	Alamogordo	NM	Active
DSH320004J	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Cardiology	2559 Medical Drive	Alamogordo	NM	Active
DSH320004K	Child	DSH	GERALD CHAMPION REGIONAL MEDICAL CTR	Surgical Association of Alamo - Suite F	2559 Medical Drive	ALAMOGORDO	NM	Terminated
DSH320004L	Child	DSH	GERALD CHAMPION REGIONAL MEDICAL CTR	Women's Specialty Services	2050 NORTH SCENIC DRIVE	ALAMOGORDO	NM	Terminated
DSH320004M	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Family Medicine Medical Drive	2539 Medical Drive	ALAMOGORDO	NM	Active
DSH320004N	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Nephrology	2579 NORTH SCENIC DRIVE	ALAMOGORDO	NM	Active
DSH320004P	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Orthopedics Complex	2559 Medical Drive	ALAMOGORDO	NM	Active
DSH320004Q	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Gastroenterology	2539 Medical Drive	ALAMOGORDO	NM	Active
DSH320004R	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Women's Health	2559 Medical Drive	Alamogordo	NM	Active
DSH320004S	Child	DSH	GERALD CHAMPION REGIONAL MEDICAL CTR	Champion Primary Group	1212 9th Street	Alamogordo	NM	Terminated
DSH320004T	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Occupational Health	2559 Medical Drive	Alamogordo	NM	Active
DSH320004U	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Behavioral Medicine Alamogordo	2351 25th Street	Alamogordo	NM	Active
DSH320004V	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Internal Medicine	2559 Medical Drive	Alamogordo	NM	Active
DSH320004W	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Pediatrics	2559 Medical Drive	Alamogordo	NM	Active
DSH320004X	Child	DSH	GERALD CHAMPION REGIONAL MEDICAL CTR	Champion Health and Wellness Clinic	1212 9th Street	Alamogordo	NM	Terminated
DSH320004Y	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Neurology	2539 Medical Drive	Alamogordo	NM	Active
DSH320004Z	Child	DSH	CHRISTUS Southern New Mexico	CHRISTUS Southern New Mexico Family Medicine	2351 25th Street Drive	Alamogordo	NM	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Update	Change Request	Champion Pharmacy 2669 SCENIC DR ALAMOGORDO, NM 88310	CHRISTUS Pharmacy 2669 SCENIC DR ALAMOGORDO, NM 88310	3/24/2025 12:45 PM
Addresses	Billing Address	Update	Change Request	Gerald Champion Regional Medical Center 2669 SCENIC DR Alamogordo, NM 88310-8700	CHRISTUS Southern New Mexico 2669 SCENIC DR Alamogordo, NM 88310-8734	3/24/2025 12:45 PM
Addresses	Shipping Address	Insert	Change Request		CHRISTUS Pharmacy Downtown 675 E Tenth ST Alamogordo, NM 88310	3/24/2025 12:45 PM
Addresses	Main Address	Update	Change Request	2669 SCENIC DR NA ALAMOGORDO, NM 88310-8700	2669 SCENIC DR ALAMOGORDO, NM 88310-8734	3/24/2025 12:45 PM
Details	Entity Name	Update	Change Request	GERALD CHAMPION REGIONAL MEDICAL CTR	CHRISTUS Southern New Mexico	3/24/2025 12:45 PM
Details	Last Recertification Date	Update	Recertification	8/30/2023 1:29:06 PM	9/10/2024 8:24:20 AM	9/10/2024 8:24 AM
Addresses	Billing Address	Insert	Recertification		Gerald Champion Regional Medical Center 2669 SCENIC DR Alamogordo, NM 88310-8700	8/30/2023 1:29 PM
Addresses	Main Address	Update	Recertification	2669 SCENIC DR ALAMOGORDO, NM 88310	2669 SCENIC DR NA ALAMOGORDO, NM 88310-8700	8/30/2023 1:29 PM
Details	Last Recertification Date	Update	Recertification	9/9/2022 1:39:50 PM	8/30/2023 1:29:06 PM	8/30/2023 1:29 PM
Details	Last Recertification Date	Update	Recertification	9/10/2021 11:45:02 AM	9/9/2022 1:39:50 PM	9/9/2022 1:39 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	28961 (AZ)		4/15/2022 4:56 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	95541843 (CO)		4/15/2022 4:56 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	108935102 (TX)		4/15/2022 4:56 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 12:11:18 PM	9/10/2021 11:45:02 AM	9/10/2021 11:45 AM
Medicaid Billing	NPI: State	Update	Recertification		NM	9/11/2020 12:11 PM
Details	Last Recertification Date	Update	Recertification	9/6/2019 4:51:06 PM	9/11/2020 12:11:18 PM	9/11/2020 12:11 PM
Contacts	Primary Contact	Update	Profile Change Request	Moore, Cheri Christine Executive Secretary to CFO/VP of Finance Otero County Hospital Associaton 5754437841	Moore, Cheri Christine Financial Analyst Otero County Hospital Associaton 5754437841	9/9/2019 1:01 PM
Details	Last Recertification Date	Update	Recertification	9/11/2018 7:35:19 AM	9/6/2019 4:51:06 PM	9/6/2019 4:51 PM
Contacts	Authorizing Official	Update	New Registration	Naser, Bashar CFO Otero County Hospital Association 5754437848	Naser, Bashar CFO Otero County Hospital Association 5754437848-5754437841	1/15/2019 5:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2018 11:16 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		28961	12/18/2018 11:16 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	12/18/2018 11:16 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2018 11:16 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		95541843	12/18/2018 11:16 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	12/18/2018 11:16 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2018 11:16 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		108935102	12/18/2018 11:16 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	12/18/2018 11:16 AM
