Covered Entity Details

DSH450352 Hunt Regional Medical Center (Active) - information as of 4/27/2025 10:43:27 PM

Main Details

Name

Hunt Regional Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450352

Medicare Provider Number

450352

Additional Details

Current Program Status

Active

Registration Date

10/5/2012

Participating Start Date

1/1/2013

Participating Approval Date

11/28/2012

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Hunt Memorial Hospital District
Terry Scoggin, CFO
(903) 408-1653

Primary Contact

Hunt Memorial Hospital District
Heather Rochford, Pharmacy Director
(903) 408-1875 Ext: 1875

Addresses

Street Address

4215 Joe Ramsey Blvd
Greenville, TX 75401

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?
Yes

State	Medicaid Number	NPI Number
TX	131038504,131038505,131038503,288145001,406342201,410772401	1598750721,1578558763,1235435892,1275031205,1033617931
OK	200768100A	1598750721
IL	751277293001	1598750721
AR	230397105	1598750721
FL	23595300	1598750721
LA	1741396	1598750721
MA	183960	1598750721
CO	9000180088	1598750721
MO	010079886	1598750721
OR	500610624	1598750721
KS	201278920A,30004685220001	1598750721
AZ	194506	1598750721
MI	1598750721	1598750721
TN	Q061055	1598750721
CA	213QFMT4	1598750721

