Covered Entity Details

DSH260163B PARKLAND HEALTH CENTER (Active) - information as of 5/5/2025 11:57:35 PM

Main Details

Name

PARKLAND HEALTH CENTER

Subdivision Name

PARKLAND HEALTH CENTER - PHC Medical Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH260163B

Medicare Provider Number

260163

Outpatient Facility Provider Number

268794

Additional Details

Current Program Status

Active

Registration Date

7/15/2024

Participating Start Date

10/1/2024

Participating Approval Date

7/23/2024

Last Recertification Date

Contacts

Authorizing Official

Parkland Health Center
Heather Lynn Taliaferro, Chief Nursing Officer
(573) 760-8239

Primary Contact

Parkland Health Center
Steven ONeal, Procurement Coordinator
(573) 760-8060

Addresses

Street Address

1103 W Liberty St
Farmington, MO 63640

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
MO	596052704	1376271205

Shipping Addresses

Shipping Address 1

PARKLAND HEALTH CENTER RHC 340B
1101 West Liberty Street
Farmington, MO 63640-1921

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
DSH260163A	Child	DSH	PARKLAND HEALTH CENTER	Oncology/Infusion Center - Oncology/Infusion	1103 W. Liberty St.	Farmington	MO	Active
DSH260163B	Child	DSH	PARKLAND HEALTH CENTER	PARKLAND HEALTH CENTER - PHC Medical Clinic	1103 W Liberty St	Farmington	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Goldsmith, Cheri L Director Finance Parkland Health Center 5737608036	Taliaferro, Heather Lynn Chief Nursing Officer Parkland Health Center 5737608239	2/7/2025 10:50 AM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Goldsmith, Cheri L Director Finance Parkland Health Center 5737608036	7/23/2024 7:07 AM
Details	340B ID	Update	New Registration		DSH260163B	7/23/2024 7:07 AM
Details	Entity Name	Update	New Registration	PARKLAND HEALTH CENTER - FARMINGTON	PARKLAND HEALTH CENTER	7/23/2024 7:07 AM
Details	Entity Subname	Update	New Registration	PARKLAND HEALTH CENTER	PARKLAND HEALTH CENTER - PHC Medical Clinic	7/23/2024 7:07 AM
Dates	Participating Approval Date	Update	New Registration		7/23/2024 7:07:14 AM	7/23/2024 7:07 AM
Details	State	Update	New Registration	Pending	Approved	7/23/2024 7:07 AM
Dates	Signed By Date	Update	New Registration		7/15/2024 1:03:00 PM	7/23/2024 7:07 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	7/23/2024 7:07 AM
Addresses	Main Address	Insert	New Registration		1103 W Liberty St Farmington, MO 63640	7/15/2024 1:02 PM
Addresses	Shipping Address	Insert	New Registration		PARKLAND HEALTH CENTER RHC 340B 1101 West Liberty Street Farmington, MO 63640-1921	7/15/2024 1:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/15/2024 1:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		596052704	7/15/2024 1:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MO	7/15/2024 1:02 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1376271205	7/15/2024 1:02 PM
Medicaid Billing	NPI: State	Insert	New Registration		MO	7/15/2024 1:02 PM
Contacts	Authorizing Official	Insert	New Registration		Goldsmith, Cheri L Director Finance Parkland Health Center 5737608036	7/15/2024 1:02 PM
Contacts	Primary Contact	Insert	New Registration		ONeal, Steven Procurement Coordinator Parkland Health Center 5737608060	7/15/2024 1:02 PM
Details	Assistance Received From Date	Insert	New Registration			7/15/2024 1:02 PM
Details	Assistance Received To Date	Insert	New Registration			7/15/2024 1:02 PM
Details	Last Recertification Date	Insert	New Registration			7/15/2024 1:02 PM
Details	Grant Number	Insert	New Registration			7/15/2024 1:02 PM
Details	340B ID	Insert	New Registration			7/15/2024 1:02 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/15/2024 1:02 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/15/2024 1:02 PM
Details	Medicare Provider Number	Insert	New Registration		260163	7/15/2024 1:02 PM
Details	Entity Name	Insert	New Registration		PARKLAND HEALTH CENTER - FARMINGTON	7/15/2024 1:02 PM
Details	NOFO Number	Insert	New Registration			7/15/2024 1:02 PM
Details	Program Code	Insert	New Registration		DSH	7/15/2024 1:02 PM
Details	Entity Subname	Insert	New Registration		PARKLAND HEALTH CENTER	7/15/2024 1:02 PM
Dates	Participating Approval Date	Insert	New Registration			7/15/2024 1:02 PM
Details	State	Insert	New Registration		Pending	7/15/2024 1:02 PM
Dates	Registration Date	Insert	New Registration		7/15/2024 1:02:54 PM	7/15/2024 1:02 PM
Dates	Signed By Date	Insert	New Registration			7/15/2024 1:02 PM
Dates	Start Date	Insert	New Registration			7/15/2024 1:02 PM
Terminations	Termination Comments	Insert	New Registration			7/15/2024 1:02 PM
Terminations	Termination Date	Insert	New Registration			7/15/2024 1:02 PM
Terminations	Termination Effective Date	Insert	New Registration			7/15/2024 1:02 PM
Terminations	Termination Reason	Insert	New Registration			7/15/2024 1:02 PM