340B Drug Pricing Program Database


DSH450102 CHRISTUS MOTHER FRANCES HOSP-TYLER (Active) - information as of 5/27/2025 2:41:11 PM

Main Details
CHRISTUS MOTHER FRANCES HOSP-TYLER
Disproportionate Share Hospital
Yes
DSH450102
450102


Additional Details
Active
3/1/2022
3/10/2022
3/10/2022
8/27/2024

Contacts

CHRISTUS Mother Frances Health System
Eric Garrison, CFO
(903) 606-4102

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

Addresses

800 EAST DAWSON
TYLER, TX 75701

CHRISTUS MOTHER FRANCES HOSP - TYLER
800 East Dawson
Tyler, TX 75701


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
TX094108001,094108002,094108004,0941080051679578439,1104406511
Shipping Addresses

CHRISTUS MOTHER FRANCES HOSPITAL - TYLER
800 EAST DAWSON ST.
Tyler, TX 75701

CHRISTUS Specialty Pharmacy
800 EAST DAWSON ST.
Suite 100
Tyler, TX 75701

CHRISTUS MOTHER FRANCES HOSP - TYLER
800 East Dawson
Tyler, TX 75701
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884903/10/202203/10/2022  03/10/2022
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750203/10/202203/10/2022  03/10/2022
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201003/10/202203/10/2022  03/10/2022
Contract DetailACCREDO HEALTH GROUP INC2410 WARDLOW RD STE 101
CORONACA9287803/10/202203/10/2022 01/01/202304/03/2023
Contract DetailACCREDO HEALTH GROUP INC9307 KIRBY DR
HOUSTONTX77054-251603/10/202203/10/2022 10/01/202310/23/2023
Contract DetailACCREDO HEALTH GROUP INC4343 W ROYAL LN STE 124
IRVINGTX75063-229903/10/202203/10/2022 01/01/202304/03/2023
Contract DetailACCREDO HEALTH GROUP INC261 CEDAR HILL ST BUILDING C
MARLBOROUGHMA01752-305603/10/202203/10/2022 01/01/202304/03/2023
Contract DetailACCREDO HEALTH GROUP INC520 ELMWOOD PARK BLVD STE 100
NEW ORLEANSLA70123-682603/10/202203/10/2022 10/01/202310/23/2023
Contract DetailACCREDO HEALTH GROUP INC4343 W ROYAL LN STE 124
IRVINGTX75063-229910/16/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624103/10/202203/10/2022 07/01/202307/20/2023
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282203/10/202203/10/2022  03/10/2022
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349203/10/202203/10/2022 01/01/202304/03/2023
Contract DetailACCREDO HEALTH GROUP, INC.11411 STRANG LINE RD STE A
LENEXAKS6621503/10/202203/10/2022 01/01/202304/03/2023
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/17/202310/01/2023  10/01/2023
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349210/16/202301/01/2024  01/01/2024
Contract DetailANDERSON DRUGAMANAH INVESTMENTS, LLC 419 S PALESTINE ST
ATHENSTX75751-251103/10/202203/10/2022  03/10/2022
Contract DetailANDERSON'S GIBSON PHARMACY600 S PALESTINE ST STE 100
ATHENSTX7575103/10/202203/10/2022  03/10/2022
Contract DetailBIOPLUS SPECIALTY PHARMACY LA, LLC2731 MANHATTAN BLVD STE B17
HARVEYLA7005801/16/202304/01/2023  04/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526107/17/202310/01/2023 08/14/202410/09/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771307/17/202310/01/2023 08/14/202410/09/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267007/17/202310/01/2023 08/14/202410/09/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY, INC3200 LAKE EMMA RD UNIT 1000
LAKE MARYFL3274601/16/202304/01/2023  04/01/2023
Contract DetailBRICK STREET PHARMACY314 W RUSK ST
TYLERTX75701-151303/10/202203/10/2022 04/07/202504/07/2025
Contract DetailBROOKSHIRE PHARMACY20100 HIGHWAY 155 SOUTH
FLINTTX7576203/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY703 HWY 31E P.O. BOX 1409
CHANDLERTX7575803/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #03521 SOUTH MAIN PO BOX 880
LINDALETX7577103/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #092020 ROSELAND BLVD.
