340B Drug Pricing Program Database


CH07213U NORTHWEST HEALTH SERVICES, INC. (Active) - information as of 6/11/2025 7:18:53 PM

Main Details
NORTHWEST HEALTH SERVICES, INC.
SOUTH SIDE HEALTH CENTER
HRSA-Funded Health Center
BPS-H80-002442
CH07213U
H80CS00671


Additional Details
Active
4/1/2005
4/1/2005
1/27/2005
2/19/2025

Contacts

Northwest Health Services
Matt Younger, CEO
(816) 307-5303

Northwest Health Services
Miranda Phillips, Director of Pharmacy
(816) 385-5997

Addresses

5001 Lake Ave
Saint Joseph, MO 64504-1170

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
NEW SITE 04/01/200504/01/2005
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
KS300038992300021194846550
MO5093842021194846550
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailSAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448503/01/201804/01/2018  03/01/2018
Contract DetailSTEVENSON FAMILY PHARMACY6201 KING HILL AVE
SAINT JOSEPHMO6450409/01/200509/01/2005  03/28/2013
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH072130ActiveBPS-H80-002392NORTHWEST HEALTH SERVICES, INC.FAMILY MEDICINE ASSOCIATES2303 Village Dr Saint JosephMO
CH07213AActiveBPS-H80-005680NORTHWEST HEALTH SERVICES, INC.King City Clinic305 Rhode Island St King CityMO
CH07213AAActiveBPS-H80-013703NORTHWEST HEALTH SERVICES, INC.Northwest Family Dental and Behavioral Health3608 FARAON ST SAINT JOSEPHMO
CH07213ABActiveBPS-H80-021517NORTHWEST HEALTH SERVICES, INC.Northwest Health Services Downtown Health Center503 S 6th St Saint JosephMO
CH07213ACActiveBPS-H80-030147NORTHWEST HEALTH SERVICES, INC.Gower Family Medicine313 S US Highway 169 GowerMO
CH07213ADActiveBPS-H80-024852NORTHWEST HEALTH SERVICES INCNorthwest Health Mobile Unit2303 Village Dr Saint JosephMO
CH07213AEActiveBPS-H80-035777NORTHWEST HEALTH SERVICES INCNorthwest Health Services - Chillicothe300 W Business 36 ChillicotheMO
CH07213BActiveBPS-H80-003069NORTHWEST HEALTH SERVICES, INC.SAVANNAH MEDICAL CLINIC803 HIGHWAY 71 WEST SAVANNAHMO
CH07213EActiveBPS-H80-006325NORTHWEST HEALTH SERVICES, INC.BRAYMER CLINIC109 MAIN STREET BRAYMERMO
CH07213FActiveBPS-H80-002437NORTHWEST HEALTH SERVICES, INC.HAMILTON MEDICAL CLINIC101 CROSS STREET HAMILTONMO
CH07213KActiveBPS-H80-009170NORTHWEST HEALTH SERVICES, INC.Mound City Clinic1303 State St Mound CityMO
CH07213QActiveBPS-H80-006309NORTHWEST HEALTH SERVICES, INC.CAINSVILLE MEDICAL CLINIC707 VICTORY LANE CAINSVILLEMO
CH07213TActiveBPS-H80-034418NORTHWEST HEALTH SERVICES, INC.NORTH END HEALTH CENTER1000 5th Avenue Saint JosephMO
CH07213UActiveBPS-H80-002442NORTHWEST HEALTH SERVICES, INC.SOUTH SIDE HEALTH CENTER5001 Lake Ave Saint JosephMO
CH07213WTerminatedBPS-H80-007691NORTHWEST HEALTH SERVICES, INC.HOME Unit904 south 10th street STE A St JosephMO
CH07213YTerminatedBPS-H80-010931NORTHWEST HEALTH SERVICES, INC.McCoy and Samples Dental Clinic - Hamilton500 1/2 S Davis St HamiltonMO
CH07213ZTerminatedBPS-H80-007618NORTHWEST HEALTH SERVICES, INC.McCoy & Samples Dental Clinic850 Fairway Dr ChillicotheMO
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH072130ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/01/2018  
CH072130ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/01/2018  
CH072130ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/01/2018  
CH072130ACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/01/2018  
CH072130ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/01/2018  
CH072130ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/01/2018  
