Covered Entity Details

RWII79601 Dignity Health Management Center, Inc. (Active) - information as of 6/7/2025 6:07:33 AM

Main Details

Name

Dignity Health Management Center, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII79601

Grant Number

X07HA00054

Additional Details

Current Program Status

Active

Registration Date

4/28/2022

Participating Start Date

4/28/2022

Participating Approval Date

4/28/2022

Last Recertification Date

2/10/2025

Time Period the Assistance was Received

4/1/2024 - 3/31/2025

Contacts

Authorizing Official

Dignity Health Management Center
Joy Ellinger, Executive Director
(325) 669-7500

Primary Contact

Dignity Health Management Center
Jamie Tarantella, Director of Programs
(325) 672-3077

Addresses

Street Address

402 Butternut St.
Abilene, TX 79602

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
Participating from effective date: (10/1/2011) until terminated effective date: (4/1/2022) reinstatement effective date: (04/28/22)	04/28/2022

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	AVITA PHARMACY 1026	PHARMBLUE ARIZONA LLC	1260 S CAMPBELL AVE STE 1152	GREEN VALLEY	AZ	85614-0504	07/03/2017	10/01/2017	04/01/2022	04/01/2022
Contract Detail	AVITA PHARMACY 1026	PHARMBLUE ARIZONA LLC	1260 S CAMPBELL AVE STE 1152	GREEN VALLEY	AZ	85614-0504	04/28/2022	04/28/2022		04/28/2022
Contract Detail	AVITA PHARMACY 1031	PHARMBLUE HOLDINGS LLC D/B/A AVITA PHARM	1495 N 7TH ST STE B	BEAUMONT	TX	77702-1345	07/03/2017	10/01/2017	04/01/2022	04/01/2022
Contract Detail	AVITA PHARMACY 1031	PHARMBLUE HOLDINGS LLC D/B/A AVITA PHARM	1495 N 7TH ST STE B	BEAUMONT	TX	77702-1345	04/28/2022	04/28/2022		04/28/2022
Contract Detail	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	07/01/2013	10/01/2013	04/01/2022	04/01/2022
Contract Detail	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	04/28/2022	04/28/2022		04/28/2022
Contract Detail	AVITA PHARMACY 1068	AVITA DRUGS LLC	426 BUTTERNUT ST	ABILENE	TX	79602-1327	08/30/2021	09/08/2021	04/01/2022	04/01/2022
Contract Detail	AVITA PHARMACY 1068	AVITA DRUGS LLC	426 BUTTERNUT ST	ABILENE	TX	79602-1327	04/28/2022	04/28/2022		04/28/2022
Contract Detail	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	01/06/2023	04/01/2023		04/01/2023
Contract Detail	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	01/06/2023	04/01/2023		04/01/2023
Contract Detail	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	10/14/2020	01/01/2021	04/01/2022	04/01/2022
Contract Detail	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	04/28/2022	04/28/2022		04/28/2022
Contract Detail	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	07/01/2013	10/01/2013	04/01/2022	04/01/2022
Contract Detail	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	04/28/2022	04/28/2022		04/28/2022

