Covered Entity Details

CHC08748-00 COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI (Terminated) - information as of 5/13/2025 10:58:19 PM

Main Details

Name

COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI

Subdivision Name

Jefferson City Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-007912

340B ID

CHC08748-00

Grant Number

H80CS08748

Additional Details

Current Program Status

Terminated

Registration Date

12/14/2010

Participating Start Date

1/1/2011

Participating Approval Date

12/14/2010

Last Recertification Date

2/9/2018

Termination Date
Termination Reason

10/1/2018
Site closure

Contacts

Authorizing Official

COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI
Toby Barnett, CFO
(573) 632-0243

Primary Contact

COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI
Kyra Clevenger, Director of Compliance and Analytics
(573) 632-0243

Addresses

Street Address

3400 W Truman Blvd
Jefferson City, MO 65109-5712

Billing Address

COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI
PO Box 104780
JEFFERSON CITY, MO 65110

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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
		1427225275

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	BOND PHARMACY	703 W BUCHANAN ST		CALIFORNIA	MO	65018	07/11/2012	07/11/2012	07/31/2017	08/01/2017
Contract Detail	STEPHEN L LA FRANCE PHARMACY INC.	DBA: LINN DRUG #15826, POWERED BY WALGRE	304 E MAIN STREET	LINN	MO	65051	07/11/2016	10/01/2016	10/01/2018	10/01/2018
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/24/2017	10/01/2017	10/01/2018	10/01/2018
Contract Detail	WAL-MART PHARMACY 10-0029	724 STADIUM WEST BLVD		JEFERSON CITY	MO	65109	08/17/2012	08/17/2012	10/01/2018	10/01/2018
Contract Detail	WAL-MART PHARMACY 10-0051	1701 NO BLUFF STREET		FULTON	MO	65251	10/16/2017	01/01/2018	10/01/2018	10/01/2018
Contract Detail	WAL-MART PHARMACY 10-5477	401 SUPERCENTER DR.		JEFFERSON CITY	MO	65101	08/17/2012	08/17/2012	10/01/2018	10/01/2018
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/24/2017	10/01/2017	10/01/2018	10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03017	2002 MISSOURI BLVD.	JEFFERSON CITY	MO	65109	07/11/2016	10/01/2016	10/01/2018	10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09713	3740 W TRUMAN BLVD	JEFFERSON CITY	MO	65109-0537	07/11/2016	10/01/2016	10/01/2018	10/01/2018
Contract Detail	WHALEY'S EAST END DRUG	630 E HIGH ST		JEFFERSON CITY	MO	65101-3219	11/14/2012	01/01/2013	10/01/2018	10/01/2018
Contract Detail	WHALEY'S WEST SIDE PHARMACY	WHALEY'S PHARMACY, INC DBA	3526 AMAZONAS DR	JEFFERSON CITY	MO	65109-5716	11/14/2012	01/01/2013	10/01/2018	10/01/2018

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC08748-00	Terminated	BPS-H80-007912	COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI	Jefferson City Clinic	3400 W Truman Blvd	Jefferson City	MO
CHC08748-01	Active	BPS-H80-033847	COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI	CHCCM-Linn Clinic	316 W Main St	Linn	MO
CHC08748-02	Terminated	BPS-H80-017780	COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI	Community Health Center of Central Missouri - Compass Pediatrics Location	1905 Stadium Blvd	Jefferson City	MO
CHC08748-03	Active	BPS-H80-032207	COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI	CHCCMO - California Clinic	606 E Buchanan	California	MO
CHC08748-04	Terminated	BPS-H80-018279	COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI	CHCCMO Magical Smiles Dix Road	408 Dix Road	Jefferson City	MO
CHC08748-05	Active	BPS-H80-012239	COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI	CHCCM- Fulton Clinic	561 Commons Dr	Fulton	MO
CHC08748-06	Active	BPS-H80-018918	COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI	Community Health Center of Central Missouri - Christy Drive	1511 Christy Drive	Jefferson City	MO
CHC08748-07	Active	BPS-H80-021897	COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI	CHCCMO - Mobile Unit	1511 Christy Drive	Jefferson City	MO