CH072130ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280907/01/2024  
CH072130BENDERS PRESCRIPTION SHOP3829 FREDERICK AVENUE
SAINT JOSEPHMO6450604/01/2015 04/11/2019
CH072130BRIOVARX OF MAINE INCDBA BRIOVARX 53 DARLING AVE
SOUTH PORTLANDME0410610/01/2018 10/01/2019
CH072130BRIOVARX OF MASSACHUSETTS, LLCD/B/A BRIOVARX BLDG 2 - UNIT A
145 BODWELL STREET
AVONMA0232210/01/2018 10/01/2019
CH072130CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/01/2020  
CH072130CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/01/2020  
CH072130CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/01/2020  
CH072130CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/01/2020  
CH072130CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/01/2020  
CH072130CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/01/2020  
CH072130CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/01/2020  
CH072130CAREMARK PUERTO RICO SPECIALTY PHARMACY,CAREMARK PUERTO RICO SPECIALTY PHARMACY 6020 AVE ROBERTO SANCHEZ VILELLA
CAROLINAPR0098210/01/2020 08/17/2022
CH072130CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813310/01/2020  
CH072130CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237410/01/2020  
CH072130CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/01/2020  
CH072130COSENTINO GROUP INCPRICE CHOPPER PHARMACY #416 2219 N BELT HWY
SAINT JOSEPHMO64506-220501/01/2017  
CH072130COUNTRYSIDE PHARMACY402 E PRICE AVE P.O. BOX 147
SAVANNAHMO64485-174207/27/2011 03/21/2025
CH072130CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/01/2021  
CH072130CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/01/2021  
CH072130CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/01/2020  
CH072130CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/01/2024  
CH072130DIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268310/01/2020 04/08/2024
CH072130GENOA HEALTHCARE LLC724 NORTH 22ND STREET
SAINT JOSEPHMO6450607/01/2024  
CH072130GENOA HEALTHCARE LLC902 EDMOND ST STE 202
SAINT JOSEPHMO6450107/01/2024  
CH072130HY-VEE INCDBA HY-VEE PHARMACY (1552) 201 N BELT HIGHWAY
ST JOSEPHMO6450610/01/2017 08/31/2024
CH072130Hy-Vee Pharmacy Fulfillment Center #4016Hy-Vee Inc 4707 Fleur Dr
Des MoinesIA5032107/01/2021 08/31/2024
CH072130Hy-Vee Pharmacy Fullfillment Center #4016Hy-Vee Inc 4704 Fleur Dr
Des MoinesIA5032110/01/2017 06/07/2021
CH072130K MART PHARMACY 40262901 5 N BELT HWY
ST JOSEPHMO6450604/01/2015 11/05/2018
CH072130MISSOURI CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05645 930 N BELT HWY
SAINT JOSEPHMO6450610/01/2016  
CH072130MISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY# 8236 1301 S BELT HWY
SAINT JOSEPHMO6450704/01/2019  
CH072130MISSOURI CVS PHARMACY, L.L.C.CVS/PHARMACY # 10506 3320 NORTH BELT HIGHWAY
SAINT JOSEPHMO6450604/01/2019  
CH072130MISSOURI CVS PHARMACY, L.L.C.CVS PHARMACY # 17093 5201 N BELT HWY STE H
SAINT JOSEPHMO6450610/01/2019  
CH072130MISSOURI CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08577 4400 NW BARRY ROAD
KANSAS CITYMO6415410/01/2020  
CH072130MISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10152 1501 E. OHIO ST.
CLINTONMO6473510/01/2020  
CH072130OPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191310/01/2018 06/01/2021
CH072130OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/06/2022 04/04/2024
CH072130OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713010/01/2018  
CH072130OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824907/01/2024  
