340B Drug Pricing Program Database


DSH450032AB GOOD SHEPHERD MEDICAL CENTER (Active) - information as of 5/2/2025 10:36:54 PM

Main Details
GOOD SHEPHERD MEDICAL CENTER
Longview Institute for Healthy Living - Wellness Clinic-- Speech Therapy
Disproportionate Share Hospital
No
DSH450032AB
450032


Additional Details
Active
5/4/2022
7/1/2022
5/12/2022
8/28/2024

Contacts

Good Shepherd Medical Center
Michael Cheek, CFO
(903) 315-1814

CHRISTUS Good Shepherd Medical Center
Jamie Lee Georgiev, Senior Pharmacy Buyer
(903) 315-3127

Addresses

3133 Good Shepherd Way
Longview, TX 75605

GOOD SHEPHERD MEDICAL CENTER
700 E. MARSHALL AVENUE
LONGVIEW, TX 75601


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participated starting 1/1/2018; Terminated 1/1/2021; Reinstated 7/1/2022.05/11/2022
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
TX11266741124092036,1285280057
Shipping Addresses

Good Shepherd Medical Center
700 E. Marshall Avenue
Longview, TX 75601
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH450032AChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLMarshall Pediatric Clinic707 S. GroveMarshallTXTerminated
DSH450032AAChildDSHGOOD SHEPHERD MEDICAL CENTEROutpatient Imaging (323 E Hawkins location)323 East Hawkins ParkwayLongviewTXActive
DSH450032ABChildDSHGOOD SHEPHERD MEDICAL CENTERLongview Institute for Healthy Living - Wellness Clinic-- Speech Therapy3133 Good Shepherd WayLongviewTXActive
DSH450032ACChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLS200 Pediatric Outpt Longview - Pediatric700 E Marshall AveLongviewTXTerminated
DSH450032ADChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Urology LGV703 E MarshallLongviewTXActive
DSH450032AEChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLCHRISTUS Trinity Clinic CV Surg LV - Clinic700 E MarshallLongviewTXTerminated
DSH450032AFChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Ortho LGV - Clinic701 E MarshallLongviewTXTerminated
DSH450032AGChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Surgery LGV705 E MarshallLongviewTXActive
DSH450032AHChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Gastro MSH815 S Washington AveMarshallTXActive
DSH450032AJChildDSHGOOD SHEPHERD MEDICAL CENTERCTC Family Medicine NorthPark323 E. Hawkins ParkwayLongviewTXActive
DSH450032AKChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Surgery MSH815 S Washington AveMarshallTXActive
DSH450032ALChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Ortho MSH815 S Washington AveMarshallTXActive
DSH450032AMChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Gastro LG701 E MarshallLongviewTXActive
DSH450032ANChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Int Med LGV703 E MarshallLongviewTXActive
DSH450032APChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Podiatry LGV - Clinic705 E. MarshallLongviewTXTerminated
DSH450032AQChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Residency LGV701 E MarshallLongviewTXActive
DSH450032ARChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Cardio LGV - Clinic703 E MarshallLongviewTXTerminated
DSH450032ASChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Int Med MSH815 S Washington AveMarshallTXActive
DSH450032ATChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLGOOD SHEPHERD MEDICAL CTR - Occup Ther - Occupational Therapy3133 Good Shepherd WayLongviewTXTerminated
DSH450032AUChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLGOOD SHEPHERD MEDICAL CTR - Speech - Speech Therapy3133 Good Shepherd WayLongviewTXTerminated
