Covered Entity Details

DSH450154C Val Verde Regional Medical Center (Active) - information as of 4/28/2025 1:49:55 AM

Main Details

Name

Val Verde Regional Medical Center

Subdivision Name

VAL VERDE HOSPITAL CORPORATION - Infusion Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH450154C

Medicare Provider Number

450154

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/9/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/10/2020

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

Val Verde Regional Medical Center
Jorge Jurado, Interim CEO
(830) 778-3794

Primary Contact

Val Verde Regional Medical Center
Irma Maria Chapa, Director of Pharmcy
(830) 778-3873

Addresses

Street Address

801 N BEDELL AVE
VAL VERDE HEALTH CLINIC
DEL RIO, TX 78840-4112

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
TX	119877204,119877202,119877203	1104830900

Shipping Addresses

Same as Street Address

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
DSH450154A	Child	DSH	Val Verde Regional Medical Center	Val Verde Health Clinic	1801 N Bedell Ave	Del Rio	TX	Active
DSH450154B	Child	DSH	Val Verde Regional Medical Center	Psychiatric/Psychological Services - Psychiatric/Psychological Services	1200 N Bedell Avenue	Del Rio	TX	Active
DSH450154C	Child	DSH	Val Verde Regional Medical Center	VAL VERDE HOSPITAL CORPORATION - Infusion Center	801 N BEDELL AVE	DEL RIO	TX	Active
DSH450154D	Child	DSH	Val Verde Regional Medical Center	VAL VERDE HOSPITAL CORPORATION - Orthopedics Clinic	801 N BEDELL AVE	DEL RIO	TX	Active
DSH450154E	Child	DSH	Val Verde Regional Medical Center	RURAL HEALTH CLINIC - FAMILY PRACTICE CLIN	1801 BEDELL AVENUE	DEL RIO	TX	Active
DSH450154F	Child	DSH	Val Verde Regional Medical Center	VAL VERDE HOSPITAL CORPORATION - Urology Clinic	801 N BEDELL AVE	DEL RIO	TX	Active
DSH450154G	Child	DSH	Val Verde Regional Medical Center	VAL VERDE HOSPITAL CORPORATION - GENERAL SURGERY CLINIC	1200 N BEDELL AVE	DEL RIO	TX	Active
DSH450154H	Child	DSH	Val Verde Regional Medical Center	PODIATRY CLINIC - PODIATRY CLINIC	1801 N Bedell Ave	Del Rio	TX	Active
DSH450154J	Child	DSH	Val Verde Regional Medical Center	RURAL HEALTH CLINIC - OBSTETRICS CLINIC	1801 N Bedell Ave	Del Rio	TX	Active
DSH450154K	Child	DSH	Val Verde Regional Medical Center	RURAL HEALTH CLINIC - PEDIATRICS CLINIC	1801 N BEDELL AVENUE	DEL RIO	TX	Active
DSH450154L	Child	DSH	Val Verde Regional Medical Center	VAL VERDE HOSPITAL CORPORATION - Endocrinology	3809 VETERANS BLVD	DEL RIO	TX	Terminated
DSH450154M	Child	DSH	Val Verde Regional Medical Center	VAL VERDE HOSPITAL CORPORATION - Cardiac Clinic	3809 VETERANS BLVD	DEL RIO	TX	Terminated
DSH450154N	Child	DSH	Val Verde Regional Medical Center	Rural Health Clinic - Dr. Hernandez OB	1801 Bedell Avenue	Del Rio	TX	Terminated
DSH450154P	Child	DSH	Val Verde Regional Medical Center	Val Verde Health Corporation - Walk-In Clinic	1801 N. Bedell Ave	Del Rio	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Chapa, Irma Maria Director of Pharmcy Val Verde Regional Medical Center 8307783675	Chapa, Irma Maria Director of Pharmcy Val Verde Regional Medical Center 8307783873	10/7/2024 1:14 PM
Details	Last Recertification Date	Update	Recertification	8/21/2023 8:50:31 AM	8/29/2024 10:38:37 AM	8/29/2024 10:38 AM
Contacts	Authorizing Official	Update	Change Request	Walker, Linda Sue Chief Executive Officer Val Verde Regional Medical Center 8307031749	Jurado, Jorge Interim CEO Val Verde Regional Medical Center 8307783794	10/2/2023 12:14 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 8:45:48 AM	8/21/2023 8:50:31 AM	8/21/2023 8:50 AM
Details	Last Recertification Date	Update	Recertification	9/13/2021 4:26:04 PM	8/29/2022 8:45:48 AM	8/29/2022 8:45 AM
Details	Last Recertification Date	Update	Recertification	9/1/2020 2:29:26 PM	9/13/2021 4:26:04 PM	9/13/2021 4:26 PM
Medicaid Billing	NPI: State	Update	Recertification		TX	9/1/2020 2:29 PM
