Covered Entity Details

SCH320016-00 GILA REGIONAL MEDICAL CENTER (Terminated) - information as of 6/14/2025 10:05:34 AM

Main Details

Name

GILA REGIONAL MEDICAL CENTER

Subdivision Name

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH320016-00

Medicare Provider Number

320016

Additional Details

Current Program Status

Terminated

Registration Date

1/15/2018

Participating Start Date

4/1/2018

Participating Approval Date

1/17/2018

Last Recertification Date

8/19/2021

Termination Date
Termination Reason

7/1/2022
Change of covered entity type (non-hospital)

Contacts

Authorizing Official

Gila Regional Medical Center
Paul H Rogers, CFO
(941) 320-2498

Primary Contact

SCH320016-00
Dana Eric Hessel, Director of Pharmcy
(575) 538-4177

Addresses

Street Address

1313 E 32ND STREET
SILVER CITY, NM 88061

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
NM	570	1336220839

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	ALBERTSONS LLC	SAV-ON PHARMACY #3914	1956 HIGHWAY 180 EAST	SILVER CITY	NM	88061	04/09/2021	07/01/2021	07/01/2022	07/01/2022
Contract Detail	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 10449	610 SILVER HEIGHTS BLVD.	SILVER CITY	NM	88061	04/09/2021	07/01/2021	07/01/2022	07/01/2022
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/09/2021	07/01/2021	07/01/2022	07/01/2022
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/09/2021	07/01/2021	07/01/2022	07/01/2022
Contract Detail	WAL-MART PHARMACY 10-1357	2501 HWY. 180 EAST		SILVER CITY	NM	88061	04/09/2021	07/01/2021	07/01/2022	07/01/2022
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/09/2021	07/01/2021	04/13/2021	04/13/2021
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/13/2021	07/01/2021	07/01/2022	07/01/2022
Contract Detail	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	07/07/2021	10/01/2021	07/01/2022	07/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10808	100 ROSEDALE RD.	SILVER CITY	NM	88061-8742	04/09/2021	07/01/2021	07/01/2022	07/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15603	122 NORTH GOLD AVENUE	DEMING	NM	88030	04/09/2021	07/01/2021	07/01/2022	07/01/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/09/2021	07/01/2021	07/01/2022	07/01/2022