DSH450032AVChildDSHGOOD SHEPHERD MEDICAL CENTERSpecialty Clinic815 S Washington AveMarshallTXActive
DSH450032AWChildDSHGOOD SHEPHERD MEDICAL CENTERGOOD SHEPHERD MEDICAL CTR - Cardiac Rehab3133 Good Shepherd WayLongviewTXTerminated
DSH450032AXChildDSHGOOD SHEPHERD MEDICAL CENTERGood Shepherd Breast Center - Clinic705 E. MarshallLongviewTXActive
DSH450032AYChildDSHGOOD SHEPHERD MEDICAL CENTERGood Shepherd ASC - Surgery700 E MarshallLongviewTXTerminated
DSH450032AZChildDSHGOOD SHEPHERD MEDICAL CENTERGOOD SHEPHERD MEDICAL CTR - North Park - Emergency Services323 E Hawkins ParkwayLongviewTXActive
DSH450032BChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLEast Texas Pediatrics618 S. GroveMarshallTXTerminated
DSH450032BAChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Outpatient Rehab - Physical Therapy612 S. GroveMarshallTXActive
DSH450032BBChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLGOOD SHEPHERD MEDICAL CTR - Physical Therapy2220 H G Mosley ParkwayLongviewTXTerminated
DSH450032BCChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Outpatient Rehab - Speech Therapy612 S. GroveMarshallTXActive
DSH450032BDChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLInfusion Clinic - Infusion323 E Hawkins PkwyLongviewTXTerminated
DSH450032BEChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLGOOD SHEPHERD MEDICAL CTR - PT Sports Med - Physical Therapy3133 Good Shepherd WayLongviewTXTerminated
DSH450032BFChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Outpatient Rehab - Occupational Therapy612 S. GroveMarshallTXActive
DSH450032BGChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Hemodialysis - Hemodialysis811 S. WashingtonMarshallTXActive
DSH450032BHChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall CT - CT811 S. WashingtonMarshallTXActive
DSH450032BJChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Radiology811 S. WashingtonMarshallTXActive
DSH450032BKChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - PAIN/NEURO LGV703 E MARSHALL AVELongviewTXActive
DSH450032BLChildDSHGOOD SHEPHERD MEDICAL CENTERWOUND HEALING CENTER - Wound Care618 S GROVE STMARSHALLTXActive
DSH450032BMChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Respiratory Therapy - Respiratory Therapy811 S. WashingtonMarshallTXActive
DSH450032BNChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Interventional Radiology - Interventional Radiology811 S Washington AveMarshallTXActive
DSH450032BPChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - INTERNAL MED MSH - INTERNAL MED MSH811 S WASHINGTON AVEMarshallTXTerminated
DSH450032BQChildDSHGOOD SHEPHERD MEDICAL CENTERGOOD SHEPHERD ASC703 E MARSHALL AVELongviewTXActive
DSH450032BRChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Surgery - Surgery811 S Washington AveMarshallTXActive
DSH450032BSChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Laboratory - Laboratory811 S Washington AveMarshallTXActive
DSH450032BTChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall MRI - MRI811 S Washington AveMarshallTXActive
DSH450032BUChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Cardiology Non invasive - Cardiology Non invasive811 S Washington AveMarshallTXActive
DSH450032BVChildDSHGOOD SHEPHERD MEDICAL CENTERLongview Institute for Healthy Living - Wellness Clinic-- Physical Therapy - E. Hawkins Location3133 Good Shepherd WayLongviewTXActive
DSH450032BWChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Cardiac Rehab - Cardiac Rehab811 S Washington AveMarshallTXActive
