| Details | Last Recertification Date | Update | Recertification | 6/1/2023 2:47:21 PM | 5/30/2024 9:43:32 AM | 5/30/2024 9:43 AM |
| Contacts | Primary Contact | Update | Recertification | Mills, Cheryl
Communication and Outreach Specialist
Texarkana-Bowie County Family Health
9037983250-3470 | Mills, Cheryl
Outreach Specialist
Texarkana-Bowie County Family Health
9037983250-3470 | 6/1/2023 2:47 PM |
| Details | Last Recertification Date | Update | Recertification | 5/18/2022 5:11:59 PM | 6/1/2023 2:47:21 PM | 6/1/2023 2:47 PM |
| Details | Grant Number | Update | Recertification | FPHPA006401 | FPHPA006521 | 6/1/2023 2:47 PM |
| Contacts | Primary Contact | Update | Recertification | Hart, Sandy
Administrative Assistant
Texarkana-Bowie County Family Health
9037983250 | Mills, Cheryl
Communication and Outreach Specialist
Texarkana-Bowie County Family Health
9037983250-3470 | 5/18/2022 5:11 PM |
| Details | Last Recertification Date | Update | Recertification | 5/24/2021 11:18:20 PM | 5/18/2022 5:11:59 PM | 5/18/2022 5:11 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1902850324 ( ) | | 5/24/2021 11:18 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1902850324 | 5/24/2021 11:18 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | TX | 5/24/2021 11:18 PM |
| Details | Last Recertification Date | Update | Recertification | 5/27/2020 8:43:36 AM | 5/24/2021 11:18:20 PM | 5/24/2021 11:18 PM |
| Details | Grant Number | Update | Recertification | FPHPA006401-02 | FPHPA006401 | 5/24/2021 11:18 PM |
| Details | Last Recertification Date | Update | Recertification | 5/22/2019 7:44:50 AM | 5/27/2020 8:43:36 AM | 5/27/2020 8:43 AM |
| Details | Grant Number | Update | Recertification | FPHPA006401 | FPHPA006401-02 | 5/27/2020 8:43 AM |
| Contacts | Primary Contact | Update | Recertification | Morris, Cheryl
Clinical LVN
Texarkana-Bowie County Family Health
9037983250 | Hart, Sandy
Administrative Assistant
Texarkana-Bowie County Family Health
9037983250 | 5/22/2019 7:44 AM |
| Details | Last Recertification Date | Update | Recertification | 5/14/2018 10:02:49 AM | 5/22/2019 7:44:50 AM | 5/22/2019 7:44 AM |
| Details | Grant Number | Update | Recertification | FPHPA066196-03-00 | FPHPA006401 | 5/22/2019 7:44 AM |
| Details | Last Recertification Date | Update | Recertification | 5/3/2017 12:00:00 AM | 5/14/2018 10:02:49 AM | 5/14/2018 10:02 AM |
| Contacts | Primary Contact | Update | New Registration | Morris, Cheryl
Clinical LVN
9037983250 | Morris, Cheryl
Clinical LVN
Texarkana-Bowie County Family Health
9037983250 | 10/12/2017 9:47 AM |
| Contacts | Authorizing Official | Update | | Brush, Kelly
Administrative Manager
9037983273 | Brush, Kelly
Administrative Manager
Texarkana Bowie County Family Health Center
9037983273 | 10/2/2017 11:44 AM |
| Addresses | Main Address | Insert | | |
902 W 12TH Street
TEXARKANA, TX 75501 | 5/3/2017 12:47 PM |
| Contacts | Authorizing Official | Update | | Haff, Cheryl
Administrative Manager
9037983273 | Brush, Kelly
Administrative Manager
9037983273 | 5/3/2017 12:47 PM |
| Contacts | Primary Contact | Update | | O'Neal, Beverly
Clinical Manager
9037983257 | Morris, Cheryl
Clinical LVN
9037983250 | 5/3/2017 12:47 PM |
| Details | Grant Number | Update | | FPHPA066072 | FPHPA066196-03-00 | 5/3/2017 12:46 PM |
| Details | Last Recertification Date | Update | | 5/19/2016 12:00:00 AM | 5/3/2017 12:00:00 AM | 5/3/2017 10:12 AM |
| Details | Last Recertification Date | Update | | 5/18/2015 12:00:00 AM | 5/19/2016 12:00:00 AM | 5/19/2016 3:42 PM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 5/18/2015 5:35 PM |
| Details | Last Recertification Date | Update | | 4/22/2014 12:00:00 AM | 5/18/2015 12:00:00 AM | 5/18/2015 5:35 PM |
| Contacts | Primary Contact | Update | | Haff, Cheryl
Administrative Manager
9037983273 | O'Neal, Beverly
Clinical Manager
9037983257 | 5/7/2014 8:22 AM |
| Contacts | Authorizing Official | Insert | | | Haff, Cheryl
Administrative Manager
9037983273 | 5/7/2014 8:22 AM |
| Contacts | Primary Contact | Update | | MOORE, KATHY
CLINIC ADMINISTRATOR
9037983250 | Haff, Cheryl
Administrative Manager