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 10:36:03 AM	2/10/2025 4:49:56 PM	2/10/2025 4:49 PM
Details	Assistance Received From Date	Update	Change Request	4/1/2023 12:00:00 AM	4/1/2024 12:00:00 AM	6/24/2024 9:24 AM
Details	Assistance Received To Date	Update	Change Request	3/31/2024 12:00:00 AM	3/31/2025 12:00:00 AM	6/24/2024 9:24 AM
Details	Last Recertification Date	Update	Recertification	2/10/2023 11:16:24 AM	1/30/2024 10:36:03 AM	1/30/2024 10:36 AM
Details	NOFO Number	Update		HRSA-17-036		12/16/2023 10:34 AM
Contacts	Authorizing Official	Update	Change Request	Young, John COO Dignity Health Management Center 3256723077	Ellinger, Joy Executive Director Dignity Health Management Center 3256697500	12/6/2023 10:44 AM
Contacts	Primary Contact	Update	Change Request	Ellinger, Joy Executive Director Dignity Health Management Center 3256723077	Tarantella, Jamie Director of Programs Dignity Health Management Center 3256723077	12/6/2023 10:44 AM
Contacts	Primary Contact	Update	Change Request	Derasari, Dhvani Consultant Big Country AIDS Resources 6825598205	Ellinger, Joy Executive Director Dignity Health Management Center 3256723077	9/14/2023 4:26 PM
Contacts	Authorizing Official	Update	Change Request	Whitman, James Executive Director Big Country AIDS Resources 3252608434	Young, John COO Dignity Health Management Center 3256723077	9/14/2023 4:26 PM
Details	Assistance Received From Date	Update	Change Request	4/1/2022 12:00:00 AM	4/1/2023 12:00:00 AM	9/14/2023 4:26 PM
Details	Assistance Received To Date	Update	Change Request	3/31/2023 12:00:00 AM	3/31/2024 12:00:00 AM	9/14/2023 4:26 PM
Details	Entity Name	Update	Change Request	Big Country AIDS Support Group	Dignity Health Management Center, Inc.	9/14/2023 4:26 PM
Details	Last Recertification Date	Update	Recertification		2/10/2023 11:16:24 AM	2/10/2023 11:16 AM
Details	NOFO Number	Update	Recertification	HRSA-21-001	HRSA-17-036	2/10/2023 11:16 AM
Contacts	Authorizing Official	Update	Profile Change Request	Whitman, James Chief Operating Officer Big Country AIDS Resources 3252608434	Whitman, James Executive Director Big Country AIDS Resources 3252608434	1/9/2023 7:28 AM
Contacts	Authorizing Official	Update	Change Request	Wagstaff, James Executive Director Big Country AIDS Resources 9175708015	Whitman, James Chief Operating Officer Big Country AIDS Resources 3252608434	11/10/2022 9:45 AM
Contacts	Primary Contact	Update	Change Request	Whitman, James Chief Operating Officer Big Country AIDS Resources 3252608434	Derasari, Dhvani Consultant Big Country AIDS Resources 6825598205	11/10/2022 9:45 AM
Contacts	Primary Contact	Update	Profile Change Request	Whitman, James Chief Operating Officer Big Country AIDS Resources 3256723077	Whitman, James Chief Operating Officer Big Country AIDS Resources 3252608434	11/10/2022 9:22 AM
Details	State	Update	OPA Edit	Approved	Active	4/28/2022 1:24 PM
Dates	Start Date	Update	OPA Edit	7/1/2022 12:00:00 AM	4/28/2022 12:00:00 AM	4/28/2022 1:24 PM
Addresses	Main Address	Insert	Reinstatement		402 Butternut St. Abilene, TX 79602	4/28/2022 1:19 PM
Contacts	Signed By	Update	Reinstatement	Sims, Betty Executive Director 3256030691	Wagstaff, James Executive Director Big Country AIDS Resources 9175708015	4/28/2022 1:19 PM
Contacts	Primary Contact	Update	Reinstatement	Wheat, Debbie Grants Manager Big Country Aids Resources 3252000485	Whitman, James Chief Operating Officer Big Country AIDS Resources 3256723077	4/28/2022 1:19 PM
Details	Assistance Received From Date	Update	Reinstatement	4/1/2021 12:00:00 AM	4/1/2022 12:00:00 AM	4/28/2022 1:19 PM
