Covered Entity Details

RRC450237-04 CHRISTUS SANTA ROSA HEALTH SYSTEM (Terminated) - information as of 4/28/2025 12:44:05 AM

Main Details

Name

CHRISTUS SANTA ROSA HEALTH SYSTEM

Subdivision Name

CHRISTUS Santa Rosa Hospital New Braunfels - Hyperbaric Center - Hyperbaric Oxygen Center

Type

Rural Referral Center

Rural

340B ID

RRC450237-04

Medicare Provider Number

450237

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/16/2018

Participating Start Date

7/1/2018

Participating Approval Date

5/8/2018

Last Recertification Date

8/25/2022

Termination Date
Termination Reason

7/1/2023
Change of covered entity type

Contacts

Authorizing Official

CHRISTUS Santa Rosa
Steve Chen, CFO
(210) 321-8031

Primary Contact

CHRISTUS Hospital Santa Rosa Medical Center
Emmanuel Aniemeke, Director of Pharmacy Services
(210) 705-6193

Addresses

Street Address

Medical Plaza Building, 598 North Union Avenue
Suite 335
New Braunfels, TX 78130

Billing Address

CHRISTUS Santa Rosa Hospital New Braunfels
600 North Union Avenue
New Braunfels, TX 78130

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	0208449-01,0944860-01	1194787218

Shipping Addresses

Shipping Address 1

CHRISTUS Santa Rosa Hospital New Braunfels
600 North Union Avenue
New Braunfels, TX 78130

