| Details | State | Update | | To Be Terminated | Terminated | 1/1/2024 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 6/19/2017 12:00:00 AM | 10/17/2023 7:45 AM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 10/17/2023 7:45 AM |
| Terminations | Termination Date | Update | Termination Request | | 1/1/2024 12:00:00 AM | 10/17/2023 7:45 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 6/20/2017 12:00:00 AM | 10/17/2023 7:45 AM |
| Terminations | Termination Reason | Update | Termination Request | | Business decision by the Covered Entity | 10/17/2023 7:45 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2022 3:07:07 PM | 8/22/2023 3:45:34 PM | 8/22/2023 3:45 PM |
| Contacts | Primary Contact | Update | Group Change Request | Rodriguez, Gina
Lead Technician
CHRISTUS Spohn Hospital Corpus Christi
3619024375 | Adame, Noreen
Lead Pharmacy Buyer
CHRISTUS Spohn Region
3619024326 | 11/16/2022 2:46 PM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2021 10:51:30 AM | 8/26/2022 3:07:07 PM | 8/26/2022 3:07 PM |
| Details | Last Recertification Date | Update | Recertification | 9/4/2020 4:58:06 PM | 8/25/2021 10:51:30 AM | 8/25/2021 10:51 AM |
| Contacts | Primary Contact | Update | Change Request | Camacho, Helen
340B Procurement Specialist
Christus Spohn
3618813859 | Rodriguez, Gina
Lead Technician
CHRISTUS Spohn Hospital Corpus Christi
3619024375 | 2/23/2021 7:28 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Rios, Becky
Vice President - Finance
CHRISTUS Spohn
3618813157 | Rios, Becky
Interim CFO
CHRISTUS Spohn
3618813157 | 9/7/2020 8:59 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | TX | 9/4/2020 4:58 PM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2019 4:33:44 PM | 9/4/2020 4:58:06 PM | 9/4/2020 4:58 PM |
| Details | Last Recertification Date | Update | Recertification | 9/10/2018 2:40:53 PM | 8/26/2019 4:33:44 PM | 8/26/2019 4:33 PM |
| Contacts | Primary Contact | Update | Change Request | Allen, Deborah
Director of Pharmacy
CHRISTUS Spohn Health System
3619026721 | Camacho, Helen
340B Procurement Specialist
Christus Spohn
3618813859 | 6/10/2019 5:38 PM |
| Details | Last Recertification Date | Update | Recertification | 12/4/2017 2:27:37 PM | 9/10/2018 2:40:53 PM | 9/10/2018 2:40 PM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2016 12:00:00 AM | 12/4/2017 2:27:37 PM | 12/4/2017 2:27 PM |
| Contacts | Primary Contact | Update | Recertification | Allen, Deborah
Director of Pharmacy
3619026721 | Allen, Deborah
Director of Pharmacy
CHRISTUS Spohn Health System
3619026721 | 12/4/2017 2:16 PM |
| Contacts | Authorizing Official | Update | | Rios, Becky
Vice President - Finance
3618813157 | Rios, Becky
Vice President - Finance
CHRISTUS Spohn
3618813157 | 10/9/2017 9:53 AM |
| Contacts | Signed By | Insert | | | Brower, Pamela L.
Chief Finance Officer
3618813432 | 8/7/2017 5:00 PM |
| Contacts | Authorizing Official | Update | | King, Steven
Group CFO
3618813289 | Rios, Becky
Vice President - Finance
3618813157 | 6/21/2017 8:50 AM |
| Contacts | Primary Contact | Update | | Cavazos, Elias
Regional Pharmacy Compliance Officer
3619855243 | Allen, Deborah
Director of Pharmacy
3619026721 | 6/21/2017 8:50 AM |
| Addresses | Main Address | Insert | | |
1357 North Armstrong Avenue
Kingsville, TX 78363 | 6/20/2017 12:34 PM |
| Addresses | Shipping Address | Insert | | | Med Safety Central
5950 Saratoga Blvd.
Corpus Christi, TX 78414 | 6/20/2017 12:34 PM |
| Addresses | Shipping Address | Insert | | | CHRISTUS Spohn Hospital Kleberg
1357 North Armstrong Avenue
Kingsville, TX 78363 | 6/20/2017 12:34 PM |
| Contacts | Primary Contact | Update | | Miller, Christopher W.