Details	Assistance Received To Date	Update	Reinstatement	3/31/2022 12:00:00 AM	3/31/2023 12:00:00 AM	4/28/2022 1:19 PM
Details	Last Recertification Date	Update	Reinstatement	3/1/2021 12:53:17 PM		4/28/2022 1:19 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	3/31/2022 12:00:00 AM		4/28/2022 1:19 PM
Dates	Participating Approval Date	Update	Reinstatement	9/19/2011 12:00:00 AM	4/28/2022 1:19:07 PM	4/28/2022 1:19 PM
Details	State	Update	Reinstatement	Terminated	Approved	4/28/2022 1:19 PM
Dates	Registration Date	Update	Reinstatement	8/24/2011 12:00:00 AM	4/28/2022 11:31:20 AM	4/28/2022 1:19 PM
Dates	Signed By Date	Update	Reinstatement	8/24/2011 12:00:00 AM	4/28/2022 11:31:24 AM	4/28/2022 1:19 PM
Dates	Start Date	Update	Reinstatement	10/1/2011 12:00:00 AM	7/1/2022 12:00:00 AM	4/28/2022 1:19 PM
Terminations	Termination Date	Update	Reinstatement	4/1/2022 12:00:00 AM		4/28/2022 1:19 PM
Terminations	Termination Effective Date	Update	Reinstatement	3/31/2022 12:00:00 AM		4/28/2022 1:19 PM
Terminations	Termination Reason	Update	Reinstatement	Failure to recertify		4/28/2022 1:19 PM
Details	Comments Public	Insert	Reinstatement		Participating from effective date: (10/1/2011) until terminated effective date: (4/1/2022) reinstatement effective date: (04/28/22)	4/28/2022 1:11 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		3/31/2022 12:00:00 AM	3/4/2022 7:27 AM
Details	State	Update	Recertification	Active	To Be Terminated	3/4/2022 7:27 AM
Terminations	Termination Date	Update	Recertification		4/1/2022 12:00:00 AM	3/4/2022 7:27 AM
Terminations	Termination Effective Date	Update	Recertification		3/31/2022 12:00:00 AM	3/4/2022 7:27 AM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	3/4/2022 7:27 AM
Contacts	Authorizing Official	Update	AO Change Request	Wagstaff, James Austin Executive Director Big Country AIDS Resource Center 3256723077-9175708015	Wagstaff, James Executive Director Big Country AIDS Resources 9175708015	3/2/2022 7:05 AM
Details	Assistance Received From Date	Update	Change Request	4/1/2020 12:00:00 AM	4/1/2021 12:00:00 AM	4/5/2021 12:15 PM
Details	Assistance Received To Date	Update	Change Request	3/31/2021 12:00:00 AM	3/31/2022 12:00:00 AM	4/5/2021 12:15 PM
Details	Assistance Received From Date	Update	Recertification		4/1/2020 12:00:00 AM	3/1/2021 12:53 PM
Details	Assistance Received To Date	Update	Recertification		3/31/2021 12:00:00 AM	3/1/2021 12:53 PM
Details	Last Recertification Date	Update	Recertification	1/30/2020 12:41:51 PM	3/1/2021 12:53:17 PM	3/1/2021 12:53 PM
Details	Grant Number	Update	Recertification	T2-TX	X07HA00054	3/1/2021 12:53 PM
Details	NOFO Number	Update	Recertification		HRSA-21-001	3/1/2021 12:53 PM
Details	Last Recertification Date	Update	Recertification	2/11/2019 1:35:27 PM	1/30/2020 12:41:51 PM	1/30/2020 12:41 PM
Contacts	Authorizing Official	Update	AO Change Request	Wagstaff, James Austin Executive Director Big Country AIDS Resources 3256032888	Wagstaff, James Austin Executive Director Big Country AIDS Resource Center 3256723077-9175708015	1/30/2020 7:50 AM
Contacts	Authorizing Official	Update	Profile Change Request	Wagstaff, James Austin Interim Executive Director Big Country AIDS Resources 3256032888	Wagstaff, James Austin Executive Director Big Country AIDS Resources 3256032888	1/28/2020 10:37 AM
Details	Last Recertification Date	Update	Recertification	3/6/2018 12:32:49 PM	2/11/2019 1:35:27 PM	2/11/2019 1:35 PM
Contacts	Authorizing Official	Update	AO Change Request	Brown, Virginia L. Business Manager Big Country Aids Resources 3254282865	Wagstaff, James Austin Interim Executive Director Big Country AIDS Resources 3256032888	2/11/2019 10:40 AM
