Covered Entity Details

DSH450046AH CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE (Terminated) - information as of 6/1/2025 4:51:04 AM

Main Details

Name

CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE

Subdivision Name

Shoreline - Pre-Testing

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450046AH

Medicare Provider Number

450046

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/11/2013

Participating Start Date

4/1/2013

Participating Approval Date

3/11/2013

Last Recertification Date

8/25/2021

Termination Date
Termination Reason

10/1/2022
Outpatient facility moved within the 4 walls of the parent hospital

Contacts

Authorizing Official

CHRISTUS Spohn
Becky Rios, CFO
(361) 881-3157

Primary Contact

CHRISTUS Spohn Hospital Corpus Christi
Gina Rodriguez, Lead Technician
(361) 902-4375

Addresses

Street Address

600 Elizabeth Street
Corpus Christi, TX 78404

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	1217754-03,1217754-01,2001414-01,1217754-05	1689641680

Shipping Addresses

Shipping Address 1

CHRISTUS Spohn Health System Corporation
5950 Saratoga Blvd
Corpus Christi, TX 78414

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
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH450046AA	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Ultrasound	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046AB	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - O/P Chemotherapy	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046AC	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Radiation Therapy	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046AD	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Cardiopulmonary	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046AE	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Endoscopy/G.I.	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046AF	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Physical Therapy	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046AG	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Special Procedures	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046AH	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Pre-Testing	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046AJ	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Emergency Room	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AK	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Mother Baby Unit	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AL	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Surgery-General	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AM	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Day Surgery	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AN	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Recovery Room	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AP	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Lab - General 1	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AQ	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Mammography	5950 Saratoga Blvd	Corpus Christi	TX	Terminated
DSH450046AR	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Nuclear Medicin	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AS	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - MRI	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AT	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Cat Scanner	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AU	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Radiology Admin	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AV	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Cardiopulmonary	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AW	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Endoscopy/G.I.	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AX	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Phys Therapy	5950 Saratoga Blvd	Corpus Christi	TX	Active
DSH450046AY	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Cancer Center Calallen	14120 Northwest Blvd	Corpus Christi	TX	Terminated
DSH450046AZ	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Cancer Center Westside	1205 S. 19th St.	Corpus Christi	TX	Terminated
DSH450046BA	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Hector P. Garcia Center Quick Care Clinic - Clinic	2606 Hospital Blvd.	Corpus Christi	TX	Active
DSH450046BB	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Christus Spohn NeuroSciences Center - Neurosciences	1227 3rd St	Corpus Christi	TX	Terminated
DSH450046BC	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	CHRISTUS SURGICAL HOSPITAL - Anesthesiology	6130 PARKWAY DR	CORPUS CHRISTI	TX	Active
DSH450046BD	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Hector P. Garcia Center Quick Care Clinic - PM&R	2606 Hospital Blvd.	CORPUS CHRISTI	TX	Active
DSH450046BE	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	CHRISTUS SURGICAL HOSPITAL - Emergency Care	6130 PARKWAY DR	CORPUS CHRISTI	TX	Terminated
DSH450046BF	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	CHRISTUS SPOHN ORTHOPEDIC CLINIC - Clinic	613 ELIZABETH ST	CORPUS CHRISTI	TX	Active
