| Dates | Last Date That 340B Drugs Purchased | Update | OPA Cancel Termination Request | 1/1/2025 12:00:00 AM | | 11/22/2024 11:02 AM |
| Details | State | Update | OPA Cancel Termination Request | To Be Terminated | Active | 11/22/2024 11:02 AM |
| Terminations | Termination Date | Update | OPA Cancel Termination Request | 1/1/2025 12:00:00 AM | | 11/22/2024 11:02 AM |
| Terminations | Termination Effective Date | Update | OPA Cancel Termination Request | 1/1/2025 12:00:00 AM | | 11/22/2024 11:02 AM |
| Terminations | Termination Reason | Update | OPA Cancel Termination Request | Change of covered entity type | | 11/22/2024 11:02 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | | 1/1/2025 12:00:00 AM | 10/29/2024 8:07 AM |
| Details | State | Update | Hospital Type Change Request | Active | To Be Terminated | 10/29/2024 8:07 AM |
| Terminations | Termination Date | Update | Hospital Type Change Request | | 1/1/2025 12:00:00 AM | 10/29/2024 8:07 AM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | | 1/1/2025 12:00:00 AM | 10/29/2024 8:07 AM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | | Change of covered entity type | 10/29/2024 8:07 AM |
| Details | Last Recertification Date | Update | Recertification | | 8/16/2024 2:56:00 PM | 8/16/2024 2:56 PM |
| Details | State | Update | | Approved | Active | 7/1/2024 12:01 AM |
| Details | Entity Name | Update | Change Request | HIGHLAND MEDICAL CENTER | CHRISTUS Shreveport-Bossier Health System | 5/28/2024 6:19 AM |
| Addresses | Billing Address | Insert | Reinstatement | | CHRISTUS Health Shreveport-Bossier
1453 East Bert Kouns Industrial Loop
Shreveport, LA 71105 | 4/29/2024 1:15 PM |
| Medicaid Billing | NPI: Number | Insert | Reinstatement | | 1417950106 | 4/29/2024 1:15 PM |
| Medicaid Billing | NPI: State | Insert | Reinstatement | | TX | 4/29/2024 1:15 PM |
| Contacts | Authorizing Official | Update | Reinstatement | Trawick, Thomas Steen
CEO
CHRISTUS SHREVEPORT-BOSSIER HEALTH SYSTEM
3186815054 | Boles, Glen
VP & Chief Financial Officer
CHRISTUS St. Michael & Shreveport-Bossier Health Systems
9036142007 | 4/29/2024 1:15 PM |
| Contacts | Signed By | Update | Reinstatement | Palmer, Isaac
CEO
CHRISTUS Shreveport-Bossier Health System
3186815729 | Boles, Glen
VP & Chief Financial Officer
CHRISTUS St. Michael & Shreveport-Bossier Health Systems
9036142007 | 4/29/2024 1:15 PM |
| Details | Last Recertification Date | Update | Reinstatement | 8/26/2022 11:14:37 AM | | 4/29/2024 1:15 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 10/1/2023 12:00:00 AM | | 4/29/2024 1:15 PM |
| Details | Entity Name | Update | Reinstatement | CHRISTUS Shreveport-Bossier Health System | HIGHLAND MEDICAL CENTER | 4/29/2024 1:15 PM |
| Dates | Participating Approval Date | Update | Reinstatement | 11/21/2017 3:03:31 PM | 4/29/2024 1:15:22 PM | 4/29/2024 1:15 PM |
| Details | State | Update | Reinstatement | Terminated | Approved | 4/29/2024 1:15 PM |
| Dates | Registration Date | Update | Reinstatement | 11/7/2017 12:46:40 PM | 4/12/2024 2:55:45 PM | 4/29/2024 1:15 PM |
| Dates | Signed By Date | Update | Reinstatement | 11/16/2017 1:10:34 PM | 4/12/2024 2:55:49 PM | 4/29/2024 1:15 PM |
| Dates | Start Date | Update | Reinstatement | 1/1/2018 12:00:00 AM | 7/1/2024 12:00:00 AM | 4/29/2024 1:15 PM |
| Terminations | Termination Date | Update | Reinstatement | 10/1/2023 12:00:00 AM | | 4/29/2024 1:15 PM |
| Terminations | Termination Effective Date | Update | Reinstatement | 10/1/2023 12:00:00 AM | | 4/29/2024 1:15 PM |
| Terminations | Termination Reason | Update | Reinstatement | Change of covered entity type | | 4/29/2024 1:15 PM |
| Details | Comments Public | Insert | Reinstatement | | Participating from effective date: (01/01/2018) until terminated effective date: (10/01/2023); reinstatement effective date: (07/1/2024) | 4/24/2024 8:04 AM |
| Details | State | Update | | To Be Terminated | Terminated | 10/1/2023 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | | 10/1/2023 12:00:00 AM | 7/11/2023 8:27 AM |
| Details | State | Update | Hospital Type Change Request | Active | To Be Terminated | 7/11/2023 8:27 AM |