Contacts	Authorizing Official	Update	AO Change Request	Godbee, Lynn Executive Director Big Country Aids Resources 3256032888	Brown, Virginia L. Business Manager Big Country Aids Resources 3254282865	1/30/2019 8:57 AM
Contacts	Primary Contact	Update	Recertification	Sims, Betty Executive Director BCAR 3256030691	Wheat, Debbie Grants Manager Big Country Aids Resources 3252000485	3/6/2018 12:32 PM
Details	Last Recertification Date	Update	Recertification	2/14/2017 12:00:00 AM	3/6/2018 12:32:49 PM	3/6/2018 12:32 PM
Contacts	Authorizing Official	Update	AO Change Request	Sims, Betty Executive Director BCAR 3256030691	Godbee, Lynn Executive Director Big Country Aids Resources 3256032888	3/5/2018 7:40 AM
Contacts	Authorizing Official	Update		Sims, Betty Executive Director 3256030691	Sims, Betty Executive Director BCAR 3256030691	9/25/2017 11:50 AM
Contacts	Primary Contact	Update		Sims, Betty Executive Director 3256030691	Sims, Betty Executive Director BCAR 3256030691	9/25/2017 11:50 AM
Contacts	Authorizing Official	Insert			Sims, Betty Executive Director 3256030691	7/3/2017 1:20 PM
Contacts	Primary Contact	Insert			Sims, Betty Executive Director 3256030691	7/3/2017 1:20 PM
Addresses	Main Address	Insert			402 Butternut St. Abilene, TX 79602	2/14/2017 3:12 PM
Contacts	Signed By	Insert			Sims, Betty Executive Director 3256030691	2/14/2017 3:12 PM
Details	Last Recertification Date	Update		2/12/2016 12:00:00 AM	2/14/2017 12:00:00 AM	2/14/2017 3:12 PM
Details	Last Recertification Date	Update		2/23/2015 12:00:00 AM	2/12/2016 12:00:00 AM	2/12/2016 8:49 AM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	2/23/2015 12:00:00 AM	2/23/2015 8:14 AM
Details	Last Recertification Date	Update		1/1/2013 12:00:00 AM	2/10/2014 12:00:00 AM	2/10/2014 7:22 AM
Details	Last Recertification Date	Update			1/1/2013 12:00:00 AM	11/27/2012 8:11 AM
Details	Grant Number	Update			T2-TX	11/2/2011 6:02 PM
Details	Last Recertification Date	Update		9/16/2011 12:00:00 AM		9/19/2011 4:25 PM
Dates	Participating Approval Date	Update			9/19/2011 12:00:00 AM	9/19/2011 4:25 PM
Details	State	Update		Pending	Active	9/19/2011 4:25 PM
Details	Last Recertification Date	Update			9/16/2011 12:00:00 AM	9/16/2011 2:33 PM
Details	340B ID	Update		ONLINE_REG	RWII79601	9/16/2011 2:33 PM
Dates	Start Date	Update			10/1/2011 12:00:00 AM	9/16/2011 2:33 PM
Details	Last Recertification Date	Insert				8/24/2011 4:05 PM
Details	Grant Number	Insert				8/24/2011 4:05 PM
Details	340B ID	Insert			ONLINE_REG	8/24/2011 4:05 PM
Details	Is Authorizing Official EHB Data	Insert				8/24/2011 4:05 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/24/2011 4:05 PM
Details	Medicare Provider Number	Insert				8/24/2011 4:05 PM
Details	Entity Name	Insert			Big Country AIDS Support Group	8/24/2011 4:05 PM
Details	Program Code	Insert			RWII	8/24/2011 4:05 PM
Details	Entity Subname	Insert				8/24/2011 4:05 PM
Dates	Participating Approval Date	Insert				8/24/2011 4:05 PM
Details	State	Insert			Pending	8/24/2011 4:05 PM
Dates	Registration Date	Insert			8/24/2011 12:00:00 AM	8/24/2011 4:05 PM
Dates	Signed By Date	Insert			8/24/2011 12:00:00 AM	8/24/2011 4:05 PM
Dates	Start Date	Insert				8/24/2011 4:05 PM
Terminations	Termination Comments	Insert				8/24/2011 4:05 PM
Terminations	Termination Date	Insert				8/24/2011 4:05 PM
Terminations	Termination Effective Date	Insert				8/24/2011 4:05 PM
Terminations	Termination Reason	Insert				8/24/2011 4:05 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History