TYLERTX7570103/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #151477 N. BEULAH STREET
HAWKINSTX7576503/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #2706 WEST MAIN PO BOX 1219
VANTX7579003/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #282734 E. FIFTH STREET
TYLERTX7570103/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #311224 N. PACIFIC AVENUE
MINEOLATX7577303/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #51100 RICE RD
TYLERTX7570303/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #61601 HWY 110 NORTH PO BOX 498
WHITEHOUSETX7579103/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #70213 NORTH US HWY 69
BULLARDTX7575703/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #8747 HWY 259 NORTH
KILGORETX7566203/10/202203/10/2022 01/03/202301/03/2023
Contract DetailBROOKSHIRE PHARMACY #8016991 OLD JACKSONVILLE HWY
TYLERTX7570303/10/202203/10/2022 01/03/202301/03/2023
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005603/10/202203/10/2022  03/10/2022
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621903/10/202203/10/2022  03/10/2022
Contract DetailCHRISTUS CABRINI INCARNATE WORD COMMUNIT3000 S MACARTHUR DR ATTN: PHARMACY
ALEXANDRIALA71301-292703/10/202203/10/2022 04/23/202404/24/2024
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/14/202201/01/2023  02/06/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00988 1702 S. BROADWAY AVE.
TYLERTX7570110/14/202201/01/2023  02/06/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 06904 4922 S BROADWAY AVE
TYLERTX7570310/14/202201/01/2023  02/06/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 07295 702 E TYLER
ATHENSTX7575110/14/202201/01/2023  02/06/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 07446 2626 EAST 5TH ST.
TYLERTX7570110/14/202201/01/2023  02/06/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 07466 1215 S TRADES DAY BLVD
CANTONTX7510310/14/202201/01/2023  02/06/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 07708 100 E. MAIN ST., P.O. BOX #1266
WHITEHOUSETX7579110/14/202201/01/2023  02/06/2023
Contract DetailCVS PHARMACY, INC.DBA CVS/PHARMACY # 10339 504 S MAIN STREET
LINDALETX7577110/14/202201/01/2023  02/06/2023
Contract DetailCVS PHARMACY, INC.DBA CVS/PHARMACY #10340 210 EAST BROAD STREET
MINEOLATX7577310/14/202201/01/2023  02/06/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 06918 1919 S. LOOP 256
PALESTINETX7580101/03/202304/01/2023  04/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 06925 1000 STONE RD
KILGORETX7566201/03/202304/01/2023  04/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 06959 725 E. MAIN ST.
HENDERSONTX7565201/03/202304/01/2023  04/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 07444 1402 EAST BROADWAY
GLADEWATERTX7564701/03/202304/01/2023  04/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 07709 1710 W GENTRY PKWY
TYLERTX7570201/03/202304/01/2023  04/01/2023
Contract DetailCVS PHARMACY, INC.DBS/CVS/PHARMACY #10343 604 S. MAIN STREET
WINNSBOROTX7549401/03/202304/01/2023  04/01/2023
Contract DetailCVS PHARMACY, INC.CVS PHARMACY # 16241 7003 S BROADWAY AVE
TYLERTX7570301/03/202304/01/2023  04/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 06899 1754 W LOOP 281
LONGVIEWTX7560407/17/202310/01/2023 12/14/202304/02/2024
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 07419 1279 W. MAIN ST.