DSH450046BG	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Hector P. Garcia Center Quick Care Clinic - Primary Care	2606 Hospital Blvd.	CORPUS CHRISTI	TX	Active
DSH450046BH	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	CHRISTUS SURGICAL HOSPITAL - General Surgery	6130 PARKWAY DR	CORPUS CHRISTI	TX	Active
DSH450046BJ	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	CHRISTUS SURGICAL HOSPITAL - Outpatient Center - General Surgery	6130 PARKWAY DR	CORPUS CHRISTI	TX	Active
DSH450046BK	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Medication Management - Clinic	5950 Saratoga Boulevard	Corpus Christi	TX	Active
DSH450046BL	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Hector P. Garcia Center Quick Care Clinic - Specialty Neurosurgery	2606 Hospital Blvd.	CORPUS CHRISTI	TX	Active
DSH450046BM	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	CHRISTUS Spohn Family Health Center - Westside - Specialty Dental	4617 Greenwood Drive	Corpus Christi	TX	Active
DSH450046BN	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Anesthesiology	5950 Saratoga Blvd	Corpus Christi	TX	ToBeTerminated
DSH450046BP	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Pre-Operative A	5950 Saratoga Blvd	Corpus Christi	TX	Approved
DSH450046BQ	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Cardiology Non-Invasive	5950 Saratoga Blvd	Corpus Christi	TX	ToBeTerminated
DSH450046BR	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Cardiac Catheterization	5950 Saratoga Blvd	Corpus Christi	TX	Approved
DSH450046BS	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Obstetrics Emergency Department	5950 Saratoga Blvd	Corpus Christi	TX	Approved
DSH450046BT	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	South - Hemodialysis	5950 Saratoga Blvd	Corpus Christi	TX	Approved
DSH450046BU	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	CHRISTUS Family Medicine Academic Center - Primary Care	2606 Hospital Blvd.	Corpus Christi	TX	Approved
DSH450046D	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	CHRISTUS SPOHN CANCER CENTER	1415 SANTA FE	CORPUS CHRISTI	TX	Active
DSH450046E	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI MEMORIAL	CHRISTUS Spohn Family Health Center - Northside	1406 Martin Luther King Drive	Corpus Christi	TX	Terminated
DSH450046F	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	CHRISTUS Spohn Family Health Center - Westside	4617 Greenwood Drive	Corpus Christi	TX	Active
DSH450046G	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI MEMORIAL	CHRISTUS Spohn Family Health Center - Padre Island	14202 S. Padre Island Drive	Corpus Christi	TX	Terminated
DSH450046H	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	CHRISTUS Spohn Family Health Center - Robstown	1038 Texas Yes Blvd	Robstown	TX	Active
DSH450046J	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Emergency Room	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046K	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Surgery-General	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046L	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Ambulatory Trea	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046M	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Recovery Room	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046N	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Lab - General 1	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046P	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Outpat Lab 1-#2	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046Q	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Cardiac Rehab	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046R	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Cardiac Cath	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046S	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Radiolo-Diagnos	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046T	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Day Surgery	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046U	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Nuclear Medicin	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046V	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - MRI	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046W	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Cat Scanner	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046X	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Cat Scanner - #2	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046Y	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Mammography	600 Elizabeth Street	Corpus Christi	TX	Terminated
DSH450046Z	Child	DSH	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	Shoreline - Hyper Oxyg Ther	600 Elizabeth Street	Corpus Christi	TX	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Rios, Becky Interim CFO CHRISTUS Spohn 3618813157	Rios, Becky CFO CHRISTUS Spohn 3618813157	5/21/2025 2:21 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		6/3/2022 12:00:00 AM	8/29/2022 6:53 PM
Details	State	Update	Recertification	Active	To Be Terminated	8/29/2022 6:53 PM
