Yes
| Details | Last Recertification Date | Update | Recertification | 2/20/2024 10:05:15 AM | 2/10/2025 11:50:07 AM | 2/10/2025 11:50 AM |
| Contacts | Primary Contact | Update | Recertification | Allen, Jolie
Chief Operations Officer
Foremost Family Health Center
2144263645-7066 | Mitchell, Herron
Chief Operations Officer
Martin Luther King Jr. Family Clinic
4694518740 | 2/20/2024 10:05 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2023 11:17:47 AM | 2/20/2024 10:05:15 AM | 2/20/2024 10:05 AM |
| Details | Last Recertification Date | Update | Recertification | | 1/31/2023 11:17:47 AM | 1/31/2023 11:17 AM |
| Details | State | Update | | Approved | Active | 10/1/2022 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | TAPLEY, JOYCE E.
CEO
Martin Luther King, Jr. Family Clinic
4696019360 | 7/6/2022 7:42 AM |
| Details | 340B ID | Update | New Registration | | CH06101B | 7/6/2022 7:42 AM |
| Dates | Participating Approval Date | Update | New Registration | | 7/6/2022 7:42:30 AM | 7/6/2022 7:42 AM |
| Details | State | Update | New Registration | Pending | Approved | 7/6/2022 7:42 AM |
| Dates | Signed By Date | Update | New Registration | | 7/5/2022 1:11:30 AM | 7/6/2022 7:42 AM |
| Dates | Start Date | Update | New Registration | | 10/1/2022 12:00:00 AM | 7/6/2022 7:42 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Allen, Jolie
Chief Operations Officer
Foremost Family Health Center
2144462018-7066 | Allen, Jolie
Chief Operations Officer
Foremost Family Health Center
2144263645-7066 | 7/1/2022 1:10 PM |
| Addresses | Main Address | Insert | New Registration | |
10327 Rylie Rd Ofc # 4
Dallas, TX 75217-8240 | 7/1/2022 1:09 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 7/1/2022 1:09 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 130713410 | 7/1/2022 1:09 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | TX | 7/1/2022 1:09 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1851492557 | 7/1/2022 1:09 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | TX | 7/1/2022 1:09 PM |
| Contacts | Authorizing Official | Insert | New Registration | | TAPLEY, JOYCE E.
CEO
Martin Luther King, Jr. Family Clinic
4696019360 | 7/1/2022 1:09 PM |
| Contacts | Primary Contact | Insert | New Registration | | Allen, Jolie
Chief Operations Officer
Foremost Family Health Center
2144462018-7066 | 7/1/2022 1:09 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Details | Grant Number | Insert | New Registration | | H80CS00127 | 7/1/2022 1:09 PM |
| Details | 340B ID | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Details | Entity Name | Insert | New Registration | | Martin Luther King Jr Family Clinic Inc | 7/1/2022 1:09 PM |
| Details | NOFO Number | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Details | Program Code | Insert | New Registration | | CH | 7/1/2022 1:09 PM |
| Details | Entity Subname | Insert | New Registration | | Foremost Family Health Centers - A+ Academy Elementary | 7/1/2022 1:09 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Details | State | Insert | New Registration | | Pending | 7/1/2022 1:09 PM |
| Dates | Registration Date | Insert | New Registration | | 7/1/2022 1:09:44 PM | 7/1/2022 1:09 PM |
| Dates | Signed By Date | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Dates | Start Date | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Terminations | Termination Date | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 7/1/2022 1:09 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 7/1/2022 1:09 PM |