Covered Entity Details

RRC450102-44 CHRISTUS MOTHER FRANCES HOSP-TYLER (Terminated) - information as of 5/27/2025 2:41:32 PM

Main Details

Name

CHRISTUS MOTHER FRANCES HOSP-TYLER

Subdivision Name

CHRISTUS MOTHER FRANCES HOSPITAL - Sleep Center

Type

Rural Referral Center

Rural

340B ID

RRC450102-44

Medicare Provider Number

450102

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/13/2020

Participating Start Date

10/1/2020

Participating Approval Date

8/18/2020

Last Recertification Date

9/15/2021

Termination Date
Termination Reason

3/10/2022
Change of hospital entity type

Contacts

Authorizing Official

CHRISTUS MF - Tyler
Elizabeth Pulliam, Chief Financial Officer
(903) 606-4102

Primary Contact

Christus Mother Frances, Jacksonville
Joshua Ward, 340B Coordinator
(903) 606-7591

Addresses

Street Address

120 E CHARNWOOD ST
TYLER, TX 75701-1708

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	094108002,094108004,094108001,094108005	1679578439

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
RRC450102-01	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Imaging - Mineola	1302 N PACIFIC ST	MINEOLA	TX	Terminated
RRC450102-02	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - HealthPark Plaza	1327 TROUP HWY	TYLER	TX	Terminated
RRC450102-03	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Athens	1505 S PALESTINE ST	ATHENS	TX	Terminated
RRC450102-04	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - PT Center - Kilgore	1711 S HENDERSON BLVD	KILGORE	TX	Terminated
RRC450102-05	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Kilgore	1718 S HENDERSON BLVD	KILGORE	TX	Terminated
RRC450102-06	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Imaging	1783 TROUP HWY	TYLER	TX	Terminated
RRC450102-07	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Imaging - Canton	18780 I-20	CANTON	TX	Terminated
RRC450102-08	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Cardiac Rehab - Canton	18780 I-20	CANTON	TX	Terminated
RRC450102-09	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Breast Center - Canton	18780 I-20	CANTON	TX	Terminated
RRC450102-10	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Canton	18780 I-20	CANTON	TX	Terminated
RRC450102-11	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Cardiac Diagnostics - Canton	18780 I-20	CANTON	TX	Terminated
RRC450102-12	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Physical Medicine and Rehab - Canton	18780 I-20	CANTON	TX	Terminated
RRC450102-13	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Mother Frances HealthPark - Lake Palestine Clinic (Physical Medicine & Rehab) - PT Center	20208 State Highway 155 S	Flint	TX	Terminated
RRC450102-14	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Mother Frances HealthPark - Lake Palestine Clinic - Clinic	20208 State Highway 155 S	Flint	TX	Terminated
RRC450102-15	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services	20208 STATE HIGHWAY 155 S	FLINT	TX	Terminated
RRC450102-16	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Mother Frances HealthPark - Lake Palestine Clinic- Cardiac Rehab	20208 State Highway 155 S	Flint	TX	Terminated
RRC450102-17	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - PT Center - Athens	210 CRESTWAY ST	ATHENS	TX	Terminated
RRC450102-18	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Lindale	3203 S MAIN ST	LINDALE	TX	Terminated
RRC450102-19	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services	3593 E GRANDE BLVD	TYLER	TX	Terminated
RRC450102-20	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Manhatton	3802 MANHATTON DR	TYLER	TX	Terminated
RRC450102-21	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Saunders	417 S SAUNDERS AVE	TYLER	TX	Terminated
RRC450102-22	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Imaging	105 Zeid Blvd.	HENDERSON	TX	Terminated
RRC450102-23	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Douglas	520 DOUGLAS BLVD	TYLER	TX	Terminated
RRC450102-24	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services	5321 S FM 14	HAWKINS	TX	Terminated