GUN BARREL CITYTX7515607/17/202310/01/2023 12/14/202304/02/2024
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 07780 824 S JACKSON ST
JACKSONVILLETX7576607/17/202310/01/2023  10/01/2023
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/14/202201/01/2023  02/06/2023
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268303/10/202203/10/2022 04/01/202201/03/2023
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K
GREENVILLESC29607-654107/17/202310/01/2023 08/14/202410/09/2024
Contract DetailEAGLE PHARMACY1404 S. MAIN ST
LINDALETX75771-626703/10/202203/10/2022  03/10/2022
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111203/10/202203/10/2022  03/10/2022
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313403/10/202203/10/2022  03/10/2022
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801603/10/202203/10/2022  03/10/2022
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607503/10/202203/10/2022  03/10/2022
Contract DetailGENOA HEALTHCARE LLC2323 W FRONT STREET
TYLERTX7570203/10/202203/10/2022  03/10/2022
Contract DetailHEALTHCARE CENTER PHARMACY2604 SAINT MICHAEL DR STE 200
TEXARKANATX7550303/10/202203/10/2022 04/10/202504/11/2025
Contract DetailKINSEY'S PHARMACY  4290 KINSEY DRIVE
TYLERTX75703-102403/10/202203/10/2022 05/06/202405/06/2024
Contract DetailOPTUM INFUSION SERVICES 103, LLC9204 BERGER RD. STE. A
COLUMBIAMD21046-172910/05/202301/01/2024  01/01/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135103/10/202203/10/2022  03/10/2022
Contract DetailOPTUM INFUSION SERVICES 500, INC8400 ESTERS BLVD STE 185
IRVINGTX75063-286403/10/202203/10/2022  03/10/2022
Contract DetailOPTUM INFUSION SERVICES 500, INC5627 UNIVERSITY HTS STE 105
SAN ANTONIOTX78249-358303/10/202203/10/2022 07/01/202209/12/2022
Contract DetailOPTUM INFUSION SERVICES 500, INC.4620 S SAM HOUSTON PKWY W STE 440
HOUSTONTX7705303/10/202203/10/2022  03/10/2022
Contract DetailOPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276510/05/202301/01/2024  01/01/2024
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/06/202205/19/2022  05/19/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520410/15/202401/01/2025  01/01/2025
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713003/10/202203/10/2022  03/10/2022
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824903/10/202203/10/2022  03/10/2022
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729803/10/202203/10/2022  03/10/2022
Contract DetailOPTUM PHARMACY 705, LLC11142 RENNER BLVD
LENEXAKS6621903/10/202203/10/2022 03/10/202209/14/2022
Contract DetailOPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970503/10/202203/10/2022  03/10/2022
Contract DetailOPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265503/10/202203/10/2022  03/10/2022
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110103/10/202203/10/2022  03/10/2022
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140103/10/202203/10/2022  03/10/2022
Contract DetailOPTUM PHARMACY 800, INC.3016 GUADALUPE ST STE A
AUSTINTX78705-286103/10/202203/10/2022 03/10/202209/14/2022
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508503/10/202203/10/2022  03/10/2022
Contract DetailOPTUM PHARMACY 806, INC.2288 AUBURN BLVD STE. 102
SACRAMENTOCA95821-161803/10/202203/10/2022 03/10/202209/14/2022
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660803/10/202203/10/2022 07/01/202209/12/2022
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983803/10/202203/10/2022  03/10/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514603/10/202203/10/2022  03/10/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2751 426 S. HENDERSON STREET
FORT WORTHTX7610401/03/202304/01/2023  04/01/2023
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255007/17/202310/01/2023 08/14/202410/09/2024
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500207/17/202310/01/2023 08/14/202410/09/2024
Contract DetailROSE CITY PHARMACYROSE CITY PHARMACY LLC 2130 W GRANDE BLVD
TYLERTX75703-757601/11/202404/01/2024 05/17/202505/21/2025
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301307/17/202310/01/2023 08/14/202410/09/2024
Contract DetailSUPER 1 FOODS PHARMACY #642172 CENTENNIAL PKWY
TYLERTX7570303/10/202203/10/2022 01/03/202301/03/2023
Contract DetailSUPER 1 PHARMACY3828 TROUP HIGHWAY
TYLERTX7570303/10/202203/10/2022 01/03/202301/03/2023
Contract DetailSUPER 1 PHARMACY #6101105 E GENTRY PARKWAY
TYLERTX7570203/10/202203/10/2022 01/03/202301/03/2023
Contract DetailSUPER ONE PHARMACY #625113 NORTH NW LOOP 323
TYLERTX7570203/10/202203/10/2022 01/03/202301/03/2023
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738603/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-01461102 US HIGHWAY 271 N
GILMERTX75644-523704/12/202307/01/2023  07/01/2023
Contract DetailWAL-MART PHARMACY 10-01652121 HWY. 79 SOUTH
HENDERSONTX7565403/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-01801311 S. JACKSON
JACKSONVILLETX7576603/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-0251135 N.E. LOOP 564
MINEOLATX7577303/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-03452223 SOUTH LOOP 256
PALESTINETX7580103/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-03992440 GILMER RD
LONGVIEWTX7560407/13/202310/01/2023  10/01/2023
Contract DetailWAL-MART PHARMACY 10-04121405 E. TYLER
ATHENSTX7575103/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-04171750 S. BROADWAY STREET
SULPHUR SPRINGSTX7548207/13/202310/01/2023  10/01/2023
Contract DetailWAL-MART PHARMACY 10-05161200 W MAIN ST
GUN BARREL CITYTX7515604/12/202307/01/2023  07/01/2023
Contract DetailWAL-MART PHARMACY 10-05721201 STONE RD
KILGORETX7566203/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-0827603 HIGHWAY 243 EAST
CANTONTX7510303/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-10223820 HIGHWAY 64 WEST
TYLERTX7570403/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-10445050 TROUP HWY
TYLERTX7570303/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-26886801 SOUTH BROADWAY
TYLERTX7570303/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-3764105 CENTENNIAL BLVD.