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC08748-00	BOND PHARMACY	703 W BUCHANAN ST		CALIFORNIA	MO	65018	07/11/2012	07/31/2017
CHC08748-06	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2020
CHC08748-06	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2020
CHC08748-06	DILLON COMPANIES, LLC	GERBES PHARMACY #118	2101 SCHOTTHILL WOODS DR	JEFFERSON CITY	MO	65101	10/01/2019	02/18/2022
CHC08748-06	GERBES PHARMACY #116	410 E NORTH ST		ELDON	MO	65026	10/01/2019	02/18/2022
CHC08748-06	GERBES PHARMACY #122	2805 WEST TRUMAN BLVD		JEFFERSON CITY	MO	65109	10/01/2019	02/18/2022
CHC08748-06	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02585	1803 N ILLINOIS ST.	SWANSEA	IL	62226	01/01/2022
CHC08748-06	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06830	4609 W. MAIN ST.	BELLEVILLE	IL	62226	01/01/2022
CHC08748-06	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16869	3400 GREEN MOUNTCROSSING DR	SHILOH	IL	62269	01/01/2022
CHC08748-06	HY-VEE PHARMACY #1303	3721 W TRUMAN BLVD		JEFFERSON CITY	MO	65109	01/01/2020	01/19/2022
CHC08748-06	Hy-Vee Pharmacy Fulfillment Center #4016	Hy-Vee Inc	4707 Fleur Dr	Des Moines	IA	50321	01/01/2020	01/19/2023
CHC08748-06	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04993	1014 HIGHWAY 51	MADISON	MS	39110	01/01/2022
CHC08748-06	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11315	600 COURT STREET	FULTON	MO	65251	10/01/2020
CHC08748-06	MISSOURI CVS PHARMACY, L.L.C.	CVS PHARMACY # 16228	735 W STADIUM BLVD	JEFFERSON CITY	MO	65109	10/01/2020
CHC08748-06	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #18087	1801 MISSOURI BLVD	JEFFERSON CITY	MO	65109	07/09/2020
CHC08748-06	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 4080	300 KESTREL LANE	LAKE OZARK	MO	65049	01/01/2022
CHC08748-06	MISSOURI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08571	4750 LEES SUMMIT RD	KANSAS CITY	MO	64136	01/01/2022
CHC08748-06	MISSOURI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08430	3825 S. NOLAND RD.	INDEPENDENCE	MO	64055	01/01/2025
CHC08748-06	SCHNUCKS PHARMACY	SCHNUCKS MARKET, INC.	1801 MISSOURI BLVD	JEFFERSON CITY	MO	65109	10/01/2019	07/31/2020
CHC08748-06	SCHNUCKS PHARMACY #399	12921 ENTERPRISE WAY		BRIDGETON	MO	63044-1206	01/01/2020	10/01/2020
CHC08748-00	STEPHEN L LA FRANCE PHARMACY INC.	DBA: LINN DRUG #15826, POWERED BY WALGRE	304 E MAIN STREET	LINN	MO	65051	10/01/2016	10/01/2018
CHC08748-06	STEPHEN L LA FRANCE PHARMACY INC.	DBA: LINN DRUG #15826, POWERED BY WALGRE	304 E MAIN STREET	LINN	MO	65051	09/07/2018
CHC08748-06	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	10/01/2019	02/18/2022
CHC08748-06	TOLSON DRUG, INC	226 EAST HIGH STREET		JEFFERSON CITY	MO	65101	10/01/2019	04/15/2024
CHC08748-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017	10/01/2018
CHC08748-06	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	09/07/2018
CHC08748-00	WAL-MART PHARMACY 10-0029	724 STADIUM WEST BLVD		JEFERSON CITY	MO	65109	08/17/2012	10/01/2018
CHC08748-06	WAL-MART PHARMACY 10-0029	724 STADIUM WEST BLVD		JEFERSON CITY	MO	65109	09/07/2018
CHC08748-00	WAL-MART PHARMACY 10-0051	1701 NO BLUFF STREET		FULTON	MO	65251	01/01/2018	10/01/2018
CHC08748-06	WAL-MART PHARMACY 10-0051	1701 NO BLUFF STREET		FULTON	MO	65251	09/07/2018
CHC08748-06	WAL-MART PHARMACY 10-0357	1003 WEST NEWTON ST	PO BOX 12	VERSAILLES	MO	65084	01/01/2019
CHC08748-00	WAL-MART PHARMACY 10-5477	401 SUPERCENTER DR.		JEFFERSON CITY	MO	65101	08/17/2012	10/01/2018
CHC08748-06	WAL-MART PHARMACY 10-5477	401 SUPERCENTER DR.		JEFFERSON CITY	MO	65101	09/07/2018
CHC08748-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017	10/01/2018
CHC08748-06	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	09/07/2018
CHC08748-06	WALGREEN CO	DBA: WALGREENS #10907	1410 N BLUFF ST	FULTON	MO	65251	04/01/2019
CHC08748-00	WALGREEN CO.	DBA: WALGREENS # 03017	2002 MISSOURI BLVD.	JEFFERSON CITY	MO	65109	10/01/2016	10/01/2018
CHC08748-00	WALGREEN CO.	DBA: WALGREENS # 09713	3740 W TRUMAN BLVD	JEFFERSON CITY	MO	65109-0537	10/01/2016	10/01/2018
CHC08748-06	WALGREEN CO.	DBA: WALGREENS # 03017	2002 MISSOURI BLVD.	JEFFERSON CITY	MO	65109	09/07/2018
CHC08748-06	WALGREEN CO.	DBA: WALGREENS # 09713	3740 W TRUMAN BLVD	JEFFERSON CITY	MO	65109-0537	09/07/2018
CHC08748-06	WALGREEN CO.	DBA: WALGREENS #12749	900 EASTLAND DRIVE	JEFFERSON CITY	MO	65101	04/01/2019
CHC08748-06	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	04/01/2023