DSH450032BXChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS GOOD SHEPHERD CENTER FOR SLEEP DISORDERS705 E MARSHALL AVELongviewTXActive
DSH450032BYChildDSHGOOD SHEPHERD MEDICAL CENTERLongview Institute for Healthy Living - Wellness Clinic-- Occupational Therapy3133 Good Shepherd WayLongviewTXActive
DSH450032BZChildDSHGOOD SHEPHERD MEDICAL CENTERMarshall Emergency Room - Emergency Room811 S Washington AveMarshallTXActive
DSH450032CChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLGood Shepherd Family Health Center805 S. Lindsey St.MarshallTXTerminated
DSH450032CAChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - ORTHOPEDIC SURGERY - ORTHOPEDIC SURGERY3133 Good Shepherd WayLongviewTXActive
DSH450032CBChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - CV SURGERY LGV - CV SURGERY701 E MARSHALL AVELONGVIEWTXTerminated
DSH450032CCChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - UROLOGY MSH815 S. Washington Ave.MarshallTXActive
DSH450032CDChildDSHGOOD SHEPHERD MEDICAL CENTEROrthopedics & Sports Medicine Institute3133 Good Shepherd WayLongviewTXActive
DSH450032CEChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS GOOD SHEPHERD HEART & VASCULAR INSTITUTE - Cardiac Rehab707 E. MARSHALL AVENUELongviewTXActive
DSH450032CFChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - ENT705 E MARSHALL AVELongviewTXActive
DSH450032CGChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - MARSHALL PAIN CLINIC - Pain Clinic815 S WASHINGTON AVEMarshallTXTerminated
DSH450032CHChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS GOOD SHEPHERD HEART & VASCULAR INSTITUTE - Imaging - Nuclear Medicine707 E MARSHALL AVELongviewTXActive
DSH450032CJChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS GOOD SHEPHERD HEART & VASCULAR INSTITUTE - Specialty Cardio707 E MARSHALL AVELongviewTXActive
DSH450032CKChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS GOOD SHEPHERD HEART & VASCULAR INSTITUTE - Electro Cardiology707 E. MARSHALL AVENUELongviewTXActive
DSH450032CLChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - Surgey - Plastic Surgery705 E. MARSHALL AVE.LONGVIEWTXActive
DSH450032CMChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - PULMONARY & CARDIOVASCULAR SURGERY705 E. MARSHALL AVELONGVIEWTXActive
DSH450032CNChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS ORTHOPEDIC & SPORTS MEDICI - Podiatry3133 GOOD SHEPHERD WAYLONGVIEWTXActive
DSH450032CPChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS Trinity Clinic - Multi-Specialty703 E Marshall Ave.LongviewTXActive
DSH450032CQChildDSHGOOD SHEPHERD MEDICAL CENTERKilgore - Clinic Services1718 S. Henderson BlvdKilgoreTXTerminated
DSH450032CRChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC FAMILY MEDI - Family Medicine1614 S HENDERSON BLVDKILGORETXActive
DSH450032CSChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - LONGVIEW - INFECTIOUS DISEASE703 E. MarshallLongviewTXActive
DSH450032CTChildDSHGOOD SHEPHERD MEDICAL CENTERNORTHPARK - Surg Anesthesiology323 E. HawkinsLongviewTXActive
DSH450032CUChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - MARSHALL OUTREACH - ORTHOPEDICS AND PODIATRY815 S WASHINGTON AVEMARSHALLTXActive
DSH450032CVChildDSHGOOD SHEPHERD MEDICAL CENTERNORTHPARK - General Surgery323 E. HawkinsLongviewTXActive
DSH450032CWChildDSHGOOD SHEPHERD MEDICAL CENTERCTC - PULMONOLOGY815 S. WASHINGTON AVE.MARSHALLTXActive
DSH450032CXChildDSHGOOD SHEPHERD MEDICAL CENTERNORTHPARK - Post Surgical PACU323 E. HawkinsLongviewTXActive
DSH450032CYChildDSHGOOD SHEPHERD MEDICAL CENTERNORTHPARK - Radiology Outpatient323 E. HawkinsLongviewTXActive