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
RRC450237-01	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital Westover Hills - Endoscopy/G.I. - Endoscopy	11212 State Highway 151	San Antonio	TX	Terminated
RRC450237-02	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital - New Braunfels - Imaging and Lab Services - CT Scan - CT Scan	600 N. Union Avenue	New Braunfels	TX	Terminated
RRC450237-03	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital Westover Hills - Cardiac Cath - Cardiac Catheterization	11212 State Highway 151	San Antonio	TX	Terminated
RRC450237-04	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital New Braunfels - Hyperbaric Center - Hyperbaric Oxygen Center	Medical Plaza Building, 598 North Union Avenue	New Braunfels	TX	Terminated
RRC450237-05	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	Creekside Crossing OP Imaging-Radiology - Radiology - Diagnostic	244 Creekside Crossing	New Braunfels	TX	Terminated
RRC450237-06	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital - New Braunfels - Imaging and Lab Services - Laboratory	600 N. Union Avenue	New Braunfels	TX	Terminated
RRC450237-07	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hyperbaric Center - Hyperbaric Oxygen Center	2833 Babcock Road, Tower 2	San Antonio	TX	Terminated
RRC450237-08	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital - New Braunfels - Imaging and Lab Services - Radiology Therapeutic - Radiology - Therapeutic	Medical Plaza Building, 598 North Union Avenue, 1st Floor	New Braunfels	TX	Terminated
RRC450237-09	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital New Braunfels - LDRPN - Delivery Room & Labor Room	600 North Union Avenue	New Braunfels	TX	Terminated
RRC450237-10	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	Creekside Crossing ED - Emergency	244 Creekside Crossing	New Braunfels	TX	Terminated
RRC450237-11	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital Westover Hills - Pedi OP Day Surgery - Operating Room	11212 State Highway 151	San Antonio	TX	Terminated
RRC450237-12	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital - New Braunfels - Imaging and Lab Services - MRI - MRI	Medical Plaza Building, 598 North Union Avenue, 1st Floor	New Braunfels	TX	Terminated
RRC450237-13	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital - New Braunfels - Imaging and Lab Services - Radiology Diagnostic - Radiology - Diagnostic	Medical Plaza Building, 598 North Union Avenue, 1st Floor	New Braunfels	TX	Terminated
RRC450237-14	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital Westover Hills - Hyper O2 Thrpy - Hyperbaric Oxygen Therapy	11212 State Highway 151	San Antonio	TX	Terminated
RRC450237-15	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital Westover Hills - Day Surgery - Operating Room	11212 State Highway 151	San Antonio	TX	Terminated
RRC450237-16	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital New Braunfels - Cardiac Cath - Cardiac Catheterization	600 North Union Avenue	New Braunfels	TX	Terminated
RRC450237-17	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital New Braunfels - Emergency Room - Emergency	600 North Union Avenue	New Braunfels	TX	Terminated
RRC450237-18	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	MC Wound Care Center Downtown - Hyperbaric Oxygen Therapy	315 N. San Saba	San Antonio	TX	Terminated
RRC450237-19	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital New Braunfels - O/P Chemotherap - Clinic	Medical Plaza Building, 598 North Union Avenue, 1st Floor	New Braunfels	TX	Terminated
RRC450237-20	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital New Braunfels - Day Surgery - Operating Room	600 North Union Avenue	New Braunfels	TX	Terminated
RRC450237-21	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital Westover Hills - Emergency Room - Emergency Room	11212 State Highway 151	San Antonio	TX	Terminated
RRC450237-22	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	Alon Emergency Center - Emergency	11503 Northwest Military Highway	San Antonio	TX	Terminated
RRC450237-23	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital New Braunfels - Outpat Radiol 1 - Radiology - Diagnostic	600 North Union Avenue	New Braunfels	TX	Terminated
RRC450237-24	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa New Braunfels -Med Surg Outpatient Observation Beds / Med Surg D - Adults & Pediatrics	600 N UNION AVE	NEW BRAUNFELS	TX	Terminated
RRC450237-25	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS SANTA ROSA HOSPITAL Outpatient Observation Beds / Intermd Cre-Gen - Adults & Pediatrics	600 N UNION AVE	NEW BRAUNFELS	TX	Terminated
RRC450237-26	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS Santa Rosa Hospital Westover Hills - Med/Surg D - Adults & Pediatrics	11212 State Highway 151	San Antonio	TX	Terminated