CH072130OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729810/01/2018 04/04/2024
CH072130OPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110110/01/2018 04/04/2024
CH072130OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/01/2024  
CH072130POIRIER PHARMACY INCPOIRIER PHARMACY 102 SO 5TH STREET
P.O. BOX 128
SAVANNAHMO6448506/16/2011 12/09/2015
CH072130PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/01/2020  
CH072130PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/01/2020  
CH072130PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681310/01/2020  
CH072130PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/01/2020  
CH072130RIVERSIDE PHARMACY ASSOCIATES, LLCDBA APEX SPECIALTY PHARMACY 616 NW PLATTE VALLEY DR
RIVERSIDEMO64150-979804/01/2019 04/08/2024
CH072130ROGERS PHARMACY3705 N BELT HWY
SAINT JOSEPHMO6450604/01/2015  
CH072130ROGERS PHARMACY607 STATE ST
MOUND CITYMO64470-114610/01/2015  
CH072130ROGERS PHARMACY411 MAIN ST
TARKIOMO6449110/01/2015  
CH072130SAVANNAH FAMILY PHARMACY205 S. 71 HWY
SAVANNAHMO6448501/05/2012 03/28/2018
CH07213BSAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018  
CH072130SAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448503/07/2018  
CH07213ASAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018  
CH07213AASAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018  
CH07213ABSAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018  
CH07213ESAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018  
CH07213FSAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018  
CH07213KSAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018  
CH07213QSAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018  
CH07213TSAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018  
CH07213USAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018  
CH07213WSAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018 04/01/2019
CH07213YSAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018 04/01/2022
CH07213ZSAVANNAH FAMILY PHARMACY205 S US HIGHWAY 71
SAVANNAHMO6448504/01/2018 04/01/2022
CH072130SHOPKO PHARMACY #2710212 N MAIN ST
GALLATINMO6464007/01/2016 06/01/2017
CH072130Stevenson Family Pharmacy6201 King Hill
St. JosephMO6450409/12/2011  
CH07213USTEVENSON FAMILY PHARMACY6201 KING HILL AVE
SAINT JOSEPHMO6450409/01/2005  
CH07213TTHE APOTHECARY1517 ST JOSEPH AVENUE
ST JOSEPHMO6450507/01/2005  
CH072130The Apothecary Pharmacy1517 St. Joseph Ave
St. JosephMO6450409/12/2011 12/21/2018
CH072130THE DRUG STOREKCJSE INC 610 N WALNUT ST
CAMERONMO64429-183106/20/2011  
CH072130THE PHARMACY AT APPLE MARKET NORTHWHEEL'S PHARMACY,LLC 903 N 36TH ST
SAINT JOSEPHMO64506-297110/01/2015 12/01/2016
CH072130WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2017  
CH072130WAL-MART PHARMACY 10-01092000 N WALNUT
CAMERONMO6442904/01/2015  
CH072130WAL-MART PHARMACY 10-01351000 GRAVES STREET
CHILLICOTHEMO6460104/01/2015  
CH072130WAL-MART PHARMACY 10-01892206 N BALTIMORE
KIRKSVILLEMO6350109/21/2012 09/18/2015
CH072130WAL-MART PHARMACY 10-0325908 S. WALTON WAY
RICHMONDMO6408504/01/2015  
CH072130WAL-MART PHARMACY 10-0342701 HOPI DR.
HIAWATHAKS6643404/01/2015  
CH072130WAL-MART PHARMACY 10-05604201 N BELT HWY
ST JOSEPHMO6450604/01/2015  
CH072130WAL-MART PHARMACY 10-08011605 SOUTH MAIN STREET
MARYVILLEMO6446804/01/2015  
CH072130WAL-MART PHARMACY 10-0834810 SOUTH 37TH STREET
BETHANYMO6442404/01/2015  
CH072130WAL-MART PHARMACY 10-29943022 SOUTH BELT HIGHWAY