RRC450102-25	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Endocrinology	619 S FLEISHEL AVE	TYLER	TX	Terminated
RRC450102-26	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Mother Frances Medical Arts Plaza - Tyler - Clinic Services	619 S FLEISHEL AVE	Tyler	TX	Terminated
RRC450102-27	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services	630 S FLEISHEL AVE	TYLER	TX	Terminated
RRC450102-28	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Louis and Peaches Owen Heart Hospital - Cardiology	703 S FLEISHEL AVE	Tyler	TX	Terminated
RRC450102-29	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Wound Care	733 S FLEISHEL AVE	TYLER	TX	Terminated
RRC450102-30	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Chandler	803 HIGHWAY 31 E	CHANDLER	TX	Terminated
RRC450102-31	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Trinity Clinic - Broadway Commons - Clinic Services	8288 S BROADWAY AVE	Tyler	TX	Terminated
RRC450102-32	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Mother Frances Hospital - South Tyler Micro Ultrasound - Ultrasound	8389 S BROADWAY AVE	Tyler	TX	Terminated
RRC450102-33	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Mother Frances Hospital - South Tyler Micro ECC - ECC	8389 S BROADWAY AVE	Tyler	TX	Terminated
RRC450102-34	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Mother Frances Hospital - South Tyler Micro MRI - MRI	8389 S BROADWAY AVE	Tyler	TX	Terminated
RRC450102-35	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL- South Tyler Imaging	8389 S BROADWAY AVE	TYLER	TX	Terminated
RRC450102-36	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Micro Surgery	8389 S BROADWAY AVE	TYLER	TX	Terminated
RRC450102-37	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Mother Frances Hospital - South Tyler Micro CT - CT	8389 S BROADWAY AVE	Tyler	TX	Terminated
RRC450102-38	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Pain Clinic	910 E HOUSTON ST	TYLER	TX	Terminated
RRC450102-39	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Urology	910 E HOUSTON ST	TYLER	TX	Terminated
RRC450102-40	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - General Surgery	910 E HOUSTON ST	TYLER	TX	Terminated
RRC450102-41	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Breast Center - North Park	910 E HOUSTON ST	TYLER	TX	Terminated
RRC450102-42	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Neurology	910 E HOUSTON ST	TYLER	TX	Terminated
RRC450102-43	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - North Park	910 E HOUSTON ST	TYLER	TX	Terminated
RRC450102-44	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Sleep Center	120 E CHARNWOOD ST	TYLER	TX	Terminated
RRC450102-45	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Lindale	3203 S MAIN ST	LINDALE	TX	Terminated
RRC450102-46	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Gastroenterology	910 E HOUSTON ST	TYLER	TX	Terminated
RRC450102-47	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Athens	1505 S PALESTINE ST	ATHENS	TX	Terminated
RRC450102-48	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS Louis and Peaches Owen Heart Hospital Clinic Services - Clinic Services	703 S FLEISHEL AVE	Tyler	TX	Terminated
RRC450102-49	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	Christus Trinity Mother Frances HealthPark Herrington - Ornelas HealthPark - Clinic	3593 E GRANDE BLVD	Tyler	TX	Terminated
RRC450102-50	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	CHRISTUS MOTHER FRANCES HOSPITAL - Cardiac Diagnostics	1505 S PALESTINE ST	ATHENS	TX	Terminated
RRC450102-51	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	TMP ENDOSCOPY - ENDOSCOPY	1700 S. Beckham Avenue	Tyler	TX	Terminated
RRC450102-52	Child	RRC	CHRISTUS MOTHER FRANCES HOSP-TYLER	TSQ OUTPATIENT SURGERY CENTER - OUTPATIENT SURGERY	415 S. Fleishel	Tyler	TX	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Dates	Last Date That 340B Drugs Purchased	Update	OPA Edit Termination Info	4/1/2022 12:00:00 AM	3/10/2022 12:00:00 AM	3/10/2022 10:10 AM
Details	State	Update	OPA Edit Termination Info	To Be Terminated	Terminated	3/10/2022 10:10 AM
