340B Drug Pricing Program Database


DSH260113 MISSOURI DELTA MEDICAL CENTER (Active) - information as of 6/24/2025 12:01:48 AM

Main Details
MISSOURI DELTA MEDICAL CENTER
Disproportionate Share Hospital
Yes
DSH260113
260113


Additional Details
Active
6/1/2006
7/1/2006
6/5/2006
8/19/2024

Contacts

Missouri Delta Medical Center
JASON SCHRUMPF, CEO
(573) 472-7600

Missouri Delta Medical Center
Christopher White, Director of Pharmacy
(573) 472-7450

Addresses

1008 NORTH MAIN
SIKESTON, MO 63801

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
MO0104189031831269539
Shipping Addresses

Missouri Delta Medical Center
1008 North Main
Sikeston, MO 63801

Missouri Delta Medical Center DBA Sikeston Pharmacy
102 Hospitality Drive
Suite B
Sikeston, MO 63801

Missouri Delta Medical Center DBA Benton Pharmacy
6468 MO-77
Benton, MO 63736

Missouri Delta Medical Center DBA Delta Regional Pharmacy
412 W Broadwater Rd
2
Malden, MO 63863
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailALPS SPECIALTY PHARMACY105 S RIDGECREST AVE STE 3A
NIXAMO6571410/18/202201/01/2023  01/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/12/202407/01/2024  07/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/12/202407/01/2024  07/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522604/12/202407/01/2024  07/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/12/202407/01/2024  07/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620304/12/202407/01/2024  07/01/2024
Contract DetailBUTLER DRUG STORE INC222 E MAIN ST
PORTAGEVILLEMO63873-161410/16/201701/01/2018 04/22/201904/23/2019
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/16/202201/01/2023  01/01/2023
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/16/202201/01/2023  01/01/2023
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/16/202201/01/2023  01/01/2023
Contract DetailCHAFFEE DRUG STOREKIEFER THOMPSON PHARMA 211 W YOAKUM AVE
CHAFFEEMO6374004/21/202004/21/2020  04/21/2020
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 8248 LACKLAND RD.
SUITE 101 		SAINT LOUISMO6311410/16/202201/01/2023 01/24/202504/11/2025
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/16/202201/01/2023  01/01/2023
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268301/17/201904/01/2019 04/12/202204/12/2022
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654104/12/202407/01/2024  07/01/2024
Contract DetailFRED'S PHARMACY #3710  415 MOTT STREET
NEW MADRIDMO6386910/03/201601/01/2017 05/08/201705/08/2017
Contract DetailL & S DISCOUNT PHARMACY406 S MAIN ST
CHARLESTONMO63834-164403/20/201203/20/2012  04/20/2017
Contract DetailMEDICAL ARTS PHARMACY808 E WAKEFIELD AVE
SIKESTONMO63801-514704/03/201204/03/2012 07/26/202308/21/2023
Contract DetailMEDICAP PHARMACY  SCRIPT MASTERS, INC.
507 NORTH MAIN 		SIKESTONMO63801-210503/23/201203/23/2012 07/14/201504/20/2017
Contract DetailMEDICAP PHARMACY211 W YOAKUM AVE TEE'S, INC.
CHAFFEEMO63740-113810/16/201901/01/2020 04/21/202004/25/2020
Contract DetailMISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10297 120 SOUTH MAIN ST.
SIKESTONMO6380110/14/201501/01/2016  04/20/2017
Contract DetailMISSOURI CVS PHARMACY, L.L.C.CVS PHARMACY # 16385 202 SIEMERS DR
CAPE GIRARDEAUMO6370110/09/201801/01/2019  01/01/2019
Contract DetailMISSOURI CVS PHARMACY, L.L.C.CVS/PHARMACY # 10025 400 S. TRUMAN BLVD.
CRYSTAL CITYMO6301910/09/201801/01/2019  01/01/2019
Contract DetailMISSOURI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10256 2161 WILLIAM ST.
CAPE GIRARDEAUMO6370310/09/201801/01/2019  01/01/2019
Contract DetailNEW MADRID PHARMACY457 MAIN ST.
NEW MADRIDMO6386901/20/201504/01/2015 10/01/201710/16/2017
Contract DetailNEW MADRID PHARMACY INC.NEW MADRID PHARMACY 457 MAIN ST
PO BOX #35 		NEW MADRIDMO6386907/26/201710/01/2017  10/01/2017
Contract DetailONCOMED THE ONCOLOGY PHARMACY OF BUFFALOD/B/A ONCO360 140 JOHN JAMES AUDUBON PKWY STE 101
AMHERSTNY1422804/06/201607/01/2016 12/16/202107/01/2022
Contract DetailOPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276504/12/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/25/202204/01/2022  04/01/2022