| Terminations | Termination Date | Update | Hospital Type Change Request | | 10/1/2023 12:00:00 AM | 7/11/2023 8:27 AM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | | 10/1/2023 12:00:00 AM | 7/11/2023 8:27 AM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | | Change of covered entity type | 7/11/2023 8:27 AM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2021 10:16:19 AM | 8/26/2022 11:14:37 AM | 8/26/2022 11:14 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Pannagl, Bryan
Chief Financial Officer
CHRISTUS Shreveport-Bossier
3186815444 | Trawick, Thomas Steen
CEO
CHRISTUS SHREVEPORT-BOSSIER HEALTH SYSTEM
3186815054 | 1/14/2022 7:05 AM |
| Details | Entity Name | Update | Change Request | CHRISTUS Health Shreveport-Bossier | CHRISTUS Shreveport-Bossier Health System | 11/29/2021 7:25 AM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2020 1:58:04 PM | 8/23/2021 10:16:19 AM | 8/23/2021 10:16 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | LA | 9/2/2020 1:58 PM |
| Details | Last Recertification Date | Update | Recertification | 9/12/2019 11:07:05 AM | 9/2/2020 1:58:04 PM | 9/2/2020 1:58 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Merryman, Scott
EVP/CFO
CHRISTUS Health
3185617172 | Pannagl, Bryan
Chief Financial Officer
CHRISTUS Shreveport-Bossier
3186815444 | 5/27/2020 8:05 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/6/2020 4:59 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1744379 | 1/6/2020 4:59 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | LA | 1/6/2020 4:59 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1417950106 | 1/6/2020 4:59 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Holland, Kevin
President and CEO
CHRISTUS Saint Patrick Hospital
3374917730 | Merryman, Scott
EVP/CFO
CHRISTUS Health
3185617172 | 9/13/2019 9:12 AM |
| Contacts | Primary Contact | Update | Recertification | Merryman, Scott
EVP/CFO
CHRISTUS Health
3185617172 | Anderson, Lois Rose
Director of Pharmacy
CHRISTUS Shreveport-Bossier Health System
3186817383 | 9/12/2019 11:07 AM |
| Details | Last Recertification Date | Update | Recertification | 9/4/2018 5:49:59 PM | 9/12/2019 11:07:05 AM | 9/12/2019 11:07 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Palmer, Isaac
CEO
CHRISTUS Shreveport-Bossier Health System
3186815729 | Holland, Kevin
President and CEO
CHRISTUS Saint Patrick Hospital
3374917730 | 9/10/2019 4:09 PM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2016 12:00:00 AM | 9/4/2018 5:49:59 PM | 9/4/2018 5:49 PM |
| Terminations | Termination Reason | Update | | DSH percentage below statutory minimum | | 7/21/2018 12:21 PM |
| Details | State | Update | | Approved | Active | 1/1/2018 12:00 AM |
| Addresses | Billing Address | Insert | Reinstatement | | CHRISTUS Health Shreveport-Bossier
1453 East Bert Kouns Industrial Loop
Shreveport, LA 71105 | 11/21/2017 3:03 PM |
| Contacts | Signed By | Insert | Reinstatement | | Palmer, Isaac
CEO
CHRISTUS Shreveport-Bossier Health System
3186815729 | 11/21/2017 3:03 PM |
| Dates | Participating Approval Date | Update | Reinstatement | | 11/21/2017 3:03:31 PM | 11/21/2017 3:03 PM |
| Details | State | Update | Reinstatement | Pending | Approved | 11/21/2017 3:03 PM |
| Dates | Signed By Date | Update | Reinstatement | 8/29/2012 12:00:00 AM | 11/16/2017 1:10:34 PM | 11/21/2017 3:03 PM |
| Dates | Start Date | Update | Reinstatement | | 1/1/2018 12:00:00 AM | 11/21/2017 3:03 PM |
| Terminations | Termination Reason | Update | Reinstatement | | DSH percentage below statutory minimum | 11/21/2017 3:03 PM |
| Details | Comments Public | Insert | Reinstatement | | Participated starting 10/1/2012, terminated 1/1/2017. Reinstated 1/1/2018. | 11/21/2017 10:23 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 11/28/2016 12:00:00 AM | | 11/7/2017 12:46 PM |
| Dates | Participating Approval Date | Update | Reinstatement | 9/13/2012 12:00:00 AM | | 11/7/2017 12:46 PM |
| Details | State | Update | Reinstatement | Terminated | Pending | 11/7/2017 12:46 PM |
| Dates | Registration Date | Update | Reinstatement | 8/29/2012 12:00:00 AM | 11/7/2017 12:46:40 PM | 11/7/2017 12:46 PM |
| Dates | Start Date | Update | Reinstatement | 10/1/2012 12:00:00 AM | | 11/7/2017 12:46 PM |
| Terminations | Termination Comments | Update | Reinstatement | | | 11/7/2017 12:46 PM |