DSH450032DChildDSHGOOD SHEPHERD MEDICAL CTR - MARSHALLFirst in Pediatrics RHC304 University Ave.MarshallTXTerminated
DSH450032EChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLMRI - Longview - MRI700 E Marshall AveLongviewTXTerminated
DSH450032FChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLNuclear Medicine - Longview - Radiology - Diagnostic700 E Marshall AveLongviewTXTerminated
DSH450032GChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLPulmonary Services - Longview - Respiratory Therapy700 E Marshall AveLongviewTXTerminated
DSH450032HChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLSurgery Dept - Longview - Operating Room700 E Marshall AveLongviewTXTerminated
DSH450032JChildDSHGOOD SHEPHERD MEDICAL CENTERDiagnostic Radiology - Longvew - Radiology - Diagnostic700 E Marshall AveLongviewTXTerminated
DSH450032KChildDSHGOOD SHEPHERD MEDICAL CENTERKilgore ED - Emergency1612 South Henderson BlvdKilgoreTXActive
DSH450032LChildDSHGOOD SHEPHERD MEDICAL CENTERLongview Northpark Emergency Department323 East Hawkins ParkwayLongviewTXTerminated
DSH450032MChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLLabor & Delivery OP-Longview - Delivery Room & Labor Room700 E Marshall AveLongviewTXTerminated
DSH450032NChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLInterventional Rad - Longview - Radiology - Diagnostic700 E Marshall AveLongviewTXTerminated
DSH450032PChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLER - SANE - Longview - Emergency700 E Marshall AveLongviewTXTerminated
DSH450032QChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLEmergency Room - Longview - Emergency Room700 E Marshall AveLongviewTXTerminated
DSH450032RChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLComputed Tomography - Longview - CT Scan700 E Marshall AveLongviewTXTerminated
DSH450032SChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLCath Lab - Longview - Cardiac Catheterization700 E Marshall AveLongviewTXTerminated
DSH450032TChildDSHGOOD SHEPHERD MEDICAL CENTERCardio Pulmonary - Longview - Cardiopulmonary Rehab700 E Marshall AveLongviewTXTerminated
DSH450032UChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLBlood Bank - Longview - Laboratory700 E Marshall AveLongviewTXTerminated
DSH450032VChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLInfusion Clinic - Infusion Clinic700 E Marshall AveLongviewTXTerminated
DSH450032WChildDSHGOOD SHEPHERD MEDICAL CENTERCHRISTUS TRINITY CLINIC - PAIN LGV703 E. Marshall AveLongviewTXActive
DSH450032XChildDSHGOOD SHEPHERD MEDICAL CENTERCenter for Wound Healing and Hyperbaric Medicine - Wound Care705 E. Marshall AveLongviewTXActive
DSH450032YChildDSHGOOD SHEPHERD MEDICAL CENTER - MARSHALLBreast Center at Good Shepherd - Longview - Radiology - Diagnostic705 E. Marshall AveLongviewTXTerminated
DSH450032ZChildDSHGOOD SHEPHERD MEDICAL CENTEROutpatient Imaging (701 E. Marshall location) - MRI701 E. Marshall AveLongviewTXActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdatePC Change RequestDudley, Drake Manager of Pharmacy Services Christus Health 9033152938Georgiev, Jamie Lee Senior Pharmacy Buyer CHRISTUS Good Shepherd Medical Center 903315312712/26/2024 2:20 PM
DetailsLast Recertification DateUpdateRecertification8/29/2023 4:18:20 PM8/28/2024 4:14:35 PM8/28/2024 4:14 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 12852800573/1/2024 1:26 PM
Medicaid BillingNPI: StateInsertGroup Change Request TX3/1/2024 1:26 PM
