| Details | Last Recertification Date | Update | Recertification | 8/21/2023 11:16:21 AM | 8/23/2024 10:16:43 AM | 8/23/2024 10:16 AM |
| Details | Last Recertification Date | Update | Recertification | 9/9/2022 1:40:57 PM | 8/21/2023 11:16:21 AM | 8/21/2023 11:16 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Vallejo, Javier
CFO
Deaf Smith County Hospital District
8063499233 | Gafford, Paul
CFO
Hereford Regional Medical Center
8063499233 | 9/15/2022 10:53 AM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2021 12:08:25 PM | 9/9/2022 1:40:57 PM | 9/9/2022 1:40 PM |
| Contacts | Primary Contact | Update | PC Change Request | Castillo, Rachel
Pharmacy Manager
Deaf Smith County Hospital District
8063642141-3316 | Estrada, Lupita
Pharmacy Manager
Hereford Regional Medical Center
8063642141 | 9/9/2022 1:29 PM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2020 12:20:33 PM | 9/1/2021 12:08:25 PM | 9/1/2021 12:08 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Hunt, Sharon
CFO
Deaf Smith County Hospital District
8063462141 | Vallejo, Javier
CFO
Deaf Smith County Hospital District
8063499233 | 8/31/2021 4:27 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/2/2020 12:20 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 111661804 | 9/2/2020 12:20 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | TX | 9/2/2020 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1811987027 | 9/2/2020 12:20 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | TX | 9/2/2020 12:20 PM |
| Details | Last Recertification Date | Update | Recertification | 9/3/2019 2:09:55 PM | 9/2/2020 12:20:33 PM | 9/2/2020 12:20 PM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2018 1:08:25 PM | 9/3/2019 2:09:55 PM | 9/3/2019 2:09 PM |
| Contacts | Authorizing Official | Update | AO Change Request | CORDER, NORALENE
CFO
Deaf Smith County Hospital District
8063642141-3233 | Hunt, Sharon
CFO
Deaf Smith County Hospital District
8063462141 | 8/9/2019 12:32 PM |
| Contacts | Primary Contact | Update | Recertification | IBARRA, ANAHELY
PHARMACY TECH
DEAF SMITH COUNTY HOSPITAL DISTRICT
8063642141 | Castillo, Rachel
Pharmacy Manager
Deaf Smith County Hospital District
8063642141-3316 | 8/28/2018 1:08 PM |
| Details | Last Recertification Date | Update | Recertification | 11/9/2017 10:51:05 AM | 8/28/2018 1:08:25 PM | 8/28/2018 1:08 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Fox, Leticia
CFO
Deaf Smith County Hospital District
8063499233 | CORDER, NORALENE
CFO
Deaf Smith County Hospital District
8063642141-3233 | 8/27/2018 4:08 PM |
| Contacts | Primary Contact | Update | Recertification | CASTILLO, CINDY
CFO
8063642141-3233 | IBARRA, ANAHELY
PHARMACY TECH
DEAF SMITH COUNTY HOSPITAL DISTRICT
8063642141 | 11/9/2017 10:51 AM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2016 12:00:00 AM | 11/9/2017 10:51:05 AM | 11/9/2017 10:51 AM |
| Contacts | Authorizing Official | Insert | AO Change Request | | Fox, Leticia
CFO
Deaf Smith County Hospital District
8063499233 | 10/24/2017 6:28 PM |
| Addresses | Main Address | Insert | | |
540 West 15th Street
Hereford, TX 79045 | 8/18/2016 3:05 PM |
| Contacts | Signed By | Insert | | | REINART, GREG
CFO
8063642141-3206 | 8/18/2016 3:05 PM |
| Contacts | Primary Contact | Update | | Flood, Nathan
CEO
8063642141-3318 | CASTILLO, CINDY
CFO
8063642141-3233 | 8/18/2016 3:05 PM |
| Details | Last Recertification Date | Update | | 8/26/2015 12:00:00 AM | 8/18/2016 12:00:00 AM | 8/18/2016 3:05 PM |
| Details | Last Recertification Date | Update | | | 8/26/2015 12:00:00 AM | 8/26/2015 10:38 AM |
| Contacts | Primary Contact | Insert | | | Flood, Nathan
CEO
8063642141-3318 | 9/8/2014 7:46 AM |
| Dates | Participating Approval Date | Update | | | 9/5/2014 12:00:00 AM | 9/5/2014 11:22 AM |
| Details | State | Update | | Pending | Active | 9/5/2014 11:22 AM |
| Dates | Start Date | Update | | | 10/1/2014 12:00:00 AM | 9/5/2014 11:22 AM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_44828 | DSH450155A | 8/28/2014 10:45 AM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_44828 | 7/9/2014 5:46 PM |
| Details | Last Recertification Date | Insert | | | | 7/9/2014 5:46 PM |
| Details | Grant Number | Insert | | | | 7/9/2014 5:46 PM |
| Details | 340B ID | Insert | | | | 7/9/2014 5:46 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/9/2014 5:46 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/9/2014 5:46 PM |
| Details | Medicare Provider Number | Insert | | | 450155 | 7/9/2014 5:46 PM |
| Details | Entity Name | Insert | | | DEAF SMITH COUNTY HOSPITAL DISTRICT DBA HEREFORD REGIONAL MEDICAL CENTER | 7/9/2014 5:46 PM |
| Details | Program Code | Insert | | | DSH | 7/9/2014 5:46 PM |
| Details | Entity Subname | Insert | | | Hereford Health Clinic | 7/9/2014 5:46 PM |
| Dates | Participating Approval Date | Insert | | | | 7/9/2014 5:46 PM |
| Details | State | Insert | | | Pending | 7/9/2014 5:46 PM |
| Dates | Registration Date | Insert | | | 7/9/2014 12:00:00 AM | 7/9/2014 5:46 PM |
| Dates | Signed By Date | Insert | | | 7/9/2014 12:00:00 AM | 7/9/2014 5:46 PM |
| Dates | Start Date | Insert | | | | 7/9/2014 5:46 PM |
| Terminations | Termination Comments | Insert | | | | 7/9/2014 5:46 PM |
| Terminations | Termination Date | Insert | | | | 7/9/2014 5:46 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/9/2014 5:46 PM |
| Terminations | Termination Reason | Insert | | | | 7/9/2014 5:46 PM |