ST JOSEPH (S)MO6450304/01/2015  
CH072130WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2017  
CH072130WALGREEN CODBA: WALGREENS #10725 4022 N BELT HIGHWAY
SAINT JOSEPHMO6450607/01/2018  
CH072130WALGREEN CO.DBA: WALGREENS # 04466 3645 FREDERICK AVENUE
ST JOSEPHMO6450607/01/2018  
CH072130WALGREEN CO.DBA: WALGREENS # 07551 2620 S BELT HIGHWAY
ST JOSEPHMO64503-164607/01/2018  
CH072130WALGREEN CO.DBA: WALGREENS #12821 1114 S MAIN ST
MARYVILLEMO6446807/01/2018 11/11/2020
CH072130WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16072 3537 BROADWAY BLVD
KANSAS CITYMO6411110/01/2018  
CH072130WALGREEN CO.COMMUNITY, A WALGREENS PHARMACY #16518 6407 W 119TH ST STE G5
OVERLAND PARKKS6620910/01/2018  
CH07213AWALGREEN CO.COMMUNITY, A WALGREENS PHARMACY #16518 6407 W 119TH ST STE G5
OVERLAND PARKKS6620910/01/2018  
CH07213AWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16072 3537 BROADWAY BLVD
KANSAS CITYMO6411110/01/2018  
CH072130Walgreens Central Fill #213942601 Hughes Road
Suite 103
LibertyMO6406810/01/2023  
CH072130WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528407/01/2018 02/26/2021
CH072130WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/01/2024  
CH072130WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/01/2024  
CH072130WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/01/2024  
CH072130WALGREENS.COM, INC.DBA: WALGREENS 2225 S. PRICE ROAD
CHANDLERAZ8528607/01/2018  
CH072130WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275607/01/2023  
CH072130Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH072130WHEEL'S PHARMACYDBA WHEEL'S MARKET PHARMACY 3002 PEAR ST
SAINT JOSEPHMO6450310/01/2015 04/03/2023
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/30/2024 5:02:15 PM2/19/2025 5:11:52 PM2/19/2025 5:11 PM
DetailsLast Recertification DateUpdateRecertification2/14/2023 10:05:07 AM1/30/2024 5:02:15 PM1/30/2024 5:02 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/14/2023 10:05 AM
Medicaid BillingMedicaid: NumberInsertRecertification 300038992300022/14/2023 10:05 AM
Medicaid BillingMedicaid: StateInsertRecertification KS2/14/2023 10:05 AM
Medicaid BillingMedicaid: NumberDeleteRecertification100288780G (KS) 2/14/2023 10:05 AM
DetailsLast Recertification DateUpdateRecertification2/22/2022 10:28:16 AM2/14/2023 10:05:07 AM2/14/2023 10:05 AM
DetailsLast Recertification DateUpdateRecertification2/10/2021 2:39:02 PM2/22/2022 10:28:16 AM2/22/2022 10:28 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestYounger, Matt CEO Northwest Health Services 8162718201Younger, Matt CEO Northwest Health Services 81630753036/3/2021 5:21 PM
Medicaid BillingNPI: NumberInsertRecertification 11948465502/10/2021 2:39 PM
Medicaid BillingNPI: StateInsertRecertification MO2/10/2021 2:39 PM
Medicaid BillingNPI: NumberInsertRecertification 11948465502/10/2021 2:39 PM
Medicaid BillingNPI: StateInsertRecertification KS2/10/2021 2:39 PM
Medicaid BillingNPI: NumberDeleteRecertification1194846550 ( ) 2/10/2021 2:39 PM
DetailsLast Recertification DateUpdateRecertification1/28/2020 1:23:21 PM2/10/2021 2:39:02 PM2/10/2021 2:39 PM
ContactsAuthorizing OfficialUpdateAO Change RequestLamb, Deanna CEO Northwest Health Services 8162718201Younger, Matt CEO Northwest Health Services 816271820110/14/2020 11:52 AM
DetailsLast Recertification DateUpdateRecertification1/28/2019 5:13:54 PM1/28/2020 1:23:21 PM1/28/2020 1:23 PM