LINDALETX7577103/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-38284006 ESTES PARKWAY
LONGVIEWTX7560307/13/202310/01/2023  10/01/2023
Contract DetailWAL-MART PHARMACY 10-41931900 EAST SE LOOP 323
TYLERTX7570303/10/202203/10/2022  03/10/2022
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283703/10/202203/10/2022  03/10/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06358 5415 S BROADWAY AVE
TYLERTX7570303/10/202203/10/2022  03/10/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 09408 2120 E SOUTHEAST LOOP 323
TYLERTX75701-831803/10/202203/10/2022  03/10/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 09410 1007 E TYLER ST
ATHENSTX7575103/10/202203/10/2022  03/10/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #11175 701 US HIGHWAY 259 N
KILGORETX75662-604103/10/202203/10/2022  03/10/2022
Contract DetailWALGREEN CO.WALGREENS #12358 110 LOOP 323 S SW
TYLERTX7570203/10/202203/10/2022  03/10/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #12522 1620 S. BROADWAY AVE.
TYLERTX7570103/10/202203/10/2022  03/10/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #11212 2126 US HIGHWAY 79 SOUTH
HENDERSONTX75654-440903/10/202203/10/2022  03/10/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 09411 2201 S LOOP 256
PALESTINETX75801-470110/14/202201/01/2023  01/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS #11910 1130 S. BROADWAY ST.
SULPHUR SPRINGSTX75482-484010/14/202201/01/2023  01/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07264 1775 W LOOP 281
LONGVIEWTX75604-273401/05/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.WALGREENS #21487 20100 STATE HIGHWAY 155 S
FLINTTX7576210/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21461 521 S MAIN ST STE B
LINDALETX7577110/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21513 PO BOX 1409
703 HWY 31 EAST
CHANDLERTX7575810/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21491 100 RICE RD
TYLERTX7570310/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21499 601 STATE HIGHWAY 110 N
WHITEHOUSETX7579110/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21469 1477 N BEAULAH ST
HAWKINSTX7576510/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21505 213 US HWY 69 NORTH
BULLARDTX7575710/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21465 2020 ROSELAND BLVD
TYLERTX7570110/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21565 6991 OLD JACKSONVILLE HWY
TYLERTX7570310/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21477 2734 E 5TH ST STE 101
TYLERTX7570110/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21460 706 W MAIN ST
VANTX7579010/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21464 747 US HIGHWAY 259 N
KILGORETX7566210/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21479 1224 N PACIFIC ST
MINEOLATX7577310/11/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21466 807 E TYLER ST
ATHENSTX7575110/13/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.WALGREENS #21539 1105 E GENTRY PKWY
TYLERTX7570201/11/202404/01/2024  04/01/2024
Contract DetailWALGREEN CO.WALGREENS #21549 113 N NW LOOP 323
TYLERTX7570201/11/202404/01/2024  04/01/2024
Contract DetailWALGREEN CO.WALGREENS #21535 3828 TROUP HWY
TYLERTX7570301/11/202404/01/2024  04/01/2024
Contract DetailWALGREEN CO.WALGREENS #21559 172 CENTENNIAL PKWY
TYLERTX7570301/11/202404/01/2024  04/01/2024
Contract DetailWalgreens #21373Walgreens Central Fill #21373 4100 Dale Earnhardt Way
STE 200
NorthlakeTX7626203/10/202203/10/2022  03/10/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503303/10/202203/10/2022  03/10/2022
Contract DetailWALMART PHARMACY 10-46055976 OLD JACKSONVILLE HWY
TYLERTX7570303/10/202203/10/2022  03/10/2022
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275604/12/202307/01/2023  07/01/2023
Contract DetailWALMART PHARMACY 10-57002151 FRANKSTON HIGHWAY
TYLERTX7570103/10/202203/10/2022  03/10/2022
Contract DetailWALMART PHARMACY 10-6467450 S SOUTHEAST LOOP 323
TYLERTX75702-757003/10/202203/10/2022  03/10/2022
