Covered Entity Details

CAH451390-02 DIMMIT REGIONAL HOSPITAL DISTRICT (Active) - information as of 4/28/2025 12:39:18 AM

Main Details

Name

DIMMIT REGIONAL HOSPITAL DISTRICT

Subdivision Name

DIMMIT REGIONAL HOSPITAL - Dimmit Regional Hospital Rural Health Clinic (Carrizo Springs)

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH451390-02

Medicare Provider Number

451390

Outpatient Facility Provider Number

678560

Additional Details

Current Program Status

Active

Registration Date

7/6/2023

Participating Start Date

10/1/2023

Participating Approval Date

9/13/2023

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Dimmit Regional Hospital
Andres Duran, CEO
(830) 876-2424 Ext: 300

Primary Contact

Dimmit Regional Hospital
Alfonso Ortiz, Director of Grants & Supplemental Funding/EEOC
(830) 876-2424 Ext: 305

Addresses

Street Address

504 HOSPITAL DR
STE B
CARRIZO SPRINGS, TX 78834-3847

Billing Address

Dimmit Regional Hospital
704 Hospital Drive
Carrizo Springs, TX 78834

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?
No

Shipping Addresses

Shipping Address 1

Dimmit Regional Hospital
704 Hospital Drive
Carrizo Springs, TX 78834

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
CAH451390-01	Child	CAH	DIMMIT REGIONAL HOSPITAL DISTRICT	DIMMIT REGIONAL HOSPITAL - Dimmit Regional Hospital Rural Health Clinic (Crystal City)	1313 VETERANS AVE	CRYSTAL CITY	TX	Active
CAH451390-02	Child	CAH	DIMMIT REGIONAL HOSPITAL DISTRICT	DIMMIT REGIONAL HOSPITAL - Dimmit Regional Hospital Rural Health Clinic (Carrizo Springs)	504 HOSPITAL DR	CARRIZO SPRINGS	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Recertification	Wilson, Melissa Chief Operating Officer Dimmit Regional Hospital 8308762424-305	Ortiz, Alfonso Director of Grants & Supplemental Funding/EEOC Dimmit Regional Hospital 8308762424-305	8/20/2024 1:34 PM
Details	Last Recertification Date	Update	Recertification		8/20/2024 1:34:23 PM	8/20/2024 1:34 PM
Contacts	Authorizing Official	Update	AO Change Request	Wilson, Melissa Chief Operating Officer Dimmit Regional Hospital 8308762424-305	Duran, Andres CEO Dimmit Regional Hospital 8308762424-300	10/17/2023 7:48 AM
Details	State	Update		Approved	Active	10/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Wilson, Melissa Chief Operating Officer Dimmit Regional Hospital 8308762424-305	9/13/2023 7:16 AM
Details	340B ID	Update	New Registration		CAH451390-02	9/13/2023 7:16 AM
Details	Entity Subname	Update	New Registration	DIMMIT REGIONAL HOSPITAL	DIMMIT REGIONAL HOSPITAL - Dimmit Regional Hospital Rural Health Clinic (Carrizo Springs)	9/13/2023 7:16 AM
Dates	Participating Approval Date	Update	New Registration		9/13/2023 7:16:50 AM	9/13/2023 7:16 AM
Details	State	Update	New Registration	Pending	Approved	9/13/2023 7:16 AM
Dates	Signed By Date	Update	New Registration		8/15/2023 9:50:18 AM	9/13/2023 7:16 AM
Dates	Start Date	Update	New Registration		10/1/2023 12:00:00 AM	9/13/2023 7:16 AM
Contacts	Authorizing Official	Update	Change Request	Graves, John A CEO Dimmit Regional Hospital 8308762426	Wilson, Melissa Chief Operating Officer Dimmit Regional Hospital 8308762424-305	7/10/2023 7:12 AM
Addresses	Main Address	Insert	New Registration		504 HOSPITAL DR STE B CARRIZO SPRINGS, TX 78834-3847	7/6/2023 11:34 AM
Addresses	Billing Address	Insert	New Registration		Dimmit Regional Hospital 704 Hospital Drive Carrizo Springs, TX 78834	7/6/2023 11:34 AM
Addresses	Shipping Address	Insert	New Registration		Dimmit Regional Hospital 704 Hospital Drive Carrizo Springs, TX 78834	7/6/2023 11:34 AM
Contacts	Authorizing Official	Insert	New Registration		Graves, John A CEO Dimmit Regional Hospital 8308762426	7/6/2023 11:34 AM
Contacts	Primary Contact	Insert	New Registration		Wilson, Melissa Chief Operating Officer Dimmit Regional Hospital 8308762424-305	7/6/2023 11:34 AM
Details	Assistance Received From Date	Insert	New Registration			7/6/2023 11:34 AM
Details	Assistance Received To Date	Insert	New Registration			7/6/2023 11:34 AM
Details	Last Recertification Date	Insert	New Registration			7/6/2023 11:34 AM
Details	Grant Number	Insert	New Registration			7/6/2023 11:34 AM
Details	340B ID	Insert	New Registration			7/6/2023 11:34 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/6/2023 11:34 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/6/2023 11:34 AM
Details	Medicare Provider Number	Insert	New Registration		451390	7/6/2023 11:34 AM
Details	Entity Name	Insert	New Registration		DIMMIT REGIONAL HOSPITAL DISTRICT	7/6/2023 11:34 AM
Details	NOFO Number	Insert	New Registration			7/6/2023 11:34 AM
Details	Program Code	Insert	New Registration		CAH	7/6/2023 11:34 AM
Details	Entity Subname	Insert	New Registration		DIMMIT REGIONAL HOSPITAL	7/6/2023 11:34 AM
Dates	Participating Approval Date	Insert	New Registration			7/6/2023 11:34 AM
Details	State	Insert	New Registration		Pending	7/6/2023 11:34 AM
Dates	Registration Date	Insert	New Registration		7/6/2023 11:34:58 AM	7/6/2023 11:34 AM
Dates	Signed By Date	Insert	New Registration			7/6/2023 11:34 AM
Dates	Start Date	Insert	New Registration			7/6/2023 11:34 AM
Terminations	Termination Comments	Insert	New Registration			7/6/2023 11:34 AM
Terminations	Termination Date	Insert	New Registration			7/6/2023 11:34 AM
Terminations	Termination Effective Date	Insert	New Registration			7/6/2023 11:34 AM
Terminations	Termination Reason	Insert	New Registration			7/6/2023 11:34 AM