ContactsPrimary ContactUpdateRecertificationHarris, Tina Director of Finance Northwest Health Services 8162718213Phillips, Miranda Director of Pharmacy Northwest Health Services 81638559971/28/2019 5:13 PM
DetailsLast Recertification DateUpdateRecertification2/12/2018 10:42:37 AM1/28/2019 5:13:54 PM1/28/2019 5:13 PM
DetailsLast Recertification DateUpdateRecertification2/13/2017 12:00:00 AM2/12/2018 10:42:37 AM2/12/2018 10:42 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/8/2018 2:48 PM
Medicaid BillingMedicaid: NumberInsertChange Request 100288780G1/8/2018 2:48 PM
Medicaid BillingMedicaid: StateInsertChange Request KS1/8/2018 2:48 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/8/2018 2:48 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5093842021/8/2018 2:48 PM
Medicaid BillingMedicaid: StateInsertChange Request MO1/8/2018 2:48 PM
Medicaid BillingNPI: NumberInsertChange Request 11948465501/8/2018 2:48 PM
ContactsPrimary ContactUpdateChange RequestLamb, Deanna CEO Northwest Health Services 8162718201Harris, Tina Director of Finance Northwest Health Services 81627182131/8/2018 2:48 PM
ContactsAuthorizing OfficialUpdate Lamb, Deanna CEO 8162718201Lamb, Deanna CEO Northwest Health Services 81627182011/2/2018 12:18 PM
ContactsPrimary ContactUpdate Lamb, Deanna CEO 8162718201Lamb, Deanna CEO Northwest Health Services 81627182011/2/2018 12:18 PM
ContactsAuthorizing OfficialInsert  Lamb, Deanna CEO 81627182017/13/2017 2:51 PM
ContactsPrimary ContactUpdate Wright, Nichole COO 8162718234Lamb, Deanna CEO 81627182017/13/2017 2:51 PM
AddressesMain AddressInsert   5001 Lake Ave Saint Joseph, MO 64504-11702/13/2017 11:43 AM
DetailsLast Recertification DateUpdate 2/26/2016 12:00:00 AM2/13/2017 12:00:00 AM2/13/2017 11:43 AM
DetailsLast Recertification DateUpdate 1/28/2015 12:00:00 AM2/26/2016 12:00:00 AM2/26/2016 11:22 AM
ContactsPrimary ContactUpdate Thompson, Laurie Director PIRM 8169011499Wright, Nichole COO 81627182345/29/2015 2:52 PM
DetailsLast Recertification DateUpdate 3/17/2014 12:00:00 AM1/28/2015 12:00:00 AM1/28/2015 2:53 PM
ContactsPrimary ContactInsert  Thompson, Laurie Director PIRM 81690114991/12/2015 5:25 PM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/17/2014 12:00:00 AM3/17/2014 12:24 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM2/25/2013 10:20 AM
DatesParticipating Approval DateUpdate 1/27/2005 2:05:59 PM1/27/2005 12:00:00 AM12/5/2012 9:09 AM
DetailsLast Recertification DateInsert   4/1/2005 12:00 AM
DetailsGrant NumberInsert  H80CS006714/1/2005 12:00 AM
Details340B IDInsert  CH07213U4/1/2005 12:00 AM
DetailsIs Authorizing Official EHB DataInsert   4/1/2005 12:00 AM
DatesLast Date That 340B Drugs PurchasedInsert   4/1/2005 12:00 AM
DetailsMedicare Provider NumberInsert   4/1/2005 12:00 AM
DetailsEntity NameInsert  NORTHWEST HEALTH SERVICES, INC.4/1/2005 12:00 AM
DetailsProgram CodeInsert  CH4/1/2005 12:00 AM
DetailsEntity SubnameInsert  SOUTH SIDE HEALTH CENTER4/1/2005 12:00 AM
DatesParticipating Approval DateInsert  1/27/2005 2:05:59 PM4/1/2005 12:00 AM
DetailsStateInsert  Active4/1/2005 12:00 AM
DatesRegistration DateInsert  4/1/2005 12:00:00 AM4/1/2005 12:00 AM
DatesSigned By DateInsert   4/1/2005 12:00 AM
DatesStart DateInsert  4/1/2005 12:00:00 AM4/1/2005 12:00 AM
TerminationsTermination CommentsInsert   4/1/2005 12:00 AM
TerminationsTermination DateInsert   4/1/2005 12:00 AM
TerminationsTermination Effective DateInsert   4/1/2005 12:00 AM
TerminationsTermination ReasonInsert   4/1/2005 12:00 AM
DetailsComments PublicInsert  NEW SITE 04/01/20054/1/2005 12:00 AM