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/16/202301/01/2024  01/01/2024
Contract DetailWOODY WEAVER PHARMACY2726 W GENTRY PKWY
TYLERTX75702-163504/06/202207/01/2022  07/01/2022
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH450102AChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Specialty Oncology Surgery501 S. Saunders AvenueTylerTXActive
DSH450102AAChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Specialty1505 S PALESTINE STATHENSTXTerminated
DSH450102ABChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Wound Care733 S FLEISHEL AVETYLERTXActive
DSH450102ACChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Endocrinology1327 TROUP HWYTYLERTXActive
DSH450102ADChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Douglas520 DOUGLAS BLVDTYLERTXActive
DSH450102AEChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Cardiac Diagnostics1505 S PALESTINE STATHENSTXActive
DSH450102AFChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Manhatton3802 MANHATTON DRTylerTXActive
DSH450102AGChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERTMP ENDOSCOPY1720 S. Beckham AvenueTylerTXActive
DSH450102AHChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Saunders417 S SAUNDERS AVETylerTXActive
DSH450102AJChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Cardiac Diagnostics - Canton18780 I-20CANTONTXActive
DSH450102AKChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Louis and Peaches Owen Heart Hospital Clinic Services703 S FLEISHEL AVETylerTXActive
DSH450102ALChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Breast Center - Canton18780 I-20CantonTXActive
DSH450102AMChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Kilgore1718 S HENDERSON BLVDKilgoreTXTerminated
DSH450102ANChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Douglas520 DOUGLAS BLVDTYLERTXActive
DSH450102APChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Neurology910 E HOUSTON STTYLERTXActive
DSH450102AQChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Imaging1783 TROUP HWYTylerTXActive
DSH450102ARChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - General Surgery910 E HOUSTON STTYLERTXActive
DSH450102ASChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - HealthPark Plaza1327 TROUP HWYTYLERTXActive
DSH450102ATChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Trinity Mother Frances Medical Arts Plaza - Tyler - Clinic Services619 S FLEISHEL AVETylerTXActive
DSH450102AUChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Trinity Mother Frances Medical Arts Plaza - Tyler - Clinic Services - Surgery619 S FLEISHEL AVETylerTXActive
DSH450102AVChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Louis and Peaches Owen Heart Hospital Clinic Services - Electrocardiology703 S FLEISHEL AVETylerTXActive
DSH450102AWChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Trinity Mother Frances HealthPark - Lake Palestine Clinic (Physical Medicine & Rehab)20208 State Highway 155 SFlintTXActive
DSH450102AXChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services20208 STATE HIGHWAY 155 SFLINTTXActive
DSH450102AYChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - North Park910 E HOUSTON STTYLERTXTerminated
DSH450102AZChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Sleep Center120 E CHARNWOOD STTYLERTXActive
DSH450102BChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Chandler803 HIGHWAY 31 ECHANDLERTXActive
DSH450102BAChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Specialty - North Park Medical Plaza910 E HOUSTON STTylerTXActive
DSH450102BBChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Lindale - Diagnostic Radiology3203 S MAIN STLINDALETXActive
DSH450102BCChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - Athens - Physical Therapy1505 S PALESTINE STATHENSTXActive
DSH450102BDChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Pain Management910 E HOUSTON STTylerTXActive
DSH450102BEChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCTC INFECTIOUS DISEASE CLINIC704 S FLEISHEL AVETylerTXActive