DetailsLast Recertification DateUpdateRecertification8/25/2022 1:08:27 PM8/29/2023 4:18:20 PM8/29/2023 4:18 PM
DetailsEntity SubnameUpdateRecertificationLongview Institute for Healthy Living - Wellness Clinic-- Speech Therapy - Speech TherapyLongview Institute for Healthy Living - Wellness Clinic-- Speech Therapy8/29/2023 4:18 PM
ContactsPrimary ContactUpdateGroup Change RequestBrown, Jonathan Director of Pharmacy Christus Good Shepherd Medical Center 9033152019Dudley, Drake Manager of Pharmacy Services Christus Health 90331529386/5/2023 3:10 PM
DetailsLast Recertification DateUpdateRecertification 8/25/2022 1:08:27 PM8/25/2022 1:08 PM
DetailsStateUpdate ApprovedActive7/1/2022 12:01 AM
AddressesShipping AddressInsertGroup Change Request Good Shepherd Medical Center 700 E. Marshall Avenue Longview, TX 756016/13/2022 9:05 AM
AddressesBilling AddressUpdateGroup Change RequestGood Shepherd Medical Center – Marshall 700 E Marshall Ave Marshall, TX 75601GOOD SHEPHERD MEDICAL CENTER 700 E. MARSHALL AVENUE LONGVIEW, TX 756016/9/2022 10:33 AM
DetailsEntity SubnameUpdateChange RequestLongview Institute for Healthy Living - Wellness ClinicLongview Institute for Healthy Living - Wellness Clinic-- Speech Therapy - Speech Therapy6/2/2022 10:48 AM
AddressesBilling AddressInsertReinstatement Good Shepherd Medical Center – Marshall 700 E Marshall Ave Marshall, TX 756015/12/2022 7:43 AM
ContactsSigned ByUpdateReinstatementCreel, Keith Vice President of Ancillary Services Good Shepherd Medical Center - Marshall 9039276797Cheek, Michael CFO Good Shepherd Medical Center 90331518145/12/2022 7:43 AM
DetailsLast Recertification DateUpdateReinstatement9/9/2020 4:22:30 PM 5/12/2022 7:43 AM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement1/1/2021 12:00:00 AM 5/12/2022 7:43 AM
DetailsEntity NameUpdateReinstatementGOOD SHEPHERD MEDICAL CENTER - MARSHALLGOOD SHEPHERD MEDICAL CENTER5/12/2022 7:43 AM
DatesParticipating Approval DateUpdateReinstatement11/7/2017 3:41:09 PM5/12/2022 7:43:01 AM5/12/2022 7:43 AM
DetailsStateUpdateReinstatementTerminatedApproved5/12/2022 7:43 AM
DatesRegistration DateUpdateReinstatement10/12/2017 2:03:51 PM5/4/2022 1:01:36 PM5/12/2022 7:43 AM
DatesSigned By DateUpdateReinstatement10/18/2017 5:08:23 PM5/4/2022 1:01:40 PM5/12/2022 7:43 AM
DatesStart DateUpdateReinstatement1/1/2018 12:00:00 AM7/1/2022 12:00:00 AM5/12/2022 7:43 AM
TerminationsTermination DateUpdateReinstatement1/1/2021 12:00:00 AM 5/12/2022 7:43 AM
TerminationsTermination Effective DateUpdateReinstatement1/1/2021 12:00:00 AM 5/12/2022 7:43 AM
TerminationsTermination ReasonUpdateReinstatementChange of covered entity type 5/12/2022 7:43 AM
DetailsComments PublicInsertReinstatement Participated starting 1/1/2018; Terminated 1/1/2021; Reinstated 7/1/2022.5/11/2022 4:05 PM
DetailsStateUpdate To Be TerminatedTerminated1/1/2021 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateHospital Type Change Request 1/1/2021 12:00:00 AM11/3/2020 10:13 AM
DetailsStateUpdateHospital Type Change RequestActiveTo Be Terminated11/3/2020 10:13 AM
TerminationsTermination DateUpdateHospital Type Change Request 1/1/2021 12:00:00 AM11/3/2020 10:13 AM
TerminationsTermination Effective DateUpdateHospital Type Change Request 1/1/2021 12:00:00 AM11/3/2020 10:13 AM
TerminationsTermination ReasonUpdateHospital Type Change Request Change of covered entity type11/3/2020 10:13 AM
Medicaid BillingNPI: NumberInsertRecertification 11240920369/9/2020 4:22 PM
Medicaid BillingNPI: StateInsertRecertification TX9/9/2020 4:22 PM