RRC450237-27	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS ULTRASOUND - Imaging	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-28	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS EKG - Cardiology	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-29	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS Emergency Room - Emergency Department	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-30	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS RADIOLO-DIAGNOS - Imaging	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-31	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS Anesthesiology - Anesthesiology	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-32	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS OP RADIOLOGY PO - Imaging	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-33	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS RECOVERY ROOM - Recovery	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-34	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS URINANALYSIS - Lab Services	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-35	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS Chemistry - Lab Services	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-36	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS PHYS THERAPY - Physical Therapy	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-37	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS Blood Bk-Trnsfu - Blood Bank	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-38	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS Hematology - Laboratory - Hematology	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-39	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS REFERENCE LAB 1 - Lab Services	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-40	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS OUTPAT RADIOL 4 - Imaging	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-41	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS Cat Scanner - Imaging	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-42	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS Central Service - Central Service	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-43	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS MICROBIOLOGY - Lab Services	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-44	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS RESPIR THERAPY - Respiration Therapy	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-45	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS SURGERY-GENERAL-801 - Surgery	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-46	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS HIST-CYT-PATH - Lab Services	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-47	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS LAB - GENERAL 1 - Lab Services	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-48	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS SEROLOGY - Lab Services	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-49	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS SURGERY-GENERAL - Surgery	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-50	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS CLINIC 20 - Clinic	423 Treeline Park	San Antonio	TX	Terminated
RRC450237-51	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	RAS ENDOSCOPY - Endoscopy	403 Treeline Park	San Antonio	TX	Terminated
RRC450237-52	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	ECC OB ED Unit at Santa Rosa Hospital Westover Hills - ED	11212 STATE HIGHWAY 151	SAN ANTONIO	TX	Terminated
RRC450237-53	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS SANTA ROSA ORTHOPEDIC & SPORTS MEDICINE CLINIC- WH - ORTHOPEDIC & SPORTS MEDICINE	11212 STATE HIGHWAY 151	San Antonio	TX	Terminated
RRC450237-54	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS SANTA ROSA CARDIOTHORACIC CENTER-NEW BRAUNFELS - CARDIOTHORACIC	730 N HOUSTON AVE	New Braunfels	TX	Terminated
RRC450237-55	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS SANTA ROSA ORTHOPEDIC & SPORTS MEDICINE CLINIC - ORTHOPEDIC & SPORTS MEDICINE	2833 BABCOCK ROAD	San Antonio	TX	Terminated
RRC450237-56	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS SANTA ROSA SURGICAL SOLUTIONS - Bariatrics	11212 STATE HIGHWAY 151, BLDG 2	San Antonio	TX	Terminated
RRC450237-57	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS SANTA ROSA SPINE CENTER - Spine	2833 BABCOCK RD	San Antonio	TX	Terminated
RRC450237-58	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS SANTA ROSA NEUROSURGICAL SPINE - MEDICAL CENTER - NEUROSURGICAL SPINE	423 TREELINE PARK	San Antonio	TX	Terminated
RRC450237-59	Child	RRC	CHRISTUS SANTA ROSA HEALTH SYSTEM	CHRISTUS SANTA ROSA NEUROSURGICAL SPINE - MEDICAL CENTER - NEUROSURGICAL SPINE	2829 Babcock Rd	San Antonio	TX	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		7/1/2023 12:00:00 AM	4/20/2023 8:20 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	4/20/2023 8:20 AM
Terminations	Termination Date	Update	Hospital Type Change Request		7/1/2023 12:00:00 AM	4/20/2023 8:20 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		7/1/2023 12:00:00 AM	4/20/2023 8:20 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	4/20/2023 8:20 AM
