| Contacts | Primary Contact | Update | Profile Change Request | Linville, Gayle
Manager Pharmacy Strategic Sourcing
Heartland Regional Medical Center
8162716069 | Linville, Gayle
Manager Pharmacy Strategic Sourcing
Heartland Regional Medical Center
8162716141 | 6/13/2024 10:58 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Kammerer, Edward P
340B Administrator
Heartland Regional Medical Center
8162717919 | Kammerer, Edward P
340B Administrator
Heartland Regional Medical Center
8162711236 | 2/8/2024 2:58 PM |
| Details | State | Update | | To Be Terminated | Terminated | 1/1/2024 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | | 1/1/2024 12:00:00 AM | 10/10/2023 4:15 PM |
| Details | State | Update | Hospital Type Change Request | Active | To Be Terminated | 10/10/2023 4:15 PM |
| Terminations | Termination Date | Update | Hospital Type Change Request | | 1/1/2024 12:00:00 AM | 10/10/2023 4:15 PM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | | 1/1/2024 12:00:00 AM | 10/10/2023 4:15 PM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | | Change of covered entity type | 10/10/2023 4:15 PM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2022 3:04:44 PM | 8/15/2023 1:35:52 PM | 8/15/2023 1:35 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Kammerer, Edward P
Chief Quality Officer
Heartland Regional Medical Center
8162717919 | Kammerer, Edward P
340B Administrator
Heartland Regional Medical Center
8162717919 | 5/21/2023 8:22 AM |
| Details | Last Recertification Date | Update | Recertification | 8/27/2021 10:43:41 AM | 8/25/2022 3:04:44 PM | 8/25/2022 3:04 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Stilson, Dwain
Chief Financial Officer
Heartland Regional Medical Center
8162717070 | Kammerer, Edward P
Chief Quality Officer
Heartland Regional Medical Center
8162717919 | 11/30/2021 10:17 AM |
| Details | Last Recertification Date | Update | Recertification | | 8/27/2021 10:43:41 AM | 8/27/2021 10:43 AM |
| Contacts | Primary Contact | Update | Group Change Request | Gordon, Craig
Manager Pharmacy Strategic Sourcing
Heartland Regional Medical Center
8162716069 | Linville, Gayle
Manager Pharmacy Strategic Sourcing
Heartland Regional Medical Center
8162716069 | 8/24/2021 2:32 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Group Change Request | | False | 6/30/2021 1:40 PM |
| Medicaid Billing | Medicaid: Number | Insert | Group Change Request | | 010156800 | 6/30/2021 1:40 PM |
| Medicaid Billing | Medicaid: State | Insert | Group Change Request | | MO | 6/30/2021 1:40 PM |
| Details | State | Update | | Approved | Active | 10/1/2020 12:01 AM |
| Addresses | Shipping Address | Delete | Reinstatement | Heartland Reg Med Ctr St Joseph Oncology Pharmacy
902 North Riverside
Suite 200
Saint Joseph, MO 64506 | | 8/28/2020 12:16 PM |
| Medicaid Billing | NPI: State | Update | Reinstatement | | MO | 8/28/2020 12:16 PM |
| Contacts | Signed By | Insert | Reinstatement | | Stilson, Dwain
Chief Financial Officer
Heartland Regional Medical Center
8162717070 | 8/28/2020 12:16 PM |
| Details | Last Recertification Date | Update | Reinstatement | 8/26/2019 12:07:26 PM | | 8/28/2020 12:16 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 7/1/2020 12:00:00 AM | | 8/28/2020 12:16 PM |
| Dates | Participating Approval Date | Update | Reinstatement | 9/7/2010 12:00:00 AM | 8/28/2020 12:16:45 PM | 8/28/2020 12:16 PM |
| Details | State | Update | Reinstatement | Terminated | Approved | 8/28/2020 12:16 PM |
| Dates | Registration Date | Update | Reinstatement | 9/7/2010 12:00:00 AM | 8/4/2020 12:59:24 PM | 8/28/2020 12:16 PM |
| Dates | Signed By Date | Update | Reinstatement | 8/31/2010 12:00:00 AM | 8/4/2020 6:14:53 PM | 8/28/2020 12:16 PM |
| Dates | Start Date | Update | Reinstatement | 9/7/2010 12:00:00 AM | 10/1/2020 12:00:00 AM | 8/28/2020 12:16 PM |
| Terminations | Termination Date | Update | Reinstatement | 7/1/2020 12:00:00 AM | | 8/28/2020 12:16 PM |
| Terminations | Termination Effective Date | Update | Reinstatement | 7/1/2020 12:00:00 AM | | 8/28/2020 12:16 PM |
| Terminations | Termination Reason | Update | Reinstatement | Change of covered entity type | | 8/28/2020 12:16 PM |
| Details | Comments Public | Insert | Reinstatement | | Participated starting 9/7/2010, Terminated 7/1/2020. Reinstated 10/1/2020. | 8/17/2020 9:20 AM |
| Details | State | Update | | To Be Terminated | Terminated | 7/1/2020 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Hospital Type Change Request | | 7/1/2020 12:00:00 AM | 4/14/2020 8:39 AM |
| Details | State | Update | Hospital Type Change Request | Active | To Be Terminated | 4/14/2020 8:39 AM |
| Terminations | Termination Date | Update | Hospital Type Change Request | | 7/1/2020 12:00:00 AM | 4/14/2020 8:39 AM |
| Terminations | Termination Effective Date | Update | Hospital Type Change Request | | 7/1/2020 12:00:00 AM | 4/14/2020 8:39 AM |