| Terminations | Termination Date | Update | Reinstatement | 1/1/2017 12:00:00 AM | | 11/7/2017 12:46 PM |
| Terminations | Termination Effective Date | Update | Reinstatement | 11/30/2016 12:00:00 AM | | 11/7/2017 12:46 PM |
| Terminations | Termination Reason | Update | Reinstatement | DSH percentage below statutory minimum | | 11/7/2017 12:46 PM |
| Contacts | Authorizing Official | Update | | Palmer, Isaac
CEO
3186815729 | Palmer, Isaac
CEO
CHRISTUS Shreveport-Bossier Health System
3186815729 | 10/16/2017 9:51 AM |
| Contacts | Primary Contact | Update | | Merryman, Scott
EVP/CFO
3185617172 | Merryman, Scott
EVP/CFO
CHRISTUS Health
3185617172 | 9/20/2017 10:13 AM |
| Contacts | Authorizing Official | Insert | | | Palmer, Isaac
CEO
3186815729 | 8/11/2017 1:30 PM |
| Contacts | Primary Contact | Insert | | | Merryman, Scott
EVP/CFO
3185617172 | 8/8/2017 12:11 PM |
| Addresses | Main Address | Insert | | |
1505 East Bert Kouns Industrial Loop
Suite 101
Shreveport, LA 71105 | 12/7/2016 7:39 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 11/28/2016 12:00:00 AM | 12/7/2016 7:39 AM |
| Details | State | Update | | Active | Terminated | 12/7/2016 7:39 AM |
| Terminations | Termination Date | Update | | | 1/1/2017 12:00:00 AM | 12/7/2016 7:39 AM |
| Terminations | Termination Effective Date | Update | | | 11/30/2016 12:00:00 AM | 12/7/2016 7:39 AM |
| Terminations | Termination Reason | Update | | | DSH percentage below statutory minimum | 12/7/2016 7:39 AM |
| Addresses | Billing Address | Insert | | | CHRISTUS Health Shreveport-Bossier
1453 East Bert Kouns Industrial Loop
Shreveport, LA 71105 | 8/26/2016 7:03 AM |
| Addresses | Shipping Address | Insert | | | CHRISTUS Health Shreveport-Bossier
1453 East Bert Kouns Industrial Loop
Shreveport, LA 71105 | 8/26/2016 7:03 AM |
| Details | Last Recertification Date | Update | | 8/24/2015 12:00:00 AM | 8/26/2016 12:00:00 AM | 8/26/2016 7:03 AM |
| Details | Last Recertification Date | Update | | 9/5/2014 12:00:00 AM | 8/24/2015 12:00:00 AM | 8/24/2015 1:17 PM |
| Details | Last Recertification Date | Update | | 8/26/2013 7:07:45 AM | 9/5/2014 12:00:00 AM | 9/5/2014 6:14 PM |
| Details | Last Recertification Date | Update | | | 8/26/2013 7:07:45 AM | 8/26/2013 7:07 AM |
| Details | Entity Name | Update | | CHRISTUS SCHUMPERT HEALTH SYSTEM | CHRISTUS Health Shreveport-Bossier | 1/18/2013 10:32 AM |
| Details | 340B ID | Update | | IS-JH-DSH190041C | DSH190041C | 9/13/2012 11:12 AM |
| Dates | Participating Approval Date | Update | | | 9/13/2012 12:00:00 AM | 9/13/2012 11:12 AM |
| Details | State | Update | | Pending | Active | 9/13/2012 11:12 AM |
| Dates | Start Date | Update | | | 10/1/2012 12:00:00 AM | 9/13/2012 11:12 AM |
| Details | 340B ID | Update | | jh090312c | IS-JH-DSH190041C | 9/10/2012 8:41 AM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | jh090312c | 9/3/2012 8:28 PM |
| Details | Last Recertification Date | Insert | | | | 8/29/2012 6:16 PM |
| Details | Grant Number | Insert | | | | 8/29/2012 6:16 PM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 8/29/2012 6:16 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/29/2012 6:16 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/29/2012 6:16 PM |
| Details | Medicare Provider Number | Insert | | | 190041 | 8/29/2012 6:16 PM |
| Details | Entity Name | Insert | | | CHRISTUS SCHUMPERT HEALTH SYSTEM | 8/29/2012 6:16 PM |
| Details | Program Code | Insert | | | DSH | 8/29/2012 6:16 PM |
| Details | Entity Subname | Insert | | | CHRISTUS Wound and Hyperbaric Medicine Center - Shreveport-Bossier | 8/29/2012 6:16 PM |
| Dates | Participating Approval Date | Insert | | | | 8/29/2012 6:16 PM |
| Details | State | Insert | | | Pending | 8/29/2012 6:16 PM |
| Dates | Registration Date | Insert | | | 8/29/2012 12:00:00 AM | 8/29/2012 6:16 PM |
| Dates | Signed By Date | Insert | | | 8/29/2012 12:00:00 AM | 8/29/2012 6:16 PM |
| Dates | Start Date | Insert | | | | 8/29/2012 6:16 PM |
| Terminations | Termination Comments | Insert | | | | 8/29/2012 6:16 PM |
| Terminations | Termination Date | Insert | | | | 8/29/2012 6:16 PM |
| Terminations | Termination Effective Date | Insert | | | | 8/29/2012 6:16 PM |
| Terminations | Termination Reason | Insert | | | | 8/29/2012 6:16 PM |