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
SCH320016-01	Child	SCH	GILA REGIONAL MEDICAL CENTER	GILA REGIONAL MEDICAL CENTER - GILA SURGERY SERVICES	1280 E 32ND ST, LAMONTANA PLAZA	SILVER CITY	NM	Terminated
SCH320016-02	Child	SCH	GILA REGIONAL MEDICAL CENTER	Gila Regional Family Medicine	3185 N LESLIE RD	Silver City	NM	Terminated
SCH320016-03	Child	SCH	GILA REGIONAL MEDICAL CENTER	GILA REGIONAL CARDIOLOGY	1302 E 32ND ST, LAMONTANA PLAZA	SILVER CITY	NM	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		4/5/2022 12:00:00 AM	4/6/2022 7:05 AM
Details	State	Update	Termination Request	Active	To Be Terminated	4/6/2022 7:05 AM
Terminations	Termination Comments	Update	Termination Request		Re-registered as CAH, was SCH	4/6/2022 7:05 AM
Terminations	Termination Date	Update	Termination Request		7/1/2022 12:00:00 AM	4/6/2022 7:05 AM
Terminations	Termination Effective Date	Update	Termination Request		4/5/2022 12:00:00 AM	4/6/2022 7:05 AM
Terminations	Termination Reason	Update	Termination Request		Change of covered entity type (non-hospital)	4/6/2022 7:05 AM
Contacts	Authorizing Official	Update	AO Change Request	Brickner, Gregory W Interim CFO Gila Regional Medical Center 5755384130	Rogers, Paul H CFO Gila Regional Medical Center 9413202498	3/9/2022 7:37 AM
Details	Last Recertification Date	Update	Recertification	9/14/2020 3:48:01 PM	8/19/2021 5:10:09 PM	8/19/2021 5:10 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336220839	2/9/2021 3:37 PM
Medicaid Billing	NPI: State	Insert	Change Request		NM	2/9/2021 3:37 PM
Contacts	Authorizing Official	Update	Change Request	Alesch, Richard L Interim CFO Gila Regional Medical Center 5755384130	Brickner, Gregory W Interim CFO Gila Regional Medical Center 5755384130	1/13/2021 11:19 AM
Contacts	Primary Contact	Update	Change Request	Enzor, Lindsay Pharmacy Director Gila Regional Medical Center 7575080188	Hessel, Dana Eric Director of Pharmcy SCH320016-00 5755384177	1/12/2021 9:20 AM
Contacts	Primary Contact	Update	Change Request	Fast-Ames, Jennifer Director of Pharmacy Gila Regional Medical Center 5755384177	Enzor, Lindsay Pharmacy Director Gila Regional Medical Center 7575080188	9/14/2020 4:13 PM
Details	Last Recertification Date	Update	Recertification	9/13/2019 11:37:50 AM	9/14/2020 3:48:01 PM	9/14/2020 3:48 PM
Contacts	Authorizing Official	Update	AO Change Request	Stokes, Richard W CFO Gila Regional Medical Center 5755384130	Alesch, Richard L Interim CFO Gila Regional Medical Center 5755384130	9/14/2020 12:04 PM
Details	Last Recertification Date	Update	Recertification	8/16/2018 12:09:03 PM	9/13/2019 11:37:50 AM	9/13/2019 11:37 AM
Contacts	Authorizing Official	Update	Change Request	Pacheco, Alfredo Rey Interim Controller Gila Regional Medical Center 5755384115	Stokes, Richard W CFO Gila Regional Medical Center 5755384130	4/10/2019 11:07 AM
Contacts	Primary Contact	Update	Profile Change Request	Fast-Ames, Jennifer Director Gila Regional Medical Center 5755384177	Fast-Ames, Jennifer Director of Pharmacy Gila Regional Medical Center 5755384177	3/12/2019 12:32 PM
Contacts	Primary Contact	Update	Change Request	Reed, Susan A Interim Pharmacy Director Gila Regional Medical Center 5755384177	Fast-Ames, Jennifer Director Gila Regional Medical Center 5755384177	3/12/2019 12:04 PM
Details	Last Recertification Date	Update	Recertification		8/16/2018 12:09:03 PM	8/16/2018 12:09 PM
Contacts	Primary Contact	Update	Change Request	Cooper, Michael E Interim Pharmacy Director Gila Regional Medicaol Center 5755384177	Reed, Susan A Interim Pharmacy Director Gila Regional Medical Center 5755384177	2/20/2018 4:22 PM
Details	State	Update	Change Request	Approved	Active	2/20/2018 4:22 PM
Contacts	Signed By	Insert	Hospital Type Change Request		Pacheco, Alfredo Rey Interim Controller Gila Regional Medical Center 5755384115	1/17/2018 3:18 PM
Details	340B ID	Update	Hospital Type Change Request		SCH320016-00	1/17/2018 3:18 PM
Dates	Participating Approval Date	Update	Hospital Type Change Request		1/17/2018 3:18:11 PM	1/17/2018 3:18 PM
Details	State	Update	Hospital Type Change Request	Pending	Approved	1/17/2018 3:18 PM
Dates	Signed By Date	Update	Hospital Type Change Request		1/15/2018 4:09:35 PM	1/17/2018 3:18 PM
Dates	Start Date	Update	Hospital Type Change Request		4/1/2018 12:00:00 AM	1/17/2018 3:18 PM
Addresses	Main Address	Insert	Hospital Type Change Request		1313 E 32ND STREET SILVER CITY, NM 88061	1/15/2018 4:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Hospital Type Change Request		False	1/15/2018 4:09 PM
Medicaid Billing	Medicaid: Number	Insert	Hospital Type Change Request		570	1/15/2018 4:09 PM
Medicaid Billing	Medicaid: State	Insert	Hospital Type Change Request		NM	1/15/2018 4:09 PM
Contacts	Authorizing Official	Insert	Hospital Type Change Request		Pacheco, Alfredo Rey Interim Controller Gila Regional Medical Center 5755384115	1/15/2018 4:09 PM
Contacts	Primary Contact	Insert	Hospital Type Change Request		Cooper, Michael E Interim Pharmacy Director Gila Regional Medicaol Center 5755384177	1/15/2018 4:09 PM
Details	Last Recertification Date	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Details	Grant Number	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Details	340B ID	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Details	Is Authorizing Official EHB Data	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Dates	Last Date That 340B Drugs Purchased	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Details	Medicare Provider Number	Insert	Hospital Type Change Request		320016	1/15/2018 4:09 PM
Details	Entity Name	Insert	Hospital Type Change Request		GILA REGIONAL MEDICAL CENTER	1/15/2018 4:09 PM
Details	Program Code	Insert	Hospital Type Change Request		SCH	1/15/2018 4:09 PM
Details	Entity Subname	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Dates	Participating Approval Date	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Details	State	Insert	Hospital Type Change Request		Pending	1/15/2018 4:09 PM
Dates	Registration Date	Insert	Hospital Type Change Request		1/15/2018 4:09:31 PM	1/15/2018 4:09 PM
Dates	Signed By Date	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Dates	Start Date	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Terminations	Termination Comments	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Terminations	Termination Date	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Terminations	Termination Effective Date	Insert	Hospital Type Change Request			1/15/2018 4:09 PM
Terminations	Termination Reason	Insert	Hospital Type Change Request			1/15/2018 4:09 PM