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	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06806	5010 WESLEY ST	GREENVILLE	TX	75401	07/15/2022	10/01/2022		10/01/2022
Contract Detail	CVS PHARMACY, INC.	DBA CVS/PHARMACY #10505	2710 HIGHWAY 24	COMMERCE	TX	75428	07/15/2022	10/01/2022		10/01/2022
Contract Detail	DYER DRUG STORE	DYER DRUG STORE INC	133 MCKINNEY ST	FARMERSVILLE	TX	75442-2221	01/15/2019	04/01/2019	11/04/2019	11/04/2019
Contract Detail	DYER DRUG STORE	DYER DRUG STORE INC	133 MCKINNEY ST	FARMERSVILLE	TX	75442-2221	07/15/2022	10/01/2022		10/01/2022
Contract Detail	LEONARD PHARMACY INC	KEGANS HERBERT EUGENE	122 W COLLIN ST PO BOX 1229	LEONARD	TX	75452-2642	01/15/2019	04/01/2019	11/04/2019	11/04/2019
Contract Detail	LEONARD PHARMACY INC	KEGANS HERBERT EUGENE	122 W COLLIN ST PO BOX 1229	LEONARD	TX	75452-2642	07/15/2022	10/01/2022		10/01/2022
Contract Detail	MEDICINE SHOPPE #2015	3001 JOE RAMSEY BLVD E		GREENVILLE	TX	75401	01/15/2019	04/01/2019	11/04/2019	11/04/2019
Contract Detail	MEDICINE SHOPPE #2015	3001 JOE RAMSEY BLVD E		GREENVILLE	TX	75401	07/15/2022	10/01/2022		10/01/2022
Contract Detail	NOBLE HEALTH SERVICES INC.	6040 TARBELL ROAD		SYRACUSE	NY	13206	10/17/2022	01/01/2023	03/23/2023	05/10/2023
Contract Detail	NOBLE HEALTH SERVICES, INC.	DBA TRANSCRIPT PHARMACY	2506 LAKELAND DR STE 201	FLOWOOD	MS	39232-7656	01/06/2023	01/12/2023	04/29/2024	04/30/2024
Contract Detail	THE PHARMACY AT HUNT REGIONAL	4215 JOE RAMSEY BLVD E STE 220		GREENVILLE	TX	75401-7852	10/14/2019	01/01/2020		01/01/2020
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/15/2019	04/01/2019	11/04/2019	11/04/2019
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/15/2022	10/01/2022		10/01/2022
Contract Detail	WAL-MART PHARMACY 10-0240	2701 HIGHWAY 50		COMMERCE	TX	75428	01/15/2019	04/01/2019	11/04/2019	11/04/2019
Contract Detail	WAL-MART PHARMACY 10-0240	2701 HIGHWAY 50		COMMERCE	TX	75428	07/15/2022	10/01/2022		10/01/2022
Contract Detail	WAL-MART PHARMACY 10-0427	7401 INTERSTATE 30		GREENVILLE	TX	75402	01/15/2019	04/01/2019	11/04/2019	11/04/2019
Contract Detail	WAL-MART PHARMACY 10-0427	7401 INTERSTATE 30		GREENVILLE	TX	75402	07/15/2022	10/01/2022		10/01/2022
Contract Detail	WAL-MART PHARMACY 10-4215	8801 HIGHWAY 34 SOUTH		QUINLAN	TX	75474	01/15/2019	04/01/2019	11/04/2019	11/04/2019
Contract Detail	WAL-MART PHARMACY 10-4215	8801 HIGHWAY 34 SOUTH		QUINLAN	TX	75474	07/15/2022	10/01/2022		10/01/2022
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/15/2019	04/01/2019	11/04/2019	11/04/2019
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	07/15/2022	10/01/2022		10/01/2022
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/15/2019	04/01/2019	11/04/2019	11/04/2019
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/15/2022	10/01/2022		10/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05827	2911 RIDGE RD	ROCKWALL	TX	75032	01/05/2023	01/12/2023		01/12/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11910	1130 S. BROADWAY ST.	SULPHUR SPRINGS	TX	75482-4840	01/05/2023	01/12/2023		01/12/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04818	8801 LAKEVIEW PARKWAY	ROWLETT	TX	75088	01/05/2023	01/12/2023		01/12/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09123	6905 WESLEY STREET	GREENVILLE	TX	75402-7376	01/05/2023	01/12/2023		01/12/2023
Contract Detail	WALGREEN CO.	WALGREENS #21492	1603 CULVER ST	COMMERCE	TX	75428	10/10/2024	01/01/2025		01/01/2025
Contract Detail	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	01/05/2023	01/12/2023		01/12/2023
Contract Detail	WALMART PHARMACY 10-4453	4715 WESLEY ST.		GREENVILLE	TX	75401	01/15/2019	04/01/2019	11/04/2019	11/04/2019
Contract Detail	WALMART PHARMACY 10-4453	4715 WESLEY ST.		GREENVILLE	TX	75401	07/15/2022	10/01/2022		10/01/2022
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/06/2023	10/01/2023		10/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH450352A	Child	DSH	Hunt Regional Medical Center	Hunt Regional Infusion Center	5101 Wellington Street	Greenville	TX	Active
DSH450352B	Child	DSH	Hunt Regional Medical Center	Commerce Infusion	2800 Hwy 24	Commerce	TX	Terminated
DSH450352C	Child	DSH	Hunt Regional Medical Center	HUNT REGIONAL EMERGENCY MEDICAL CEN	2800 HWY 24	COMMERCE	TX	Active
DSH450352D	Child	DSH	Hunt Regional Medical Center	HUNT REGIONAL EMERGENCY CENTER AT Q	738 E QUINLAN PARKWAY	QUINLAN	TX	Active
DSH450352E	Child	DSH	Hunt Regional Medical Center	HUNT MEMORIAL HOSPITAL DISTRICT - Hunt Regional Specialists	4211 JOE RAMSEY BLVD E	GREENVILLE	TX	Terminated
DSH450352F	Child	DSH	Hunt Regional Medical Center	HUNT MEMORIAL HOSPITAL DISTRICT - Hunt Regional Urgent Care	3206 INTERSTATE 30 WEST, SUITE B	GREENVILLE	TX	Active
DSH450352G	Child	DSH	Hunt Regional Medical Center	HUNT MEMORIAL HOSPITAL DISTRICT - Hunt Regional Family Medicine	4501 JOE RAMSEY BLVD E	GREENVILLE	TX	Active
DSH450352H	Child	DSH	Hunt Regional Medical Center	Hunt Regional Urgent Care Rockwall - Hunt Regional Urgent Care	810 E. Ralph Hall Pkwy	Rockwall	TX	Active
DSH450352J	Child	DSH	Hunt Regional Medical Center	Hunt Regional Urgent Care Royse City - Hunt Regional Urgent Care	576 I-30 Frontage Rd	Royse City	TX	Active
