Covered Entity Details

DSH450346N BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL (Active) - information as of 6/24/2025 3:00:23 AM

Main Details

Name

BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL

Subdivision Name

RADIOLOGY ONCOLOGY ALTUS - Radiology Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450346N

Medicare Provider Number

450346

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

8/25/2021

Participating Start Date

9/14/2021

Participating Approval Date

9/14/2021

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Baptist Hospitals of Southeast Texas
Bryan Chandler, Chief Operations Officer
(409) 212-5004

Primary Contact

Baptist Hospitals of Southeast Texas
Aily Powell, Administrative Director of Pharmacy
(409) 212-7282

Addresses

Street Address

310 N 11th Street
Beaumont, TX 77702-1802

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	094148602	1093744187
LA	1731242	1093744187

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
DSH450346A	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Baptist Beaumont Hospital Outpatient Cancer Infusion Clinic	3555 Stagg Drive	Beaumont	TX	Active
DSH450346B	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Baptist Beaumont Hospital Outpatient Infusion Clinic	3070 College Street	Beaumont	TX	Active
DSH450346C	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	BAPTIST BEAUMONT HOSPITAL-Behavioral Health	3250 FANNIN ST	BEAUMONT	TX	Active
DSH450346D	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Orange / Radiology	608 Strickland Dr	Orange	TX	Active
DSH450346E	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Orange / Emergency Room	608 Strickland Dr	Orange	TX	Terminated
DSH450346F	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Orange / Outpatient Infusion	608 Strickland Dr	Orange	TX	Active
DSH450346G	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Wound Healing Center / Wound Care Clinic	810 Hospital Drive Suite 200	Beaumont	TX	Active
DSH450346H	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Smart Health Clinic	3282 College St.	Beaumont	TX	Active
DSH450346J	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	CANCER CENTER OF SOUTHEAST TEXAS	8333 9TH AVENUE	PORT ARTHUR	TX	Active
DSH450346K	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	ALTUS CANCER CENTER - Hematology	310 N 11TH ST	BEAUMONT	TX	Active
DSH450346L	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Outpatient Infusion - Woodville - Infusion	1100 W. Bluff St.	Woodville	TX	Terminated
DSH450346M	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Wound Care Center- Orange - Wound Healing Center	608 Strickland Drive	Orange	TX	Active
DSH450346N	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	RADIOLOGY ONCOLOGY ALTUS - Radiology Oncology	310 N 11th Street	Beaumont	TX	Active
DSH450346P	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Radiation Oncology- Port Arthur - Radiology Oncology	8333 9TH Avenue	Port Arthur	TX	Active
DSH450346Q	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Jasper Outpatient Infusion - Outpatient Infusion Clinic	1440 FM 777	Jasper	TX	Active
DSH450346R	Child	DSH	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	Lumberton Infusion Clinic - Outpatient Infusion Clinic	114 South LHS Drive	Lumberton	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 12:47:42 PM	8/21/2024 12:28:23 PM	8/21/2024 12:28 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 3:00:30 PM	8/15/2023 12:47:42 PM	8/15/2023 12:47 PM
Contacts	Authorizing Official	Update	Change Request	Troutman, Gary Chief Financial Officer Baptist Hospitals of Southeast Texas 4092125003	Chandler, Bryan Chief Operations Officer Baptist Hospitals of Southeast Texas 4092125004	7/26/2023 6:54 AM
Details	Last Recertification Date	Update	Recertification		8/30/2022 3:00:30 PM	8/30/2022 3:00 PM
