| Details | Last Recertification Date | Update | Recertification | 1/29/2024 5:32:49 PM | 2/10/2025 11:03:25 AM | 2/10/2025 11:03 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2023 11:11:14 AM | 1/29/2024 5:32:49 PM | 1/29/2024 5:32 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 8/16/2023 4:10 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 334829401 | 8/16/2023 4:10 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | TX | 8/16/2023 4:10 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1699966754 | 8/16/2023 4:10 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | TX | 8/16/2023 4:10 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1073935441 | 8/16/2023 4:10 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | TX | 8/16/2023 4:10 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 3348294-01 (TX) | | 7/10/2023 10:25 AM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1073935441 (TX) | | 7/10/2023 10:25 AM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2022 10:51:38 AM | 2/1/2023 11:11:14 AM | 2/1/2023 11:11 AM |
| Contacts | Primary Contact | Update | Group Change Request | Green, Kara
Clinical Director
Asian American Health Coalition dba HOPE Clinic
7137730803-154 | Leicht, Claudia
Pharmacist
Asian American Health Coalition
7137730803 | 1/17/2023 12:17 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/2/2022 11:58 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 3348294-01 | 12/2/2022 11:58 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | TX | 12/2/2022 11:58 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1073935441 | 12/2/2022 11:58 AM |
| Medicaid Billing | NPI: State | Insert | Change Request | | TX | 12/2/2022 11:58 AM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2021 12:32:16 PM | 2/2/2022 10:51:38 AM | 2/2/2022 10:51 AM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 10:32:41 AM | 2/4/2021 12:32:16 PM | 2/4/2021 12:32 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | OPA Cancel Termination Request | 8/10/2020 12:00:00 AM | | 8/25/2020 9:24 AM |
| Details | State | Update | OPA Cancel Termination Request | To Be Terminated | Active | 8/25/2020 9:24 AM |
| Terminations | Termination Comments | Update | OPA Cancel Termination Request | HOPE Clinic moved its location and this pharmacy is not longer useful for our patients. | | 8/25/2020 9:24 AM |
| Terminations | Termination Date | Update | OPA Cancel Termination Request | 10/1/2020 12:00:00 AM | | 8/25/2020 9:24 AM |
| Terminations | Termination Effective Date | Update | OPA Cancel Termination Request | 8/10/2020 12:00:00 AM | | 8/25/2020 9:24 AM |
| Terminations | Termination Reason | Update | OPA Cancel Termination Request | Business decision by the Covered Entity | | 8/25/2020 9:24 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 8/10/2020 12:00:00 AM | 8/24/2020 5:56 PM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 8/24/2020 5:56 PM |
| Terminations | Termination Comments | Update | Termination Request | | HOPE Clinic moved its location and this pharmacy is not longer useful for our patients. | 8/24/2020 5:56 PM |
| Terminations | Termination Date | Update | Termination Request | | 10/1/2020 12:00:00 AM | 8/24/2020 5:56 PM |
| Terminations | Termination Effective Date | Update | Termination Request | | 8/10/2020 12:00:00 AM | 8/24/2020 5:56 PM |
| Terminations | Termination Reason | Update | Termination Request | | Business decision by the Covered Entity | 8/24/2020 5:56 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2019 12:04:46 PM | 1/28/2020 10:32:41 AM | 1/28/2020 10:32 AM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2018 5:15:51 PM | 1/30/2019 12:04:46 PM | 1/30/2019 12:04 PM |