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502904/12/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/10/202007/20/2020  07/20/2020
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824904/12/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 705, LLC11142 RENNER BLVD
LENEXAKS6621907/10/202007/20/2020 10/13/202110/18/2021
Contract DetailOPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265510/18/202101/01/2022  01/01/2022
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/12/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970504/12/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/10/202007/20/2020  07/20/2020
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983810/18/202101/01/2022  01/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.CVS/PHARMACY #10994 60 MARKET CENTER DRIVE
SUITE 103 		COLLIERVILLETN3801701/24/202004/01/2020  04/01/2020
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255004/12/202407/01/2024  07/01/2024
Contract DetailRandy's Rx1012 North Main
SikestonMO6380104/09/201204/09/2012 04/15/202504/15/2025
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/12/202407/01/2024  07/01/2024
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/12/202407/01/2024  07/01/2024
Contract DetailSIKESTON PHARMACY LLCSIKESTON MEDICENTER PHARMACY 507 N MAIN ST.
SIKESTONMO63801-210507/15/201510/01/2015  04/20/2017
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022304/06/201607/01/2016  04/20/2017
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104204/06/201607/01/2016  04/20/2017
Contract DetailSORKIN'S RX LTDD/B/A CAREMED PHARMACEUTICAL SERVICES 1985 MARCUS AVE STE 130
NEW HYDE PARKNY11042-202410/05/201701/01/2018 03/16/202207/01/2022
Contract DetailSTERLING PHARMACY808 HUNTER AVE STE 1A PO BOX 886
SIKESTONMO63801-225304/12/201607/01/2016  04/20/2017
Contract DetailSUPER D DRUGS ACQUISITION CO.DBA: WALGREENS #15800 904 W. HWY BUSINESS 60
DEXTERMO6384110/09/201501/01/2016  04/20/2017
Contract DetailSUPER D DRUGS ACQUISITION CO.DBA: WALGREENS #15801 310 MAIN STREET
MALDENMO6386310/09/201501/01/2016 04/05/202304/12/2023
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/16/201704/01/2017  04/20/2017
Contract DetailWAL-MART PHARMACY 10-00091303 S MAIN ST
SIKESTONMO6380102/01/201304/01/2013  04/20/2017
Contract DetailWAL-MART PHARMACY 10-00302025 W. BUSINESS HIGHWAY 60 WEST
DEXTERMO6384104/06/201607/01/2016  04/20/2017
Contract DetailWAL-MART PHARMACY 10-0156  STATE HWY 84 WEST
PO BOX 971 		CARUTHERSVILLEMO6383004/06/201607/01/2016 01/20/201704/20/2017
Contract DetailWAL-MART PHARMACY 10-01901500 E FIRST ST
KENNETTMO6385704/06/201607/01/2016  04/20/2017
Contract DetailWAL-MART PHARMACY 10-04531007 N DOUGLAS
MALDENMO6386304/06/201607/01/2016  04/20/2017
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/16/201704/01/2017  04/20/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 09301 299 N MAIN
SIKESTONMO6380107/23/201410/01/2014  04/20/2017
Contract DetailWalgreens #21389Walgreens Central Fill #21389 3299 Tchulatech Dr
Suite 101 		MemphisTN3811807/13/202210/01/2022  10/01/2022
Contract DetailWALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528407/23/201410/01/2014 07/01/201504/20/2017
Contract DetailWALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904907/23/201410/01/2014 07/01/201504/20/2017
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275601/16/202304/01/2023  04/01/2023
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/09/202301/01/2024  01/01/2024
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH260113AAChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA PHYSICIAN SERVICES - GYN/ONCOLOGY201 PLAZA DRSIKESTONMOActive
DSH260113ABChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA PHYSICIAN SERVICES - Specialty Clinic135 PLAZA DR 102SIKESTONMOActive
DSH260113ACChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA PHYSICIAN SERVICES - ENT/AUDIOLOGY135 PLAZA DR 202SIKESTONMOActive