DSH450102BFChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS ORTHOPEDICS AND SPORTS MEDICINE INSTITUTE - TYLER8591 S BROADWAY AVETylerTXActive
DSH450102BGChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERLINDALE TRINITY CLINIC - Cardiac Rehab3203 S MAIN STREETLINDALETXActive
DSH450102BHChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERLINDALE TRINITY CLINIC - Emergency Care3203 S MAIN STREETLINDALETXActive
DSH450102BJChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERLINDALE TRINITY CLINIC - Cardiovascular Services3203 S MAIN STREETLINDALETXActive
DSH450102BKChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS TRINITY MOTHER FRANCES ATHENS - Emergency Care1509 S PALESTINE STATHENSTXActive
DSH450102BLChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERTHE CARDIOLOGY ASSOCIATES OF EAST TEXAS - Cardiology Clinic1783 TROUP HIGHWAYTYLERTXActive
DSH450102BMChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERTHE CARDIOLOGY ASSOCIATES OF EAST TEXAS - Cardiac Catheterization1783 TROUP HIGHWAYTYLERTXActive
DSH450102BNChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS TRINITY MOTHER FRANCES NORTHPARK MEDICAL PLAZA - Infusion Services910 E. HOUSTON STTYLERTXActive
DSH450102BPChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS TRINITY MOTHER FRANCES Herrington Ornelas Health Park - Physical Therapy3593 E GRANDE BLVDTYLERTXActive
DSH450102BQChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS TRINITY MOTHER FRANCES Herrington Ornelas Health Park - Clinic3593 E GRANDE BLVDTYLERTXActive
DSH450102BRChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS TRINITY MOTHER FRANCES NORTHPARK MEDICAL PLAZA - Pain Management910 E. HOUSTON STTYLERTXActive
DSH450102BSChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL – IMAGING - Nuclear Medicine501 SAUNDERS AVETYLERTXActive
DSH450102BTChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - HVI - Cardiac Cath/Cardiology1783 TROUP HWYTYLERTXTerminated
DSH450102BUChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Infusion910 E HOUSTON STTylerTXTerminated
DSH450102BVChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Sleep Lab18780 I-20CANTONTXActive
DSH450102BWChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Nuclear Medicine1327 TROUP HWYTylerTXActive
DSH450102BXChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Endoscopy910 E HOUSTON STTylerTXActive
DSH450102BZChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Heart Failure Clinic619 S FLEISHEL AVETYLERTXActive
DSH450102CChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Micro Surgery8389 S BROADWAY AVETYLERTXActive
DSH450102CAChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Primary Care3593 E GRANDE BLVDTYLERTXActive
DSH450102CBChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Physical Therapy1711 S HENDERSON BLVDKILGORETXActive
DSH450102CCChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Christus Heart & Vascular – EP1783 TROUP HWYTYLERTXActive
DSH450102CDChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS TRINITY CLINIC - Primary Care700 S FLEISHEL AVETYLERTXActive
DSH450102CEChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Orthopedics & Sports Medicine Institute - Podiatry8591 S. BroadwayTylerTXApproved
DSH450102CFChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Orthopedics & Sports Medicine Institute - Orthopedics & Sports Medicine8591 S. BroadwayTylerTXApproved
DSH450102CGChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Trinity Clinic - Pulmonary619 S. FleishelTYLERTXApproved
DSH450102CHChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Trinity Clinic - Neurosurgery910 E. HoustonTylerTXApproved
DSH450102DChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services - HealthPark Plaza1327 TROUP HWYTylerTXActive
DSH450102EChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Mother Frances Hospital - South Tyler Micro ECC8389 S BROADWAY AVETylerTXActive