Addresses	Shipping Address	Insert	Change Request		Champion Pharmacy 2669 SCENIC DR ALAMOGORDO, NM 88310	9/28/2018 1:38 PM
Contacts	Primary Contact	Update	Change Request	Seaman, Pete VP Finance Otero County Hospital Association 5754437827	Moore, Cheri Christine Executive Secretary to CFO/VP of Finance Otero County Hospital Associaton 5754437841	9/28/2018 1:38 PM
Addresses	Main Address	Update	Recertification	2669 N SCENIC DR ALAMOGORDO, NM 88310	2669 SCENIC DR ALAMOGORDO, NM 88310	9/11/2018 7:35 AM
Details	Last Recertification Date	Update	Recertification	11/21/2017 12:53:31 PM	9/11/2018 7:35:19 AM	9/11/2018 7:35 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1861450579	3/21/2018 12:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/8/2018 2:02 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00000018	3/8/2018 2:02 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NM	3/8/2018 2:02 PM
Details	Last Recertification Date	Update	Recertification	9/2/2016 12:00:00 AM	11/21/2017 12:53:31 PM	11/21/2017 12:53 PM
Contacts	Primary Contact	Update	Recertification	Seaman, Pete Chief Financial Officer 5754437827	Seaman, Pete VP Finance Otero County Hospital Association 5754437827	11/21/2017 12:48 PM
Contacts	Authorizing Official	Update		Naser, Bashar CFO 5754437848	Naser, Bashar CFO Otero County Hospital Association 5754437848	11/21/2017 12:30 PM
Contacts	Authorizing Official	Insert			Naser, Bashar CFO 5754437848	4/17/2017 12:40 PM
Addresses	Main Address	Insert			2669 N SCENIC DR ALAMOGORDO, NM 88310	9/2/2016 3:32 PM
Contacts	Primary Contact	Insert			Seaman, Pete Chief Financial Officer 5754437827	9/2/2016 3:32 PM
Details	Last Recertification Date	Update		8/24/2015 12:00:00 AM	9/2/2016 12:00:00 AM	9/2/2016 3:31 PM
Details	Last Recertification Date	Update			8/24/2015 12:00:00 AM	8/24/2015 10:34 AM
Details	Comments Public	Insert			3/12/15 hospital participating under this 340B ID from 1/1/2011 thru 6/30/2012, hospital changed to SCH entity type effective 7/1/12, changed back to DSH effective 4/1/15 based on on-line registration submitted in January 2015.	4/28/2015 5:59 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM		3/12/2015 6:36 PM
Details	Entity Name	Update		GERALD CHAMPION REGIONAL MEDICAL CENTER	GERALD CHAMPION REGIONAL MEDICAL CTR	3/12/2015 6:36 PM
Details	State	Update		Terminated	Active	3/12/2015 6:36 PM
Dates	Start Date	Update		1/1/2011 12:00:00 AM	4/1/2015 12:00:00 AM	3/12/2015 6:36 PM
Terminations	Termination Date	Update		7/1/2012 12:00:00 AM		3/12/2015 6:36 PM
Terminations	Termination Reason	Update		Site closure		3/12/2015 6:36 PM
Details	Comments Public	Insert			3/12/15 hospital participating under this 340B ID from 1/1/2011 thru 6/30/2012, hospital changed to SCH entity type effective 7/1/12, changed back to DSH effective 4/1/15 based on on-line registration submitted in January 2015, Govt certifying official is Pamela Heltner, County Manager, County of Otero, 575-439-2621, pheltner@co.otero.nm.us	3/12/2015 6:36 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/15/2012 1:45 PM
Details	State	Update		Active	Terminated	6/15/2012 1:45 PM
Terminations	Termination Date	Update			7/1/2012 12:00:00 AM	6/15/2012 1:45 PM
Terminations	Termination Reason	Update			Site closure	6/15/2012 1:45 PM
Details	Last Recertification Date	Insert				12/14/2010 7:28 PM
Details	Grant Number	Insert				12/14/2010 7:28 PM
Details	340B ID	Insert			DSH320004	12/14/2010 7:28 PM
Details	Is Authorizing Official EHB Data	Insert				12/14/2010 7:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert				12/14/2010 7:28 PM
Details	Medicare Provider Number	Insert			320004	12/14/2010 7:28 PM
Details	Entity Name	Insert			GERALD CHAMPION REGIONAL MEDICAL CENTER	12/14/2010 7:28 PM
Details	Program Code	Insert			DSH	12/14/2010 7:28 PM
Details	Entity Subname	Insert				12/14/2010 7:28 PM
Dates	Participating Approval Date	Insert			12/14/2010 12:00:00 AM	12/14/2010 7:28 PM
Details	State	Insert			Active	12/14/2010 7:28 PM
Dates	Registration Date	Insert			12/14/2010 12:00:00 AM	12/14/2010 7:28 PM
Dates	Signed By Date	Insert			11/24/2010 12:00:00 AM	12/14/2010 7:28 PM
Dates	Start Date	Insert			1/1/2011 12:00:00 AM	12/14/2010 7:28 PM
Terminations	Termination Comments	Insert				12/14/2010 7:28 PM
Terminations	Termination Date	Insert				12/14/2010 7:28 PM
Terminations	Termination Effective Date	Insert				12/14/2010 7:28 PM
Terminations	Termination Reason	Insert				12/14/2010 7:28 PM