Contacts	Authorizing Official	Update	Change Request	Shannon, Patrick Chief Operating Officer Baptist Hospitals of Southeast Texas 4092125005	Troutman, Gary Chief Financial Officer Baptist Hospitals of Southeast Texas 4092125003	10/1/2021 6:36 AM
Details	State	Update	OPA Edit	Approved	Active	9/14/2021 6:30 PM
Dates	Start Date	Update	OPA Edit	10/1/2021 12:00:00 AM	9/14/2021 12:00:00 AM	9/14/2021 6:30 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	9/14/2021 6:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		094148602	9/14/2021 6:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	9/14/2021 6:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	9/14/2021 6:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1731242	9/14/2021 6:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	9/14/2021 6:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1093744187	9/14/2021 6:29 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	9/14/2021 6:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1093744187	9/14/2021 6:29 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	9/14/2021 6:29 PM
Contacts	Signed By	Insert	New Registration		Shannon, Patrick Chief Operating Officer Baptist Hospitals of Southeast Texas 4092125005	9/14/2021 6:29 PM
Details	340B ID	Update	New Registration		DSH450346N	9/14/2021 6:29 PM
Details	Entity Name	Update	New Registration	BAPTIST BEAUMONT HOSPITAL	BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL	9/14/2021 6:29 PM
Details	Entity Subname	Update	New Registration	RADIOLOGY ONCOLOGY ALTUS	RADIOLOGY ONCOLOGY ALTUS - Radiology Oncology	9/14/2021 6:29 PM
Dates	Participating Approval Date	Update	New Registration		9/14/2021 6:29:08 PM	9/14/2021 6:29 PM
Details	State	Update	New Registration	Pending	Approved	9/14/2021 6:29 PM
Dates	Signed By Date	Update	New Registration		9/13/2021 12:15:11 PM	9/14/2021 6:29 PM
Dates	Start Date	Update	New Registration		10/1/2021 12:00:00 AM	9/14/2021 6:29 PM
Addresses	Main Address	Insert	New Registration		310 N 11th Street Beaumont, TX 77702-1802	8/25/2021 12:48 PM
Contacts	Authorizing Official	Insert	New Registration		Shannon, Patrick Chief Operating Officer Baptist Hospitals of Southeast Texas 4092125005	8/25/2021 12:48 PM
Contacts	Primary Contact	Insert	New Registration		Powell, Aily Administrative Director of Pharmacy Baptist Hospitals of Southeast Texas 4092127282	8/25/2021 12:48 PM
Details	Assistance Received From Date	Insert	New Registration			8/25/2021 12:48 PM
Details	Assistance Received To Date	Insert	New Registration			8/25/2021 12:48 PM
Details	Last Recertification Date	Insert	New Registration			8/25/2021 12:48 PM
Details	Grant Number	Insert	New Registration			8/25/2021 12:48 PM
Details	340B ID	Insert	New Registration			8/25/2021 12:48 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			8/25/2021 12:48 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			8/25/2021 12:48 PM
Details	Medicare Provider Number	Insert	New Registration		450346	8/25/2021 12:48 PM
Details	Entity Name	Insert	New Registration		BAPTIST BEAUMONT HOSPITAL	8/25/2021 12:48 PM
Details	NOFO Number	Insert	New Registration			8/25/2021 12:48 PM
Details	Program Code	Insert	New Registration		DSH	8/25/2021 12:48 PM
Details	Entity Subname	Insert	New Registration		RADIOLOGY ONCOLOGY ALTUS	8/25/2021 12:48 PM
Dates	Participating Approval Date	Insert	New Registration			8/25/2021 12:48 PM
Details	State	Insert	New Registration		Pending	8/25/2021 12:48 PM
Dates	Registration Date	Insert	New Registration		8/25/2021 12:48:06 PM	8/25/2021 12:48 PM
Dates	Signed By Date	Insert	New Registration			8/25/2021 12:48 PM
Dates	Start Date	Insert	New Registration			8/25/2021 12:48 PM
Terminations	Termination Comments	Insert	New Registration			8/25/2021 12:48 PM
Terminations	Termination Date	Insert	New Registration			8/25/2021 12:48 PM
Terminations	Termination Effective Date	Insert	New Registration			8/25/2021 12:48 PM
Terminations	Termination Reason	Insert	New Registration			8/25/2021 12:48 PM