DSH450352K	Child	DSH	Hunt Regional Medical Center	Hunt Regional Urgent Care Commerce - Hunt Regional Urgent Care	1704 Live Oak Street	Commerce	TX	Active
DSH450352L	Child	DSH	Hunt Regional Medical Center	Hunt Regional Family Medicine Royse City - Family Medicine	616 E Lamar St	Royse City	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Boles, Lee CEO Hunt Memorial Hospital District 9034081658	Scoggin, Terry CFO Hunt Memorial Hospital District 9034081653	4/2/2025 12:39 PM
Contacts	Authorizing Official	Update	Change Request	Morgan, Jamie Chief Financial Officer Hunt Regional Memorial Hospital 9034081653	Boles, Lee CEO Hunt Memorial Hospital District 9034081658	12/19/2024 7:01 AM
Details	Last Recertification Date	Update	Recertification	8/31/2023 2:45:47 PM	8/19/2024 12:18:55 PM	8/19/2024 12:18 PM
Details	Last Recertification Date	Update	Recertification	9/1/2022 3:47:29 PM	8/31/2023 2:45:47 PM	8/31/2023 2:45 PM
Contacts	Authorizing Official	Update	AO Change Request	Robertson, James Ayers Chief Financial Officer Hunt Regional Healthcare 9034081607	Morgan, Jamie Chief Financial Officer Hunt Regional Memorial Hospital 9034081653	8/29/2023 8:11 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/23/2023 9:56 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		30004685220001	3/23/2023 9:56 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		KS	3/23/2023 9:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/9/2022 1:21 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		288145001	9/9/2022 1:21 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	9/9/2022 1:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/9/2022 1:21 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		406342201	9/9/2022 1:21 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	9/9/2022 1:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/9/2022 1:21 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		410772401	9/9/2022 1:21 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	9/9/2022 1:21 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1235435892	9/9/2022 1:21 PM
Medicaid Billing	NPI: State	Insert	Change Request		TX	9/9/2022 1:21 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1275031205	9/9/2022 1:21 PM
Medicaid Billing	NPI: State	Insert	Change Request		TX	9/9/2022 1:21 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1033617931	9/9/2022 1:21 PM
Medicaid Billing	NPI: State	Insert	Change Request		TX	9/9/2022 1:21 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 3:47:17 PM	9/1/2022 3:47:29 PM	9/1/2022 3:47 PM
Contacts	Authorizing Official	Update	Change Request	Boles, Lee CFO Hunt Memorial Hospital District 9034081658	Robertson, James Ayers Chief Financial Officer Hunt Regional Healthcare 9034081607	4/22/2022 10:25 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/25/2021 2:26 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q061055	8/25/2021 2:26 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	8/25/2021 2:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/25/2021 2:26 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		213QFMT4	8/25/2021 2:26 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	8/25/2021 2:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	8/25/2021 2:26 PM
Medicaid Billing	NPI: State	Insert	Change Request		TN	8/25/2021 2:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	8/25/2021 2:26 PM
Medicaid Billing	NPI: State	Insert	Change Request		CA	8/25/2021 2:26 PM
Details	Last Recertification Date	Update	Recertification	8/31/2020 12:20:29 PM	8/16/2021 3:47:17 PM	8/16/2021 3:47 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		MO	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		MI	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		LA	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		MA	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		OK	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		KS	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		AR	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		FL	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		IL	11/18/2020 4:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 4:43 PM
Medicaid Billing	NPI: State	Insert	Change Request		CO	11/18/2020 4:43 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	131038503 (TX)		11/18/2020 2:34 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/18/2020 2:34 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		131038503	11/18/2020 2:34 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	11/18/2020 2:34 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598750721	11/18/2020 2:34 PM
Medicaid Billing	NPI: State	Insert	Change Request		TX	11/18/2020 2:34 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578558763	11/18/2020 2:34 PM
Medicaid Billing	NPI: State	Insert	Change Request		TX	11/18/2020 2:34 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		9000180088	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CO	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		010079886	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MO	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500610624	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		201278920A	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		KS	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		194506	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1598750721	8/31/2020 12:20 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MI	8/31/2020 12:20 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1598750721 ( )		8/31/2020 12:20 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1578558763 ( )		8/31/2020 12:20 PM