Terminations	Termination Comments	Update	Recertification		Parent Site changed as of 6/2; child site is now within the 4 walls of the hospital (parent site)	8/29/2022 6:53 PM
Terminations	Termination Date	Update	Recertification		10/1/2022 12:00:00 AM	8/29/2022 6:53 PM
Terminations	Termination Effective Date	Update	Recertification		6/3/2022 12:00:00 AM	8/29/2022 6:53 PM
Terminations	Termination Reason	Update	Recertification		Outpatient facility moved within the 4 walls of the parent hospital	8/29/2022 6:53 PM
Details	Entity Name	Update	Change Request	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI MEMORIAL	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI SHORELINE	6/2/2022 7:57 AM
Details	Last Recertification Date	Update	Recertification	9/4/2020 3:58:14 PM	8/25/2021 10:37:47 AM	8/25/2021 10:37 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	2/22/2021 4:40 PM
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 3:58 PM
Details	Last Recertification Date	Update	Recertification	8/26/2019 4:02:25 PM	9/4/2020 3:58:14 PM	9/4/2020 3:58 PM
Details	Last Recertification Date	Update	Recertification	9/10/2018 2:51:53 PM	8/26/2019 4:02:25 PM	8/26/2019 4:02 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 3:55 PM
Details	Last Recertification Date	Update	Recertification	12/4/2017 3:47:48 PM	9/10/2018 2:51:53 PM	9/10/2018 2:51 PM
Details	Entity Name	Update	Recertification	CHRISTUS Spohn Hospital Corpus Christi	CHRISTUS SPOHN HOSPITAL CORPUS CHRISTI MEMORIAL	12/4/2017 4:47 PM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	12/4/2017 3:47:48 PM	12/4/2017 3:47 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			600 Elizabeth Street Corpus Christi, TX 78404	6/20/2017 12:36 PM
Addresses	Shipping Address	Insert			CHRISTUS Spohn Health System Corporation 5950 Saratoga Blvd Corpus Christi, TX 78414	6/20/2017 12:36 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	Update		Brower, Pamela Chief Finance Officer 3618813432	King, Steven Group CFO 3618813289	9/1/2016 8:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/29/2016 12:02 PM
Medicaid Billing	Medicaid: Number	Insert			2001414-01	8/29/2016 12:02 PM
Medicaid Billing	Medicaid: State	Insert			TX	8/29/2016 12:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/29/2016 12:02 PM
Medicaid Billing	Medicaid: Number	Insert			1217754-05	8/29/2016 12:02 PM
Medicaid Billing	Medicaid: State	Insert			TX	8/29/2016 12:02 PM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 12:02 PM
Details	Last Recertification Date	Update		8/25/2014 12:00:00 AM	8/31/2015 12:00:00 AM	9/2/2015 3:41 PM
Contacts	Primary Contact	Insert			Miller, Christopher W. Director of Pharmacy Services 3619024903	3/13/2015 8:02 AM
Details	Last Recertification Date	Update		9/9/2013 12:00:00 AM	8/25/2014 12:00:00 AM	8/25/2014 7:25 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/9/2013 10:27 PM
Medicaid Billing	Medicaid: Number	Insert			1217754-03	9/9/2013 10:27 PM
Medicaid Billing	Medicaid: State	Insert			TX	9/9/2013 10:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/9/2013 10:27 PM
Medicaid Billing	Medicaid: Number	Insert			1217754-01	9/9/2013 10:27 PM
Medicaid Billing	Medicaid: State	Insert			TX	9/9/2013 10:27 PM
Medicaid Billing	NPI: Number	Insert			1689641680	9/9/2013 10:27 PM
Details	Last Recertification Date	Update			9/9/2013 12:00:00 AM	9/9/2013 10:27 PM
Details	Entity Subname	Update		Pre-Testing	Shoreline - Pre-Testing	9/9/2013 10:27 PM
Contacts	Authorizing Official	Insert			Brower, Pamela Chief Finance Officer 3618813432	3/11/2013 2:50 PM
Details	Entity Subname	Update		Pre-Testing - 600 Elizabeth Street	Pre-Testing	3/11/2013 1:38 PM
Details	340B ID	Update		ISBLDSH450046AH	DSH450046AH	3/11/2013 1:23 PM
Details	Entity Subname	Update		Pre-Testing	Pre-Testing - 600 Elizabeth Street	3/11/2013 1:23 PM
Dates	Participating Approval Date	Update			3/11/2013 12:00:00 AM	3/11/2013 1:23 PM
Details	State	Update		Pending	Active	3/11/2013 1:23 PM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	3/11/2013 1:23 PM
Details	Medicare Provider Number	Update			450046	3/11/2013 11:50 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	ISBLDSH450046AH	2/12/2013 3:25 PM
Details	Last Recertification Date	Insert				1/11/2013 1:35 PM
Details	Grant Number	Insert				1/11/2013 1:35 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/11/2013 1:35 PM
Details	Is Authorizing Official EHB Data	Insert				1/11/2013 1:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/11/2013 1:35 PM
Details	Medicare Provider Number	Insert				1/11/2013 1:35 PM
Details	Entity Name	Insert			CHRISTUS Spohn Hospital Corpus Christi	1/11/2013 1:35 PM
Details	Program Code	Insert			DSH	1/11/2013 1:35 PM
Details	Entity Subname	Insert			Pre-Testing	1/11/2013 1:35 PM
Dates	Participating Approval Date	Insert				1/11/2013 1:35 PM
Details	State	Insert			Pending	1/11/2013 1:35 PM
Dates	Registration Date	Insert			1/11/2013 12:00:00 AM	1/11/2013 1:35 PM
Dates	Signed By Date	Insert			1/11/2013 12:00:00 AM	1/11/2013 1:35 PM
Dates	Start Date	Insert				1/11/2013 1:35 PM
Terminations	Termination Comments	Insert				1/11/2013 1:35 PM
Terminations	Termination Date	Insert				1/11/2013 1:35 PM
Terminations	Termination Effective Date	Insert				1/11/2013 1:35 PM
Terminations	Termination Reason	Insert				1/11/2013 1:35 PM