Covered Entity Details

CAH451345-01 Crosbyton Clinic Hospital (Terminated) - information as of 6/2/2025 8:27:19 AM

Main Details

Name

Crosbyton Clinic Hospital

Subdivision Name

Crosbyton Clinic Hospital Rural Health Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH451345-01

Medicare Provider Number

451345

Outpatient Facility Provider Number

458829

Additional Details

Current Program Status

Terminated

Registration Date

11/30/2011

Participating Start Date

1/1/2012

Participating Approval Date

12/13/2011

Last Recertification Date

8/19/2019

Termination Date
Termination Reason

10/1/2020
Failure to recertify

Contacts

Authorizing Official

Crosbyton Clinic Hopsital
Debra Miller, Administrator
(806) 675-8700

Primary Contact

Crosbyton Clinic Hospital
Debbie Tue, Director
(806) 675-8700 Ext: 290

Addresses

Street Address

710 West Main Street
Crosbyton, TX 79322

Billing Address
Same as Street Address

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	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	DANA'S PHARMACY	315 BURLINGTON AVE		SPUR	TX	79370-2812	10/03/2013	01/01/2014		10/01/2020	10/01/2020

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH451345-01	Child	CAH	Crosbyton Clinic Hospital	Crosbyton Clinic Hospital Rural Health Clinic	710 West Main Street	Crosbyton	TX	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/30/2020 12:00:00 AM	9/16/2020 8:19 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/16/2020 8:19 AM
Terminations	Termination Date	Update	Recertification		10/1/2020 12:00:00 AM	9/16/2020 8:19 AM
Terminations	Termination Effective Date	Update	Recertification		9/30/2020 12:00:00 AM	9/16/2020 8:19 AM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	9/16/2020 8:19 AM
Details	Last Recertification Date	Update	Recertification	8/27/2018 10:38:32 AM	8/19/2019 4:16:59 PM	8/19/2019 4:16 PM
Details	Last Recertification Date	Update	Recertification	11/7/2017 10:56:54 AM	8/27/2018 10:38:32 AM	8/27/2018 10:38 AM
Details	Last Recertification Date	Update	Recertification	8/31/2016 12:00:00 AM	11/7/2017 10:56:54 AM	11/7/2017 10:56 AM
Contacts	Authorizing Official	Update		Miller, Debra Administrator 8066758700	Miller, Debra Administrator Crosbyton Clinic Hopsital 8066758700	10/3/2017 10:08 AM
Contacts	Signed By	Update		Miller, Debra Administrator 8066758700	Miller, Debra Administrator Crosbyton Clinic Hopsital 8066758700	10/3/2017 10:08 AM
Contacts	Primary Contact	Update		Tue, Debbie Director 8066758700-290	Tue, Debbie Director Crosbyton Clinic Hospital 8066758700-290	9/28/2017 11:47 AM
Addresses	Main Address	Insert			710 West Main Street Crosbyton, TX 79322	8/31/2016 10:51 AM
Contacts	Primary Contact	Insert			Tue, Debbie Director 8066758700-290	8/31/2016 10:51 AM
Contacts	Authorizing Official	Insert			Miller, Debra Administrator 8066758700	8/31/2016 10:51 AM
Contacts	Signed By	Insert			Miller, Debra Administrator 8066758700	8/31/2016 10:51 AM
Details	Last Recertification Date	Update		8/26/2015 12:00:00 AM	8/31/2016 12:00:00 AM	8/31/2016 10:51 AM
Details	Last Recertification Date	Update		8/20/2014 12:00:00 AM	8/26/2015 12:00:00 AM	8/26/2015 11:42 AM
Details	Last Recertification Date	Update		8/22/2013 11:38:35 AM	8/20/2014 12:00:00 AM	8/20/2014 3:00 PM
Details	Last Recertification Date	Update			8/22/2013 11:38:35 AM	8/22/2013 11:38 AM
Dates	Participating Approval Date	Update			12/13/2011 12:00:00 AM	12/13/2011 10:46 AM
Details	State	Update		Pending	Active	12/13/2011 10:46 AM
Details	340B ID	Update		CA11211B	CAH451345-01	12/6/2011 9:09 AM
Dates	Start Date	Update			1/1/2012 12:00:00 AM	12/6/2011 9:09 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	CA11211B	12/1/2011 10:13 AM
Details	Last Recertification Date	Insert				11/30/2011 11:52 AM
Details	Grant Number	Insert				11/30/2011 11:52 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	11/30/2011 11:52 AM
Details	Is Authorizing Official EHB Data	Insert				11/30/2011 11:52 AM
Dates	Last Date That 340B Drugs Purchased	Insert				11/30/2011 11:52 AM
Details	Medicare Provider Number	Insert			451345	11/30/2011 11:52 AM
Details	Entity Name	Insert			Crosbyton Clinic Hospital	11/30/2011 11:52 AM
Details	Program Code	Insert			CAH	11/30/2011 11:52 AM
Details	Entity Subname	Insert			Crosbyton Clinic Hospital Rural Health Clinic	11/30/2011 11:52 AM
Dates	Participating Approval Date	Insert				11/30/2011 11:52 AM
Details	State	Insert			Pending	11/30/2011 11:52 AM
Dates	Registration Date	Insert			11/30/2011 12:00:00 AM	11/30/2011 11:52 AM
Dates	Signed By Date	Insert			11/30/2011 12:00:00 AM	11/30/2011 11:52 AM
Dates	Start Date	Insert				11/30/2011 11:52 AM
Terminations	Termination Comments	Insert				11/30/2011 11:52 AM
Terminations	Termination Date	Insert				11/30/2011 11:52 AM
Terminations	Termination Effective Date	Insert				11/30/2011 11:52 AM
Terminations	Termination Reason	Insert				11/30/2011 11:52 AM