Director of Pharmacy Services
3619024903 | Cavazos, Elias
Regional Pharmacy Compliance Officer
3619855243 | 2/16/2017 7:26 AM |
| Contacts | Authorizing Official | Insert | | | King, Steven
Group CFO
3618813289 | 9/1/2016 8:46 AM |
| Details | Last Recertification Date | Update | | 9/2/2015 12:00:00 AM | 8/31/2016 12:00:00 AM | 8/31/2016 3:09 PM |
| Details | Last Recertification Date | Update | | 8/22/2014 12:00:00 AM | 9/2/2015 12:00:00 AM | 9/2/2015 3:45 PM |
| Contacts | Primary Contact | Update | | Vasquez, Kyle
Senior Consultant
8157273355 | Miller, Christopher W.
Director of Pharmacy Services
3619024903 | 3/13/2015 8:02 AM |
| Details | Last Recertification Date | Update | | 9/6/2013 12:00:00 AM | 8/22/2014 12:00:00 AM | 8/22/2014 2:18 PM |
| Details | Last Recertification Date | Update | | 9/6/2013 3:51:08 PM | 9/6/2013 12:00:00 AM | 3/20/2014 10:38 AM |
| Details | Last Recertification Date | Update | | | 9/6/2013 3:51:08 PM | 9/6/2013 3:51 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/12/2013 6:25 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 136436606 | 8/12/2013 6:25 AM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 8/12/2013 6:25 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1093783391 | 8/12/2013 6:25 AM |
| Contacts | Primary Contact | Insert | | | Vasquez, Kyle
Senior Consultant
8157273355 | 6/27/2012 9:52 AM |
| Details | 340B ID | Update | | IS-JH-DSH450163A | DSH450163A | 6/27/2012 9:51 AM |
| Dates | Participating Approval Date | Update | | | 6/27/2012 12:00:00 AM | 6/27/2012 9:51 AM |
| Details | State | Update | | Pending | Active | 6/27/2012 9:51 AM |
| Dates | Start Date | Update | | | 7/1/2012 12:00:00 AM | 6/27/2012 9:51 AM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | IS-JH-DSH450163A | 6/13/2012 1:29 PM |
| Details | Last Recertification Date | Insert | | | | 5/31/2012 7:20 PM |
| Details | Grant Number | Insert | | | | 5/31/2012 7:20 PM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 5/31/2012 7:20 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 5/31/2012 7:20 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 5/31/2012 7:20 PM |
| Details | Medicare Provider Number | Insert | | | 450163 | 5/31/2012 7:20 PM |
| Details | Entity Name | Insert | | | CHRISTUS SPOHN HOSPITAL KLEBERG | 5/31/2012 7:20 PM |
| Details | Program Code | Insert | | | DSH | 5/31/2012 7:20 PM |
| Details | Entity Subname | Insert | | | CHRISTUS Spohn Physical Therapy and Rehab | 5/31/2012 7:20 PM |
| Dates | Participating Approval Date | Insert | | | | 5/31/2012 7:20 PM |
| Details | State | Insert | | | Pending | 5/31/2012 7:20 PM |
| Dates | Registration Date | Insert | | | 5/31/2012 12:00:00 AM | 5/31/2012 7:20 PM |
| Dates | Signed By Date | Insert | | | 5/31/2012 12:00:00 AM | 5/31/2012 7:20 PM |
| Dates | Start Date | Insert | | | | 5/31/2012 7:20 PM |
| Terminations | Termination Comments | Insert | | | | 5/31/2012 7:20 PM |
| Terminations | Termination Date | Insert | | | | 5/31/2012 7:20 PM |
| Terminations | Termination Effective Date | Insert | | | | 5/31/2012 7:20 PM |
| Terminations | Termination Reason | Insert | | | | 5/31/2012 7:20 PM |