DSH260113ADChildDSHMISSOURI DELTA MEDICAL CENTERMissouri Delta Malden Clinic - Primary Care412 W Broadwater StMaldenMOActive
DSH260113AEChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA GASTRO - Gastroenterology23 DOCTORS PARKCAPE GIRARDEAUMOActive
DSH260113BChildDSHMISSOURI DELTA MEDICAL CENTERWOMEN'S CARE CENTER1013 N MAINSIKESTONMOActive
DSH260113CChildDSHMISSOURI DELTA MEDICAL CENTERSmith Street Clinic123 Smith StreetSikestonMOActive
DSH260113DChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA EXPRESS CARE1008 N MAINSIKESTONMOActive
DSH260113EChildDSHMISSOURI DELTA MEDICAL CENTERCommunity Care Center1403 E MARSHALLCHARLESTONMOActive
DSH260113FChildDSHMISSOURI DELTA MEDICAL CENTERMissouri Delta Wound and Hyperbaric Center201 Plaza DriveSikestonMOActive
DSH260113GChildDSHMISSOURI DELTA MEDICAL CENTERMissouri Delta Cancer and Infusion Center1126 North MainSikestonMOActive
DSH260113HChildDSHMISSOURI DELTA MEDICAL CENTERMissouri Delta Primary Care102 Hospitality DriveSikestonMOActive
DSH260113JChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA PHYSICIAN SERVICES - DR. HUNTER-PEARSON1017 NORTH MAINSIKESTONMOActive
DSH260113KChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA ORTHOPAEDICS201 PLAZA DRIVESIKESTONMOActive
DSH260113LChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA UROLOGY1106 N MAIN STSIKESTONMOActive
DSH260113MChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA PHYSICIAN SERVICES SURGEONS1015 North MainSIKESTONMOTerminated
DSH260113NChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA PHYSICIAN SERVICES / Pulmonology1019 N MAIN STSIKESTONMOActive
DSH260113PChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA PHYSICIAN SERVICES / Nephrology1019 N MAIN STSIKESTONMOTerminated
DSH260113QChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA PHYSICIAN SERVICES / Internal Medicine1019 N MAIN STSIKESTONMOActive
DSH260113RChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA ENDOCRINE & DIABETIC1118 N MAIN STSIKESTONMOActive
DSH260113SChildDSHMISSOURI DELTA MEDICAL CENTERPORTAGEVILLE COMMUNITY CARE CENTER204 EAST THIRDPORTAGEVILLEMOActive
DSH260113TChildDSHMISSOURI DELTA MEDICAL CENTERNEW MADRID COMMUNITY CARE CENTER615 MAIN STNEW MADRIDMOActive
DSH260113UChildDSHMISSOURI DELTA MEDICAL CENTERDexter Community Care Center911 B WEST BUSINESS HWY 60DEXTERMOActive
DSH260113VChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA PHYSICIAN SERVICES / Surgery1019 N MAIN STSIKESTONMOActive
DSH260113WChildDSHMISSOURI DELTA MEDICAL CENTERBenton Community Care Center6468 STATE HIGHWAY 77BENTONMOActive
DSH260113XChildDSHMISSOURI DELTA MEDICAL CENTERPAIN MANAGEMENT135 PLAZA DR 201SIKESTONMOActive
DSH260113YChildDSHMISSOURI DELTA MEDICAL CENTERChaffee Medical Clinic - Primary Care209 West Yoakum AveChaffeeMOActive
DSH260113ZChildDSHMISSOURI DELTA MEDICAL CENTERMISSOURI DELTA PHYSICIAN SERVICES - DERMATOLOGY1015 NORTH MAINSIKESTONMOActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertChange Request Missouri Delta Medical Center DBA Delta Regional Pharmacy 412 W Broadwater Rd 2 Malden, MO 638631/22/2025 12:10 PM
DetailsLast Recertification DateUpdateRecertification8/22/2023 3:31:59 PM8/19/2024 4:20:05 PM8/19/2024 4:20 PM
ContactsPrimary ContactUpdateChange RequestParker, Ryan Director of Pharmacy Missouri Delta Medical Center 5734727450White, Christopher Director of Pharmacy Missouri Delta Medical Center 57347274502/22/2024 1:29 PM
AddressesShipping AddressInsertChange Request Missouri Delta Medical Center DBA Benton Pharmacy 6468 MO-77 Benton, MO 6373610/20/2023 8:14 AM
DetailsLast Recertification DateUpdateRecertification9/19/2022 10:09:29 AM8/22/2023 3:31:59 PM8/22/2023 3:31 PM
DetailsLast Recertification DateUpdateRecertification8/22/2021 9:28:22 AM9/19/2022 10:09:29 AM9/19/2022 10:09 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/15/2022 10:03 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0104189033/15/2022 10:03 AM
Medicaid BillingMedicaid: StateInsertChange Request MO3/15/2022 10:03 AM
Medicaid BillingNPI: NumberInsertChange Request 18312695393/15/2022 10:03 AM