Details	Last Recertification Date	Update	Recertification		9/1/2020 2:29:26 PM	9/1/2020 2:29 PM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Authorizing Official	Update	Profile Change Request	Walker, Linda Sue Chief Executive Officer Val Verde Regional Medical Center 8307781749	Walker, Linda Sue Chief Executive Officer Val Verde Regional Medical Center 8307031749	4/24/2020 12:33 PM
Contacts	Signed By	Update	Profile Change Request	Walker, Linda Sue Chief Executive Officer Val Verde Regional Medical Center 8307781749	Walker, Linda Sue Chief Executive Officer Val Verde Regional Medical Center 8307031749	4/24/2020 12:33 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	365016004 (TX)		4/15/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	365016005 (TX)		4/15/2020 11:56 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1891124640 ( )		4/15/2020 11:56 AM
Contacts	Signed By	Insert	New Registration		Walker, Linda Sue Chief Executive Officer Val Verde Regional Medical Center 8307781749	4/10/2020 9:27 AM
Details	340B ID	Update	New Registration		DSH450154C	4/10/2020 9:27 AM
Details	Entity Name	Update	New Registration	VAL VERDE REGIONAL MEDICAL CENTER	Val Verde Regional Medical Center	4/10/2020 9:27 AM
Details	Entity Subname	Update	New Registration	VAL VERDE HOSPITAL CORPORATION	VAL VERDE HOSPITAL CORPORATION - Infusion Center	4/10/2020 9:27 AM
Dates	Participating Approval Date	Update	New Registration		4/10/2020 9:27:28 AM	4/10/2020 9:27 AM
Details	State	Update	New Registration	Pending	Approved	4/10/2020 9:27 AM
Dates	Signed By Date	Update	New Registration		4/9/2020 3:50:39 PM	4/10/2020 9:27 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/10/2020 9:27 AM
Addresses	Main Address	Insert	New Registration		801 N BEDELL AVE VAL VERDE HEALTH CLINIC DEL RIO, TX 78840-4112	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		365016004	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		365016005	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		119877204	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		119877202	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		119877203	4/9/2020 1:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/9/2020 1:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1891124640	4/9/2020 1:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104830900	4/9/2020 1:14 PM
Contacts	Primary Contact	Insert	New Registration		Chapa, Irma Maria Director of Pharmcy Val Verde Regional Medical Center 8307783675	4/9/2020 1:14 PM
Contacts	Authorizing Official	Insert	New Registration		Walker, Linda Sue Chief Executive Officer Val Verde Regional Medical Center 8307781749	4/9/2020 1:14 PM
Details	Last Recertification Date	Insert	New Registration			4/9/2020 1:14 PM
Details	Grant Number	Insert	New Registration			4/9/2020 1:14 PM
Details	340B ID	Insert	New Registration			4/9/2020 1:14 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/9/2020 1:14 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/9/2020 1:14 PM
Details	Medicare Provider Number	Insert	New Registration		450154	4/9/2020 1:14 PM
Details	Entity Name	Insert	New Registration		VAL VERDE REGIONAL MEDICAL CENTER	4/9/2020 1:14 PM
Details	Program Code	Insert	New Registration		DSH	4/9/2020 1:14 PM
Details	Entity Subname	Insert	New Registration		VAL VERDE HOSPITAL CORPORATION	4/9/2020 1:14 PM
Dates	Participating Approval Date	Insert	New Registration			4/9/2020 1:14 PM
Details	State	Insert	New Registration		Pending	4/9/2020 1:14 PM
Dates	Registration Date	Insert	New Registration		4/9/2020 1:14:24 PM	4/9/2020 1:14 PM
Dates	Signed By Date	Insert	New Registration			4/9/2020 1:14 PM
Dates	Start Date	Insert	New Registration			4/9/2020 1:14 PM
Terminations	Termination Comments	Insert	New Registration			4/9/2020 1:14 PM
Terminations	Termination Date	Insert	New Registration			4/9/2020 1:14 PM
Terminations	Termination Effective Date	Insert	New Registration			4/9/2020 1:14 PM
Terminations	Termination Reason	Insert	New Registration			4/9/2020 1:14 PM