Contacts	Primary Contact	Update	Group Change Request	Morris, Phillip Director of Pharmacy CHRISTUS Santa Rosa Medical Center 2107056193	Aniemeke, Emmanuel Director of Pharmacy Services CHRISTUS Hospital Santa Rosa Medical Center 2107056193	9/14/2022 11:34 AM
Details	Last Recertification Date	Update	Recertification	8/17/2021 5:04:08 PM	8/25/2022 3:17:23 PM	8/25/2022 3:17 PM
Contacts	Authorizing Official	Update	AO Change Request	Parker, Stephanie VP Finance Christus Santa Rosa 2107043657	Chen, Steve CFO CHRISTUS Santa Rosa 2103218031	4/11/2022 6:59 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 12:21:25 PM	8/17/2021 5:04:08 PM	8/17/2021 5:04 PM
Medicaid Billing	NPI: State	Update	Recertification		TX	9/3/2020 12:21 PM
Details	Last Recertification Date	Update	Recertification	8/31/2019 7:32:36 AM	9/3/2020 12:21:25 PM	9/3/2020 12:21 PM
Contacts	Primary Contact	Update	Change Request	Dvorkin, Vladimir Director of Pharmacy Christus Santa Rosa - Westover Hills 2107038124	Morris, Phillip Director of Pharmacy CHRISTUS Santa Rosa Medical Center 2107056193	4/8/2020 1:15 PM
Contacts	Authorizing Official	Update	AO Change Request	Kirks, Linda Regional VP/CFO The Children's Hospital of San Antonio 2107042624	Parker, Stephanie VP Finance Christus Santa Rosa 2107043657	1/9/2020 9:36 AM
Contacts	Primary Contact	Update	Recertification	Tysdal, Dustyn DIRECTOR OF PHARMACY CHRISTUS Santa Rosa Hospital - New Braunfels 8306435377	Dvorkin, Vladimir Director of Pharmacy Christus Santa Rosa - Westover Hills 2107038124	8/31/2019 7:32 AM
Details	Last Recertification Date	Update	Recertification	9/4/2018 11:41:08 AM	8/31/2019 7:32:36 AM	8/31/2019 7:32 AM
Details	Last Recertification Date	Update	Recertification		9/4/2018 11:41:08 AM	9/4/2018 11:41 AM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Kirks, Linda Regional VP/CFO The Children's Hospital of San Antonio 2107042624	5/8/2018 3:17 PM
Details	340B ID	Update	New Registration		RRC450237-04	5/8/2018 3:17 PM
Details	Entity Subname	Update	New Registration	CHRISTUS Santa Rosa Hospital New Braunfels - Hyperbaric Center	CHRISTUS Santa Rosa Hospital New Braunfels - Hyperbaric Center - Hyperbaric Oxygen Center	5/8/2018 3:17 PM
Dates	Participating Approval Date	Update	New Registration		5/8/2018 3:17:56 PM	5/8/2018 3:17 PM
Details	State	Update	New Registration	Pending	Approved	5/8/2018 3:17 PM
Dates	Signed By Date	Update	New Registration		4/16/2018 1:11:29 PM	5/8/2018 3:17 PM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	5/8/2018 3:17 PM
Addresses	Main Address	Insert	New Registration		Medical Plaza Building, 598 North Union Avenue Suite 335 New Braunfels, TX 78130	4/16/2018 1:11 PM
Addresses	Billing Address	Insert	New Registration		CHRISTUS Santa Rosa Hospital New Braunfels 600 North Union Avenue New Braunfels, TX 78130	4/16/2018 1:11 PM
Addresses	Shipping Address	Insert	New Registration		CHRISTUS Santa Rosa Hospital New Braunfels 600 North Union Avenue New Braunfels, TX 78130	4/16/2018 1:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/16/2018 1:11 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0208449-01	4/16/2018 1:11 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/16/2018 1:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/16/2018 1:11 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0944860-01	4/16/2018 1:11 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/16/2018 1:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1194787218	4/16/2018 1:11 PM
Contacts	Authorizing Official	Insert	New Registration		Kirks, Linda Regional VP/CFO The Children's Hospital of San Antonio 2107042624	4/16/2018 1:11 PM
Contacts	Primary Contact	Insert	New Registration		Tysdal, Dustyn DIRECTOR OF PHARMACY CHRISTUS Santa Rosa Hospital - New Braunfels 8306435377	4/16/2018 1:11 PM
Details	Last Recertification Date	Insert	New Registration			4/16/2018 1:11 PM
Details	Grant Number	Insert	New Registration			4/16/2018 1:11 PM
Details	340B ID	Insert	New Registration			4/16/2018 1:11 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/16/2018 1:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/16/2018 1:11 PM
Details	Medicare Provider Number	Insert	New Registration		450237	4/16/2018 1:11 PM
Details	Entity Name	Insert	New Registration		CHRISTUS SANTA ROSA HEALTH SYSTEM	4/16/2018 1:11 PM
Details	Program Code	Insert	New Registration		RRC	4/16/2018 1:11 PM
Details	Entity Subname	Insert	New Registration		CHRISTUS Santa Rosa Hospital New Braunfels - Hyperbaric Center	4/16/2018 1:11 PM
Dates	Participating Approval Date	Insert	New Registration			4/16/2018 1:11 PM
Details	State	Insert	New Registration		Pending	4/16/2018 1:11 PM
Dates	Registration Date	Insert	New Registration		4/16/2018 1:11:26 PM	4/16/2018 1:11 PM
Dates	Signed By Date	Insert	New Registration			4/16/2018 1:11 PM
Dates	Start Date	Insert	New Registration			4/16/2018 1:11 PM
Terminations	Termination Comments	Insert	New Registration			4/16/2018 1:11 PM
Terminations	Termination Date	Insert	New Registration			4/16/2018 1:11 PM
Terminations	Termination Effective Date	Insert	New Registration			4/16/2018 1:11 PM
Terminations	Termination Reason	Insert	New Registration			4/16/2018 1:11 PM