| Contacts | Primary Contact | Update | Recertification | Caracostis, Andrea
Chief Executive Officer
Asian American Health Coalition dba HOPE Clinic
7133373640 | Green, Kara
Clinical Director
Asian American Health Coalition dba HOPE Clinic
7137730803-154 | 2/7/2018 5:15 PM |
| Details | Last Recertification Date | Update | Recertification | 1/25/2017 12:00:00 AM | 2/7/2018 5:15:51 PM | 2/7/2018 5:15 PM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/7/2018 5:15 PM |
| Contacts | Authorizing Official | Update | | Caracostis, Andrea
Chief Executive Officer
7133373640 | Caracostis, Andrea
Chief Executive Officer
Asian American Health Coalition dba HOPE Clinic
7133373640 | 10/13/2017 11:08 AM |
| Contacts | Primary Contact | Update | | Caracostis, Andrea
Chief Executive Officer
7133373640 | Caracostis, Andrea
Chief Executive Officer
Asian American Health Coalition dba HOPE Clinic
7133373640 | 10/13/2017 11:08 AM |
| Contacts | Signed By | Update | | Caracostis, Andrea
Chief Executive Officer
7133373640 | Caracostis, Andrea
Chief Executive Officer
Asian American Health Coalition dba HOPE Clinic
7133373640 | 10/13/2017 11:08 AM |
| Contacts | Authorizing Official | Insert | | | Caracostis, Andrea
Chief Executive Officer
7133373640 | 4/5/2017 11:00 AM |
| Contacts | Primary Contact | Insert | | | Caracostis, Andrea
Chief Executive Officer
7133373640 | 4/5/2017 11:00 AM |
| Contacts | Signed By | Insert | | | Caracostis, Andrea
Chief Executive Officer
7133373640 | 4/5/2017 11:00 AM |
| Addresses | Main Address | Insert | | |
12121 Westheimer Road Suite 205
Houston, TX 77077-6682 | 2/8/2017 11:14 AM |
| Details | Last Recertification Date | Update | | 3/1/2016 12:00:00 AM | 1/25/2017 12:00:00 AM | 1/25/2017 10:42 AM |
| Details | Last Recertification Date | Update | | 3/2/2015 12:00:00 AM | 3/1/2016 12:00:00 AM | 3/1/2016 11:40 AM |
| Details | Last Recertification Date | Update | | | 3/2/2015 12:00:00 AM | 3/2/2015 9:50 AM |
| Dates | Participating Approval Date | Update | | | 7/21/2014 12:00:00 AM | 7/21/2014 11:31 AM |
| Details | State | Update | | Pending | Active | 7/21/2014 11:31 AM |
| Dates | Start Date | Update | | | 10/1/2014 12:00:00 AM | 7/21/2014 11:31 AM |
| Details | 340B ID | Update | | ONLINE_REG_45357 | CHC24153-01 | 7/21/2014 11:20 AM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_45357 | 7/11/2014 3:17 PM |
| Details | Last Recertification Date | Insert | | | | 7/11/2014 3:17 PM |
| Details | Grant Number | Insert | | | H80CS24153 | 7/11/2014 3:17 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 7/11/2014 3:17 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 7/11/2014 3:17 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/11/2014 3:17 PM |
| Details | Medicare Provider Number | Insert | | | | 7/11/2014 3:17 PM |
| Details | Entity Name | Insert | | | ASIAN AMERICAN HEALTH COALITION OF THE GREATER HOUSTON AREA, INC. | 7/11/2014 3:17 PM |
| Details | Program Code | Insert | | | CH | 7/11/2014 3:17 PM |
| Details | Entity Subname | Insert | | | HOPE Clinic WEST | 7/11/2014 3:17 PM |
| Dates | Participating Approval Date | Insert | | | | 7/11/2014 3:17 PM |
| Details | State | Insert | | | Pending | 7/11/2014 3:17 PM |
| Dates | Registration Date | Insert | | | 7/11/2014 12:00:00 AM | 7/11/2014 3:17 PM |
| Dates | Signed By Date | Insert | | | 7/11/2014 12:00:00 AM | 7/11/2014 3:17 PM |
| Dates | Start Date | Insert | | | | 7/11/2014 3:17 PM |
| Terminations | Termination Comments | Insert | | | | 7/11/2014 3:17 PM |
| Terminations | Termination Date | Insert | | | | 7/11/2014 3:17 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/11/2014 3:17 PM |
| Terminations | Termination Reason | Insert | | | | 7/11/2014 3:17 PM |