Terminations	Termination Date	Update	OPA Edit Termination Info	4/1/2022 12:00:00 AM	3/10/2022 12:00:00 AM	3/10/2022 10:10 AM
Terminations	Termination Effective Date	Update	OPA Edit Termination Info	4/1/2022 12:00:00 AM	3/10/2022 12:00:00 AM	3/10/2022 10:10 AM
Terminations	Termination Reason	Update	OPA Edit Termination Info	Change of covered entity type	Change of hospital entity type	3/10/2022 10:10 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		4/1/2022 12:00:00 AM	3/10/2022 10:07 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	3/10/2022 10:07 AM
Terminations	Termination Date	Update	Hospital Type Change Request		4/1/2022 12:00:00 AM	3/10/2022 10:07 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		4/1/2022 12:00:00 AM	3/10/2022 10:07 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	3/10/2022 10:07 AM
Addresses	Main Address	Update	Recertification	120 E CHARNWOOD ST #A TYLER, TX 75701-1708	120 E CHARNWOOD ST TYLER, TX 75701-1708	9/15/2021 8:17 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	025244701 (TX)		9/15/2021 8:17 AM
Details	Last Recertification Date	Update	Recertification		9/15/2021 8:17:55 AM	9/15/2021 8:17 AM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094108002	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094108004	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094108001	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094108005	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		025244701	8/18/2020 9:39 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	8/18/2020 9:39 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1679578439	8/18/2020 9:39 AM
Medicaid Billing	NPI: State	Insert	New Registration		TX	8/18/2020 9:39 AM
Contacts	Signed By	Insert	New Registration		Pulliam, Elizabeth Chief Financial Officer CHRISTUS MF - Tyler 9036064102	8/18/2020 9:39 AM
Details	340B ID	Update	New Registration		RRC450102-44	8/18/2020 9:39 AM
Details	Entity Subname	Update	New Registration	CHRISTUS MOTHER FRANCES HOSPITAL	CHRISTUS MOTHER FRANCES HOSPITAL - Sleep Center	8/18/2020 9:39 AM
Dates	Participating Approval Date	Update	New Registration		8/18/2020 9:39:06 AM	8/18/2020 9:39 AM
Details	State	Update	New Registration	Pending	Approved	8/18/2020 9:39 AM
Dates	Signed By Date	Update	New Registration		8/13/2020 1:17:58 PM	8/18/2020 9:39 AM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	8/18/2020 9:39 AM
Addresses	Main Address	Insert	New Registration		120 E CHARNWOOD ST #A TYLER, TX 75701-1708	7/13/2020 6:01 PM
Contacts	Primary Contact	Insert	New Registration		Ward, Joshua 340B Coordinator Christus Mother Frances, Jacksonville 9036067591	7/13/2020 6:01 PM
Contacts	Authorizing Official	Insert	New Registration		Pulliam, Elizabeth Chief Financial Officer CHRISTUS MF - Tyler 9036064102	7/13/2020 6:01 PM
Details	Last Recertification Date	Insert	New Registration			7/13/2020 6:01 PM
Details	Grant Number	Insert	New Registration			7/13/2020 6:01 PM
Details	340B ID	Insert	New Registration			7/13/2020 6:01 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2020 6:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2020 6:01 PM
Details	Medicare Provider Number	Insert	New Registration		450102	7/13/2020 6:01 PM
Details	Entity Name	Insert	New Registration		CHRISTUS MOTHER FRANCES HOSP-TYLER	7/13/2020 6:01 PM
Details	Program Code	Insert	New Registration		RRC	7/13/2020 6:01 PM
Details	Entity Subname	Insert	New Registration		CHRISTUS MOTHER FRANCES HOSPITAL	7/13/2020 6:01 PM
Dates	Participating Approval Date	Insert	New Registration			7/13/2020 6:01 PM
Details	State	Insert	New Registration		Pending	7/13/2020 6:01 PM
Dates	Registration Date	Insert	New Registration		7/13/2020 6:01:58 PM	7/13/2020 6:01 PM
Dates	Signed By Date	Insert	New Registration			7/13/2020 6:01 PM
Dates	Start Date	Insert	New Registration			7/13/2020 6:01 PM
Terminations	Termination Comments	Insert	New Registration			7/13/2020 6:01 PM
Terminations	Termination Date	Insert	New Registration			7/13/2020 6:01 PM
Terminations	Termination Effective Date	Insert	New Registration			7/13/2020 6:01 PM
Terminations	Termination Reason	Insert	New Registration			7/13/2020 6:01 PM