CHC08748-06	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CHC08748-06	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CHC08748-00	WHALEY'S EAST END DRUG	630 E HIGH ST		JEFFERSON CITY	MO	65101-3219	01/01/2013	10/01/2018
CHC08748-06	WHALEY'S EAST END DRUG	630 E HIGH ST		JEFFERSON CITY	MO	65101-3219	09/07/2018	07/25/2023
CHC08748-00	WHALEY'S WEST SIDE PHARMACY	WHALEY'S PHARMACY, INC DBA	3526 AMAZONAS DR	JEFFERSON CITY	MO	65109-5716	01/01/2013	10/01/2018
CHC08748-06	WHALEY'S WEST SIDE PHARMACY	WHALEY'S PHARMACY, INC DBA	3526 AMAZONAS DR	JEFFERSON CITY	MO	65109-5716	09/01/2018	07/25/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2018 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		5/31/2018 12:00:00 AM	7/16/2018 8:02 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/16/2018 8:02 AM
Terminations	Termination Comments	Update	Termination Request		3400 Truman Blvd location was moved to 1511 Christy Dr. 1511 Christy Dr has already been added and approved	7/16/2018 8:02 AM
Terminations	Termination Date	Update	Termination Request		10/1/2018 12:00:00 AM	7/16/2018 8:02 AM
Terminations	Termination Effective Date	Update	Termination Request		5/31/2018 12:00:00 AM	7/16/2018 8:02 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	7/16/2018 8:02 AM
Details	Last Recertification Date	Update	Recertification	1/26/2017 12:00:00 AM	2/9/2018 10:33:26 AM	2/9/2018 10:33 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1427225275	10/16/2017 10:44 AM
Contacts	Primary Contact	Update	Change Request	Miller, Joseph Operations Specialist 5736320243	Clevenger, Kyra Director of Compliance and Analytics COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI 5736320243	10/16/2017 10:44 AM
Contacts	Authorizing Official	Update		Barnett, Toby CFO 5736320243	Barnett, Toby CFO COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI 5736320243	9/26/2017 4:31 PM
Contacts	Authorizing Official	Update		STEVENS, ALAN EXECUTIVE DIRECTOR 5736320243	Barnett, Toby CFO 5736320243	7/24/2017 4:56 PM
Addresses	Main Address	Insert			3400 W Truman Blvd Jefferson City, MO 65109-5712	1/26/2017 10:07 AM
Contacts	Primary Contact	Update		STEVENS, ALAN EXECUTIVE DIRECTOR 5736320243	Miller, Joseph Operations Specialist 5736320243	1/26/2017 10:07 AM
Details	Last Recertification Date	Update		2/29/2016 12:00:00 AM	1/26/2017 12:00:00 AM	1/26/2017 10:07 AM
Details	Last Recertification Date	Update		3/9/2015 12:00:00 AM	2/29/2016 12:00:00 AM	2/29/2016 4:20 PM
Details	Last Recertification Date	Update		3/15/2014 12:00:00 AM	3/9/2015 12:00:00 AM	3/9/2015 10:23 AM
Addresses	Billing Address	Insert			COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI PO Box 104780 JEFFERSON CITY, MO 65110	3/5/2015 4:22 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/15/2014 12:00:00 AM	3/15/2014 5:19 AM
Details	Entity Subname	Update			Jefferson City Clinic	3/15/2014 5:19 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/27/2013 3:19 PM
Contacts	Authorizing Official	Insert			STEVENS, ALAN EXECUTIVE DIRECTOR 5736320243	12/14/2010 9:19 AM
Contacts	Primary Contact	Insert			STEVENS, ALAN EXECUTIVE DIRECTOR 5736320243	12/14/2010 9:19 AM
Details	Last Recertification Date	Insert				12/14/2010 9:18 AM
Details	Grant Number	Insert			H80CS08748	12/14/2010 9:18 AM
Details	340B ID	Insert			CHC08748-00	12/14/2010 9:18 AM
Details	Is Authorizing Official EHB Data	Insert				12/14/2010 9:18 AM
Dates	Last Date That 340B Drugs Purchased	Insert				12/14/2010 9:18 AM
Details	Medicare Provider Number	Insert				12/14/2010 9:18 AM
Details	Entity Name	Insert			COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI	12/14/2010 9:18 AM
Details	Program Code	Insert			CH	12/14/2010 9:18 AM
Details	Entity Subname	Insert				12/14/2010 9:18 AM
Dates	Participating Approval Date	Insert			12/14/2010 12:00:00 AM	12/14/2010 9:18 AM
Details	State	Insert			Active	12/14/2010 9:18 AM
Dates	Registration Date	Insert			12/14/2010 12:00:00 AM	12/14/2010 9:18 AM
Dates	Signed By Date	Insert			10/18/2010 12:00:00 AM	12/14/2010 9:18 AM
Dates	Start Date	Insert			1/1/2011 12:00:00 AM	12/14/2010 9:18 AM
Terminations	Termination Comments	Insert				12/14/2010 9:18 AM
Terminations	Termination Date	Insert				12/14/2010 9:18 AM
Terminations	Termination Effective Date	Insert				12/14/2010 9:18 AM
Terminations	Termination Reason	Insert				12/14/2010 9:18 AM

340B Drug Pricing Program Database