Medicaid BillingNPI: StateInsertChange Request MO3/15/2022 10:03 AM
DetailsLast Recertification DateUpdateRecertification9/14/2020 11:43:23 AM8/22/2021 9:28:22 AM8/22/2021 9:28 AM
Medicaid BillingMedicaid: NumberDeleteChange Request010418903 (MO) 6/15/2021 4:15 PM
Medicaid BillingNPI: NumberDeleteChange Request1831269539 (MO) 6/15/2021 4:15 PM
AddressesShipping AddressInsertChange Request Missouri Delta Medical Center 1008 North Main Sikeston, MO 638016/3/2021 6:25 AM
AddressesShipping AddressInsertChange Request Missouri Delta Medical Center DBA Sikeston Pharmacy 102 Hospitality Drive Suite B Sikeston, MO 638016/3/2021 6:25 AM
Medicaid BillingNPI: NumberInsertRecertification 18312695399/14/2020 11:43 AM
Medicaid BillingNPI: StateInsertRecertification MO9/14/2020 11:43 AM
Medicaid BillingNPI: NumberDeleteRecertification1831269539 ( ) 9/14/2020 11:43 AM
DetailsLast Recertification DateUpdateRecertification9/9/2019 4:38:32 PM9/14/2020 11:43:23 AM9/14/2020 11:43 AM
DetailsLast Recertification DateUpdateRecertification9/7/2018 11:56:38 AM9/9/2019 4:38:32 PM9/9/2019 4:38 PM
DetailsLast Recertification DateUpdateRecertification11/8/2017 12:49:05 PM9/7/2018 11:56:38 AM9/7/2018 11:56 AM
DetailsLast Recertification DateUpdateRecertification8/17/2016 12:00:00 AM11/8/2017 12:49:05 PM11/8/2017 12:49 PM
ContactsAuthorizing OfficialUpdate SCHRUMPF, JASON CEO 5734727600SCHRUMPF, JASON CEO Missouri Delta Medical Center 57347276009/25/2017 3:37 PM
ContactsPrimary ContactUpdate Parker, Ryan Director of Pharmacy 5734727450Parker, Ryan Director of Pharmacy Missouri Delta Medical Center 57347274509/25/2017 2:57 PM
ContactsAuthorizing OfficialInsert  SCHRUMPF, JASON CEO 57347276008/12/2017 7:50 AM
ContactsPrimary ContactUpdate Lacy, Barbara Administrative Assistant 5734727601Parker, Ryan Director of Pharmacy 57347274508/12/2017 7:50 AM
AddressesMain AddressInsert   1008 NORTH MAIN SIKESTON, MO 638018/12/2017 7:48 AM
ContactsPrimary ContactUpdate Dockins, Gini Administrative Assistant 5734727601Lacy, Barbara Administrative Assistant 57347276014/20/2017 5:14 PM
DetailsLast Recertification DateUpdate 8/12/2015 12:00:00 AM8/17/2016 12:00:00 AM8/17/2016 12:07 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse8/13/2015 11:22 AM
DetailsLast Recertification DateUpdate 8/18/2014 12:00:00 AM8/12/2015 12:00:00 AM8/13/2015 11:22 AM
DetailsLast Recertification DateUpdate 8/22/2013 12:00:00 AM8/18/2014 12:00:00 AM8/18/2014 2:23 PM
ContactsPrimary ContactInsert  Dockins, Gini Administrative Assistant 57347276017/3/2014 4:20 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/22/2013 12:00:00 AM8/22/2013 5:51 AM
Medicaid BillingNPI: NumberInsert  18312695395/16/2012 7:54 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/16/2012 7:54 AM
DetailsLast Recertification DateInsert   8/2/2006 12:02 PM
DetailsGrant NumberInsert   8/2/2006 12:02 PM
Details340B IDInsert  DSH2601138/2/2006 12:02 PM
DetailsIs Authorizing Official EHB DataInsert   8/2/2006 12:02 PM
DatesLast Date That 340B Drugs PurchasedInsert   8/2/2006 12:02 PM
DetailsMedicare Provider NumberInsert  2601138/2/2006 12:02 PM
DetailsEntity NameInsert  MISSOURI DELTA MEDICAL CENTER8/2/2006 12:02 PM
DetailsProgram CodeInsert  DSH8/2/2006 12:02 PM
DetailsEntity SubnameInsert   8/2/2006 12:02 PM
DatesParticipating Approval DateInsert  6/5/2006 12:00:00 AM8/2/2006 12:02 PM
DetailsStateInsert  Active8/2/2006 12:02 PM
DatesRegistration DateInsert  6/1/2006 12:00:00 AM8/2/2006 12:02 PM
DatesSigned By DateInsert  5/30/2006 12:00:00 AM8/2/2006 12:02 PM
DatesStart DateInsert  7/1/2006 12:00:00 AM8/2/2006 12:02 PM
TerminationsTermination CommentsInsert   8/2/2006 12:02 PM
TerminationsTermination DateInsert   8/2/2006 12:02 PM
TerminationsTermination Effective DateInsert   8/2/2006 12:02 PM
TerminationsTermination ReasonInsert   8/2/2006 12:02 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True6/1/2006 12:49 PM
Medicaid BillingMedicaid: NumberInsert  0104189036/1/2006 12:49 PM
Medicaid BillingMedicaid: StateInsert  MO6/1/2006 12:49 PM