DSH450102FChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Lindale3203 S MAIN STLINDALETXActive
DSH450102GChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Louis and Peaches Owen Heart Hospital - Cardiology703 S FLEISHEL AVETylerTXActive
DSH450102HChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Physical Medicine and Rehab - Canton18780 I-20CantonTXActive
DSH450102JChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic Services733 S. Fleishel AveTylerTXActive
DSH450102KChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL- South Tyler Imaging8389 S BROADWAY AVETYLERTXActive
DSH450102LChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Cardiac Rehab - Canton18780 I-20CantonTXActive
DSH450102MChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Trinity Mother Frances Health Park - Lake Palestine Clinic20208 State Highway 155 SFlintTXActive
DSH450102NChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERTSQ OUTPATIENT SURGERY CENTER415 S. FleishelTylerTXActive
DSH450102PChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Trinity Mother Frances HealthPark - Lake Palestine Clinic- Cardiac Rehab20208 State Highway 155 SFlintTXActive
DSH450102QChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Mother Frances Hospital - South Tyler Micro CT8389 S BROADWAY AVETylerTXActive
DSH450102RChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Emergency18780 I-20CANTONTXActive
DSH450102SChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Clinic - Athens1505 S PALESTINE STATHENSTXActive
DSH450102TChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Gastroenterology910 E HOUSTON STTYLERTXActive
DSH450102UChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Imaging - Canton18780 I-20CantonTXActive
DSH450102VChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Urology910 E HOUSTON STTYLERTXActive
DSH450102WChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Trinity Clinic - Broadway Commons - Clinic Services8288 S BROADWAY AVETylerTXActive
DSH450102XChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS MOTHER FRANCES HOSPITAL - Breast Center - North Park910 E HOUSTON STTYLERTXActive
DSH450102YChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Mother Frances Hospital - South Tyler Micro MRI8389 S BROADWAY AVETylerTXActive
DSH450102ZChildDSHCHRISTUS MOTHER FRANCES HOSP-TYLERCHRISTUS Mother Frances Hospital - South Tyler Micro Ultrasound8389 S BROADWAY AVETylerTXActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification9/7/2023 3:33:02 PM8/27/2024 2:53:09 PM8/27/2024 2:53 PM
AddressesBilling AddressInsertGroup Change Request CHRISTUS MOTHER FRANCES HOSP - TYLER 800 East Dawson Tyler, TX 757019/12/2023 12:50 PM
AddressesShipping AddressInsertGroup Change Request CHRISTUS MOTHER FRANCES HOSP - TYLER 800 East Dawson Tyler, TX 757019/12/2023 12:50 PM
DetailsLast Recertification DateUpdateRecertification9/12/2022 2:48:45 PM9/7/2023 3:33:02 PM9/7/2023 3:33 PM
ContactsAuthorizing OfficialUpdateAO Change RequestProctor, Jason President CHRISTUS® Mother Frances Hospital – Tyler 9036064638Garrison, Eric CFO CHRISTUS Mother Frances Health System 90360641027/26/2023 4:58 PM
ContactsAuthorizing OfficialUpdateAO Change RequestPulliam, Elizabeth Chief Financial Officer CHRISTUS MF - Tyler 9036064102Proctor, Jason President CHRISTUS® Mother Frances Hospital – Tyler 90360646385/1/2023 12:48 PM
DetailsLast Recertification DateUpdateRecertification 9/12/2022 2:48:45 PM9/12/2022 2:48 PM
Medicaid BillingNPI: NumberInsertChange Request 11044065117/6/2022 3:09 PM
Medicaid BillingNPI: StateInsertChange Request TX7/6/2022 3:09 PM
Medicaid BillingNPI: NumberDeleteChange Request1104406511 (TX) 5/10/2022 4:36 PM
DetailsStateUpdateOPA EditApprovedActive3/10/2022 10:09 AM
DatesStart DateUpdateOPA Edit4/1/2022 12:00:00 AM3/10/2022 12:00:00 AM3/10/2022 10:09 AM
Details340B IDUpdateHospital Type Change Request DSH4501023/10/2022 10:07 AM
DatesParticipating Approval DateUpdateHospital Type Change Request 3/10/2022 10:07:29 AM3/10/2022 10:07 AM