Details	Last Recertification Date	Update	Recertification	9/9/2019 8:39:28 AM	8/31/2020 12:20:29 PM	8/31/2020 12:20 PM
Contacts	Primary Contact	Update	Change Request	Rich, Jeri Sr. Financial Analyst Hunt Memorial Hospital District 9034081865	Rochford, Heather Pharmacy Director Hunt Memorial Hospital District 9034081875-1875	3/9/2020 6:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		200768100A	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OK	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		751277293001	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		230397105	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		23595300	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1741396	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		183960	9/30/2019 10:40 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	9/30/2019 10:40 AM
Details	Last Recertification Date	Update	Recertification	8/22/2018 4:14:35 PM	9/9/2019 8:39:28 AM	9/9/2019 8:39 AM
Details	Last Recertification Date	Update	Recertification	11/7/2017 10:36:03 AM	8/22/2018 4:14:35 PM	8/22/2018 4:14 PM
Contacts	Primary Contact	Insert	Recertification		Rich, Jeri Sr. Financial Analyst Hunt Memorial Hospital District 9034081865	11/7/2017 10:36 AM
Details	Last Recertification Date	Update	Recertification	8/25/2016 12:00:00 AM	11/7/2017 10:36:03 AM	11/7/2017 10:36 AM
Contacts	Authorizing Official	Update		Boles, Lee CFO 9034081658	Boles, Lee CFO Hunt Memorial Hospital District 9034081658	10/23/2017 2:06 PM
Contacts	Signed By	Update	Profile Change Request	Rich, Jeri CFO Hunt Memorial Hospital District 9034081865	Rich, Jeri Sr. Financial Analyst Hunt Memorial Hospital District 9034081865	10/18/2017 10:52 AM
Contacts	Signed By	Update		Rich, Jeri CFO 9034081865	Rich, Jeri CFO Hunt Memorial Hospital District 9034081865	10/18/2017 10:49 AM
Contacts	Authorizing Official	Insert			Boles, Lee CFO 9034081658	8/2/2017 2:38 PM
Addresses	Main Address	Insert			4215 Joe Ramsey Blvd Greenville, TX 75401	7/12/2017 5:51 PM
Contacts	Signed By	Insert			Rich, Jeri CFO 9034081865	7/12/2017 5:51 PM
Details	Last Recertification Date	Update		8/11/2015 12:00:00 AM	8/25/2016 12:00:00 AM	8/25/2016 11:49 AM
Details	Last Recertification Date	Update		8/26/2014 12:00:00 AM	8/11/2015 12:00:00 AM	8/11/2015 11:14 AM
Details	Last Recertification Date	Update		8/30/2013 12:00:00 AM	8/26/2014 12:00:00 AM	8/26/2014 7:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/30/2013 12:04 PM
Medicaid Billing	Medicaid: Number	Insert			131038505	8/30/2013 12:04 PM
Medicaid Billing	Medicaid: State	Insert			TX	8/30/2013 12:04 PM
Details	Last Recertification Date	Update			8/30/2013 12:00:00 AM	8/30/2013 12:04 PM
Details	340B ID	Update		IS-DR-DSH450352	DSH450352	11/28/2012 9:59 AM
Dates	Participating Approval Date	Update			11/28/2012 12:00:00 AM	11/28/2012 9:59 AM
Details	State	Update		Pending	Active	11/28/2012 9:59 AM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	11/28/2012 9:59 AM
Details	340B ID	Update		DR-DSH450352	IS-DR-DSH450352	11/19/2012 3:17 PM
Details	340B ID	Update		DR100812D	DR-DSH450352	10/16/2012 2:19 PM
Details	340B ID	Update		ONLINE_REG	DR100812D	10/8/2012 4:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/5/2012 5:08 PM
Medicaid Billing	Medicaid: Number	Insert			131038504	10/5/2012 5:08 PM
Medicaid Billing	Medicaid: State	Insert			TX	10/5/2012 5:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/5/2012 5:08 PM
Medicaid Billing	Medicaid: Number	Insert			131038503	10/5/2012 5:08 PM
Medicaid Billing	Medicaid: State	Insert			TX	10/5/2012 5:08 PM
Medicaid Billing	NPI: Number	Insert			1598750721	10/5/2012 5:08 PM
Medicaid Billing	NPI: Number	Insert			1578558763	10/5/2012 5:08 PM
Details	Last Recertification Date	Insert				10/5/2012 5:08 PM
Details	Grant Number	Insert				10/5/2012 5:08 PM
Details	340B ID	Insert			ONLINE_REG	10/5/2012 5:08 PM
Details	Is Authorizing Official EHB Data	Insert				10/5/2012 5:08 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/5/2012 5:08 PM
Details	Medicare Provider Number	Insert			450352	10/5/2012 5:08 PM
Details	Entity Name	Insert			Hunt Regional Medical Center	10/5/2012 5:08 PM
Details	Program Code	Insert			DSH	10/5/2012 5:08 PM
Details	Entity Subname	Insert				10/5/2012 5:08 PM
Dates	Participating Approval Date	Insert				10/5/2012 5:08 PM
Details	State	Insert			Pending	10/5/2012 5:08 PM
Dates	Registration Date	Insert			10/5/2012 12:00:00 AM	10/5/2012 5:08 PM
Dates	Signed By Date	Insert			10/5/2012 12:00:00 AM	10/5/2012 5:08 PM
Dates	Start Date	Insert				10/5/2012 5:08 PM
Terminations	Termination Comments	Insert				10/5/2012 5:08 PM
Terminations	Termination Date	Insert				10/5/2012 5:08 PM
Terminations	Termination Effective Date	Insert				10/5/2012 5:08 PM
Terminations	Termination Reason	Insert				10/5/2012 5:08 PM