| Terminations | Termination Reason | Update | Hospital Type Change Request | | Change of covered entity type | 4/14/2020 8:39 AM |
| Details | Last Recertification Date | Update | Recertification | 8/27/2018 2:25:08 PM | 8/26/2019 12:07:26 PM | 8/26/2019 12:07 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 010156800 (MO) | | 8/5/2019 3:38 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 100099580A (KS) | | 8/5/2019 3:38 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1437259694 | 8/5/2019 3:38 PM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1659698231 ( ) | | 8/5/2019 3:38 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Gordon, Craig
340B Program Manager
Heartland Regional Medical Center
8162716069 | Gordon, Craig
Manager Pharmacy Strategic Sourcing
Heartland Regional Medical Center
8162716069 | 11/13/2018 9:01 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Gordon, Craig
340B Program Manager
Heartland Regional Medical Center
8162717832 | Gordon, Craig
340B Program Manager
Heartland Regional Medical Center
8162716069 | 11/13/2018 9:01 AM |
| Details | Last Recertification Date | Update | Recertification | 11/9/2017 10:02:00 AM | 8/27/2018 2:25:08 PM | 8/27/2018 2:25 PM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2016 12:00:00 AM | 11/9/2017 10:02:00 AM | 11/9/2017 10:02 AM |
| Contacts | Primary Contact | Update | Change Request | BILEK, BARBARA
TL PHARMACY SERVICES
8162716157 | Gordon, Craig
340B Program Manager
Heartland Regional Medical Center
8162717832 | 9/26/2017 12:03 PM |
| Contacts | Authorizing Official | Update | | Stilson, Dwain
Chief Financial Officer
8162717070 | Stilson, Dwain
Chief Financial Officer
Heartland Regional Medical Center
8162717070 | 9/26/2017 11:53 AM |
| Contacts | Authorizing Official | Insert | | | Stilson, Dwain
Chief Financial Officer
8162717070 | 8/9/2017 6:19 PM |
| Addresses | Main Address | Insert | | |
902 NORTH RIVERSIDE ROAD
SUITE 200
SAINT JOSEPH, MO 64507-3488 | 7/28/2017 6:16 PM |
| Addresses | Billing Address | Insert | | | HEARTLAND REGIONAL MEDICAL CENTER
PO BOX 802223
Kansas City, MO 64180-2223 | 7/28/2017 6:16 PM |
| Addresses | Shipping Address | Insert | | | Heartland Reg Med Ctr St Joseph Oncology Pharmacy
902 North Riverside
Suite 200
Saint Joseph, MO 64506 | 7/28/2017 6:16 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1659698231 | 7/28/2017 6:15 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/28/2017 6:15 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 100099580A | 7/28/2017 6:15 PM |
| Medicaid Billing | Medicaid: State | Insert | | | KS | 7/28/2017 6:15 PM |
| Contacts | Primary Contact | Insert | | | BILEK, BARBARA
TL PHARMACY SERVICES
8162716157 | 1/12/2017 9:50 AM |
| Details | Last Recertification Date | Update | | 8/27/2015 12:00:00 AM | 8/22/2016 12:00:00 AM | 8/22/2016 3:33 PM |
| Details | Last Recertification Date | Update | | 8/27/2014 12:00:00 AM | 8/27/2015 12:00:00 AM | 8/27/2015 11:32 AM |
| Details | Last Recertification Date | Update | | 9/5/2013 12:43:57 PM | 8/27/2014 12:00:00 AM | 8/27/2014 11:21 AM |
| Details | Last Recertification Date | Update | | 7/1/2012 12:00:00 AM | 9/5/2013 12:43:57 PM | 9/5/2013 12:43 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/21/2012 11:08 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 010156800 | 8/21/2012 11:08 AM |
| Medicaid Billing | Medicaid: State | Insert | | | MO | 8/21/2012 11:08 AM |
| Details | Last Recertification Date | Update | | | 7/1/2012 12:00:00 AM | 5/9/2012 8:45 AM |
| Details | Last Recertification Date | Insert | | | | 3/16/2011 1:11 PM |
| Details | Grant Number | Insert | | | | 3/16/2011 1:11 PM |
| Details | 340B ID | Insert | | | SCH260006-01 | 3/16/2011 1:11 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 3/16/2011 1:11 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 3/16/2011 1:11 PM |
| Details | Medicare Provider Number | Insert | | | 260006 | 3/16/2011 1:11 PM |
| Details | Entity Name | Insert | | | HEARTLAND REGIONAL MEDICAL CENTER | 3/16/2011 1:11 PM |
| Details | Program Code | Insert | | | SCH | 3/16/2011 1:11 PM |
| Details | Entity Subname | Insert | | | HEARTLAND ONCOLOGY | 3/16/2011 1:11 PM |
| Dates | Participating Approval Date | Insert | | | 9/7/2010 12:00:00 AM | 3/16/2011 1:11 PM |
| Details | State | Insert | | | Active | 3/16/2011 1:11 PM |
| Dates | Registration Date | Insert | | | 9/7/2010 12:00:00 AM | 3/16/2011 1:11 PM |
| Dates | Signed By Date | Insert | | | 8/31/2010 12:00:00 AM | 3/16/2011 1:11 PM |
| Dates | Start Date | Insert | | | 9/7/2010 12:00:00 AM | 3/16/2011 1:11 PM |
| Terminations | Termination Comments | Insert | | | | 3/16/2011 1:11 PM |
| Terminations | Termination Date | Insert | | | | 3/16/2011 1:11 PM |
| Terminations | Termination Effective Date | Insert | | | | 3/16/2011 1:11 PM |
| Terminations | Termination Reason | Insert | | | | 3/16/2011 1:11 PM |
| Details | Comments Public | Insert | | | 03/16/2011 UPDATED ADDR.(WAS 902 NORTH RIVERSIDE ROAD) | 3/16/2011 1:11 PM |