DetailsStateUpdateHospital Type Change RequestPendingApproved3/10/2022 10:07 AM
DatesSigned By DateUpdateHospital Type Change Request 3/1/2022 1:57:36 PM3/10/2022 10:07 AM
DatesStart DateUpdateHospital Type Change Request 4/1/2022 12:00:00 AM3/10/2022 10:07 AM
AddressesMain AddressInsertHospital Type Change Request  800 EAST DAWSON TYLER, TX 757013/1/2022 1:57 PM
AddressesShipping AddressInsertHospital Type Change Request CHRISTUS MOTHER FRANCES HOSPITAL - TYLER 800 EAST DAWSON ST. Tyler, TX 757013/1/2022 1:57 PM
AddressesShipping AddressInsertHospital Type Change Request CHRISTUS Specialty Pharmacy 800 EAST DAWSON ST. Suite 100 Tyler, TX 757013/1/2022 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/1/2022 1:57 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 0941080013/1/2022 1:57 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request TX3/1/2022 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/1/2022 1:57 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 0941080023/1/2022 1:57 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request TX3/1/2022 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/1/2022 1:57 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 0941080043/1/2022 1:57 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request TX3/1/2022 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/1/2022 1:57 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 0941080053/1/2022 1:57 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request TX3/1/2022 1:57 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 16795784393/1/2022 1:57 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request TX3/1/2022 1:57 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 11044065113/1/2022 1:57 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request TX3/1/2022 1:57 PM
ContactsPrimary ContactInsertHospital Type Change Request Ward, Joshua 340B Coordinator Christus Mother Frances, Jacksonville 90360675913/1/2022 1:57 PM
ContactsAuthorizing OfficialInsertHospital Type Change Request Pulliam, Elizabeth Chief Financial Officer CHRISTUS MF - Tyler 90360641023/1/2022 1:57 PM
ContactsSigned ByInsertHospital Type Change Request Pulliam, Elizabeth Chief Financial Officer CHRISTUS MF - Tyler 90360641023/1/2022 1:57 PM
DetailsAssistance Received From DateInsertHospital Type Change Request  3/1/2022 1:57 PM
DetailsAssistance Received To DateInsertHospital Type Change Request  3/1/2022 1:57 PM
DetailsLast Recertification DateInsertHospital Type Change Request  3/1/2022 1:57 PM
DetailsGrant NumberInsertHospital Type Change Request  3/1/2022 1:57 PM
Details340B IDInsertHospital Type Change Request  3/1/2022 1:57 PM
DetailsIs Authorizing Official EHB DataInsertHospital Type Change Request  3/1/2022 1:57 PM
DatesLast Date That 340B Drugs PurchasedInsertHospital Type Change Request  3/1/2022 1:57 PM
DetailsMedicare Provider NumberInsertHospital Type Change Request 4501023/1/2022 1:57 PM
DetailsEntity NameInsertHospital Type Change Request CHRISTUS MOTHER FRANCES HOSP-TYLER3/1/2022 1:57 PM
DetailsNOFO NumberInsertHospital Type Change Request  3/1/2022 1:57 PM
DetailsProgram CodeInsertHospital Type Change Request DSH3/1/2022 1:57 PM
DetailsEntity SubnameInsertHospital Type Change Request  3/1/2022 1:57 PM
DatesParticipating Approval DateInsertHospital Type Change Request  3/1/2022 1:57 PM
DetailsStateInsertHospital Type Change Request Pending3/1/2022 1:57 PM
DatesRegistration DateInsertHospital Type Change Request 3/1/2022 1:57:32 PM3/1/2022 1:57 PM
DatesSigned By DateInsertHospital Type Change Request  3/1/2022 1:57 PM
DatesStart DateInsertHospital Type Change Request  3/1/2022 1:57 PM
TerminationsTermination CommentsInsertHospital Type Change Request  3/1/2022 1:57 PM
TerminationsTermination DateInsertHospital Type Change Request  3/1/2022 1:57 PM
TerminationsTermination Effective DateInsertHospital Type Change Request  3/1/2022 1:57 PM
TerminationsTermination ReasonInsertHospital Type Change Request  3/1/2022 1:57 PM