DetailsLast Recertification DateUpdateRecertification8/26/2019 8:16:33 AM9/9/2020 4:22:30 PM9/9/2020 4:22 PM
ContactsAuthorizing OfficialUpdateAO Change RequestAdams, Jason COO Christus Good Shepherd Medical Center 9033152440Cheek, Michael CFO Good Shepherd Medical Center 903315181410/7/2019 11:29 AM
ContactsPrimary ContactInsertRecertification Brown, Jonathan Director of Pharmacy Christus Good Shepherd Medical Center 90331520198/26/2019 8:16 AM
DetailsLast Recertification DateUpdateRecertification8/28/2018 4:48:22 PM8/26/2019 8:16:33 AM8/26/2019 8:16 AM
ContactsAuthorizing OfficialUpdateAO Change RequestCreel, Keith Vice President of Ancillary Services Good Shepherd Medical Center - Marshall 9039276797Adams, Jason COO Christus Good Shepherd Medical Center 90331524401/7/2019 11:20 AM
DetailsLast Recertification DateUpdateRecertification 8/28/2018 4:48:22 PM8/28/2018 4:48 PM
DetailsStateUpdate ApprovedActive1/1/2018 12:00 AM
ContactsSigned ByInsertNew Registration Creel, Keith Vice President of Ancillary Services Good Shepherd Medical Center - Marshall 903927679711/7/2017 3:41 PM
Details340B IDUpdateNew Registration DSH450032AB11/7/2017 3:41 PM
DetailsEntity SubnameUpdateNew RegistrationLongview Institute for Healthy LivingLongview Institute for Healthy Living - Wellness Clinic11/7/2017 3:41 PM
DatesParticipating Approval DateUpdateNew Registration 11/7/2017 3:41:09 PM11/7/2017 3:41 PM
DetailsStateUpdateNew RegistrationPendingApproved11/7/2017 3:41 PM
DatesSigned By DateUpdateNew Registration 10/18/2017 5:08:23 PM11/7/2017 3:41 PM
DatesStart DateUpdateNew Registration 1/1/2018 12:00:00 AM11/7/2017 3:41 PM
AddressesMain AddressInsertNew Registration  3133 Good Shepherd Way Longview, TX 7560510/12/2017 2:03 PM
AddressesBilling AddressInsertNew Registration Good Shepherd Medical Center – Marshall 700 E Marshall Ave Marshall, TX 7560110/12/2017 2:03 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/12/2017 2:03 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 112667410/12/2017 2:03 PM
Medicaid BillingMedicaid: StateInsertNew Registration TX10/12/2017 2:03 PM
ContactsAuthorizing OfficialInsertNew Registration Creel, Keith Vice President of Ancillary Services Good Shepherd Medical Center - Marshall 903927679710/12/2017 2:03 PM
DetailsLast Recertification DateInsertNew Registration  10/12/2017 2:03 PM
DetailsGrant NumberInsertNew Registration  10/12/2017 2:03 PM
Details340B IDInsertNew Registration  10/12/2017 2:03 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/12/2017 2:03 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/12/2017 2:03 PM
DetailsMedicare Provider NumberInsertNew Registration 45003210/12/2017 2:03 PM
DetailsEntity NameInsertNew Registration GOOD SHEPHERD MEDICAL CENTER - MARSHALL10/12/2017 2:03 PM
DetailsProgram CodeInsertNew Registration DSH10/12/2017 2:03 PM
DetailsEntity SubnameInsertNew Registration Longview Institute for Healthy Living10/12/2017 2:03 PM
DatesParticipating Approval DateInsertNew Registration  10/12/2017 2:03 PM
DetailsStateInsertNew Registration Pending10/12/2017 2:03 PM
DatesRegistration DateInsertNew Registration 10/12/2017 2:03:51 PM10/12/2017 2:03 PM
DatesSigned By DateInsertNew Registration  10/12/2017 2:03 PM
DatesStart DateInsertNew Registration  10/12/2017 2:03 PM
TerminationsTermination CommentsInsertNew Registration  10/12/2017 2:03 PM
TerminationsTermination DateInsertNew Registration  10/12/2017 2:03 PM
TerminationsTermination Effective DateInsertNew Registration  10/12/2017 2:03 PM
TerminationsTermination ReasonInsertNew Registration  10/12/2017 2:03 PM