9037983273 | 5/7/2014 8:22 AM |
| Details | Last Recertification Date | Update | | | 4/22/2014 12:00:00 AM | 4/22/2014 8:20 AM |
| Medicaid Billing | Medicaid: Number | Update | | 1372575 08 | PH0064 | 12/2/2013 3:11 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1902850324 | 12/2/2013 3:11 PM |
| Details | Last Recertification Date | Update | | 7/1/2013 12:00:00 AM | | 12/2/2013 3:11 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | 7/1/2013 12:00:00 AM | | 12/2/2013 3:11 PM |
| Details | State | Update | | Terminated | Active | 12/2/2013 3:11 PM |
| Dates | Start Date | Update | | 1/1/2002 12:00:00 AM | 1/1/2014 12:00:00 AM | 12/2/2013 3:11 PM |
| Terminations | Termination Comments | Update | | failure to recertify | | 12/2/2013 3:11 PM |
| Terminations | Termination Date | Update | | 7/1/2013 12:00:00 AM | | 12/2/2013 3:11 PM |
| Terminations | Termination Effective Date | Update | | 7/1/2013 12:00:00 AM | | 12/2/2013 3:11 PM |
| Terminations | Termination Reason | Update | | Failure to recertify | | 12/2/2013 3:11 PM |
| Details | Comments Public | Insert | | | 12/2/13 enrolled 1/1/02 thru 6/30/13, not enrolled 7/1/13 thru 7/1/13 thru 12/31/13 due to failure to recertify, re-instated based on on-line registration submitted in Oct. 2013; 4/20/06 ADDR UPDATED | 12/2/2013 3:11 PM |
| Contacts | Primary Contact | Insert | | | MOORE, KATHY
CLINIC ADMINISTRATOR
9037983250 | 11/20/2013 8:56 PM |
| Details | Grant Number | Update | | FPHPA066072-01-00 | FPHPA066072 | 11/20/2013 8:56 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 7/1/2013 12:00:00 AM | 11/20/2013 8:56 PM |
| Terminations | Termination Comments | Update | | | failure to recertify | 11/20/2013 8:56 PM |
| Terminations | Termination Effective Date | Update | | | 7/1/2013 12:00:00 AM | 11/20/2013 8:56 PM |
| Details | Last Recertification Date | Update | | 4/1/2012 12:00:00 AM | 7/1/2013 12:00:00 AM | 6/9/2013 8:45 AM |
| Details | State | Update | | Active | Terminated | 6/9/2013 8:45 AM |
| Terminations | Termination Date | Update | | | 7/1/2013 12:00:00 AM | 6/9/2013 8:45 AM |
| Terminations | Termination Reason | Update | | | Failure to recertify | 6/9/2013 8:45 AM |
| Details | Grant Number | Update | | FPHPA060898 | FPHPA066072-01-00 | 4/26/2013 8:53 AM |
| Details | Last Recertification Date | Update | | 4/1/2010 12:00:00 AM | 4/1/2012 12:00:00 AM | 3/20/2012 3:51 PM |
| Details | Last Recertification Date | Insert | | | 4/1/2010 12:00:00 AM | 3/22/2010 11:12 AM |
| Details | Grant Number | Insert | | | FPHPA060898 | 3/22/2010 11:12 AM |
| Details | 340B ID | Insert | | | FP75501 | 3/22/2010 11:12 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 3/22/2010 11:12 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 3/22/2010 11:12 AM |
| Details | Medicare Provider Number | Insert | | | | 3/22/2010 11:12 AM |
| Details | Entity Name | Insert | | | TEXARKANA BOWIE COUNTY FAMILY HEALTH CENTER | 3/22/2010 11:12 AM |
| Details | Program Code | Insert | | | FP | 3/22/2010 11:12 AM |
| Details | Entity Subname | Insert | | | | 3/22/2010 11:12 AM |
| Dates | Participating Approval Date | Insert | | | 3/17/2004 12:00:00 AM | 3/22/2010 11:12 AM |
| Details | State | Insert | | | Active | 3/22/2010 11:12 AM |
| Dates | Registration Date | Insert | | | 1/1/2002 12:00:00 AM | 3/22/2010 11:12 AM |
| Dates | Signed By Date | Insert | | | 4/1/2010 12:00:00 AM | 3/22/2010 11:12 AM |
| Dates | Start Date | Insert | | | 1/1/2002 12:00:00 AM | 3/22/2010 11:12 AM |
| Terminations | Termination Comments | Insert | | | | 3/22/2010 11:12 AM |
| Terminations | Termination Date | Insert | | | | 3/22/2010 11:12 AM |
| Terminations | Termination Effective Date | Insert | | | | 3/22/2010 11:12 AM |
| Terminations | Termination Reason | Insert | | | | 3/22/2010 11:12 AM |
| Details | Comments Public | Insert | | | 4/20/06 ADDR UPDATED | 3/22/2010 11:12 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 1/1/2002 12:00 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 1372575 08 | 1/1/2002 12:00 AM |
| Medicaid Billing | Medicaid: State | Insert | | | TX | 1/1/2002 12:00 AM |