| Details | State | Update | | To Be Terminated | Terminated | 4/1/2021 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 5/31/2020 12:00:00 AM | 2/25/2021 11:27 AM |
| Details | State | Update | Recertification | Active | To Be Terminated | 2/25/2021 11:27 AM |
| Terminations | Termination Date | Update | Recertification | | 4/1/2021 12:00:00 AM | 2/25/2021 11:27 AM |
| Terminations | Termination Effective Date | Update | Recertification | | 5/31/2020 12:00:00 AM | 2/25/2021 11:27 AM |
| Terminations | Termination Reason | Update | Recertification | | Site closure | 2/25/2021 11:27 AM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2019 3:33:55 PM | 1/31/2020 10:00:59 AM | 1/31/2020 10:00 AM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2018 4:52:47 PM | 2/8/2019 3:33:55 PM | 2/8/2019 3:33 PM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2017 12:00:00 AM | 2/21/2018 4:52:47 PM | 2/21/2018 4:52 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Fuentes, Hilda
President & CEO
Rodgers Health
8168894600 | Theis, Bob
CFO & COO
SAmuel U. Rodgers Health Center
8168894802 | 2/21/2018 2:41 PM |
| Contacts | Primary Contact | Update | OPA Edit | Theis, Bob
CFO & COO
SAmuel U. Rodgers Health Center
8168894802 | Walker, Chris
CFO
Rodgers Health
8168894801 | 2/21/2018 12:35 PM |
| Contacts | Authorizing Official | Update | OPA Edit | Fuentes, Hilda
President & CEO
8168894600 | Fuentes, Hilda
President & CEO
Rodgers Health
8168894600 | 2/21/2018 12:35 PM |
| Contacts | Signed By | Update | OPA Edit | Fuentes, Hilda
President & CEO
8168894600 | Fuentes, Hilda
President & CEO
Rodgers Health
8168894600 | 2/21/2018 12:35 PM |
| Contacts | Primary Contact | Update | | Theis, Bob
CFO & COO
8168894802 | Theis, Bob
CFO & COO
SAmuel U. Rodgers Health Center
8168894802 | 2/16/2018 8:50 AM |
| Contacts | Authorizing Official | Insert | | | Fuentes, Hilda
President & CEO
8168894600 | 3/16/2017 11:14 AM |
| Contacts | Signed By | Insert | | | Fuentes, Hilda
President & CEO
8168894600 | 3/16/2017 11:14 AM |
| Contacts | Primary Contact | Update | | Caro, Ralph
COO
8168894620 | Theis, Bob
CFO & COO
8168894802 | 3/16/2017 11:14 AM |
| Addresses | Main Address | Insert | | |
811A SOUTH STATE HIGHWAY 13
LEXINGTON, MO 64067-1513 | 2/8/2017 3:08 PM |
| Details | Last Recertification Date | Update | | 2/17/2016 12:00:00 AM | 2/8/2017 12:00:00 AM | 2/8/2017 3:08 PM |
| Details | Last Recertification Date | Update | | 3/4/2015 12:00:00 AM | 2/17/2016 12:00:00 AM | 2/17/2016 2:52 PM |
| Contacts | Primary Contact | Update | | Darby, Helen
CCO
8168894756 | Caro, Ralph
COO
8168894620 | 3/4/2015 10:40 AM |
| Medicaid Billing | NPI: Number | Update | | 1265469388 | 1265649388 | 3/4/2015 10:39 AM |
| Details | Last Recertification Date | Update | | 3/13/2014 12:00:00 AM | 3/4/2015 12:00:00 AM | 3/4/2015 10:39 AM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/13/2014 12:00:00 AM | 3/13/2014 3:11 PM |
| Details | Entity Name | Update | | SAMUEL U. RODGERS HLTH CTR.,INC. | SAMUEL U RODGERS HEALTH CENTER, INC. | 3/13/2014 3:11 PM |
| Details | Entity Subname | Update | | | Samuel U. Rodgers Health Center Lafayette Family Medicine, Dental & WIC Services | 3/13/2014 3:11 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/14/2013 1:53 PM |
| Contacts | Primary Contact | Insert | | | Darby, Helen
CCO
8168894756 | 12/20/2012 4:12 PM |
| Addresses | Billing Address | Insert | | | Samuel U. Rodgers Health Center
825 Euclid Ave
Kansas City, MO 64124 | 11/14/2012 11:40 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 11/14/2012 11:40 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 500859186 | 11/14/2012 11:40 AM |
| Medicaid Billing | Medicaid: State | Insert | | | MO | 11/14/2012 11:40 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1164614053 | 11/14/2012 11:40 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1265469388 | 11/14/2012 11:40 AM |
| Details | 340B ID | Update | | IS-RM-CH07029B | CH07029B | 6/14/2012 9:55 AM |
| Dates | Participating Approval Date | Update | | | 6/14/2012 12:00:00 AM | 6/14/2012 9:55 AM |
| Details | State | Update | | Pending | Active | 6/14/2012 9:55 AM |
| Dates | Start Date | Update | | | 7/1/2012 12:00:00 AM | 6/14/2012 9:55 AM |
| Details | 340B ID | Update | | RM-CH07029B | IS-RM-CH07029B | 5/3/2012 9:30 AM |
| Details | 340B ID | Update | | ONLINE_REG | RM-CH07029B | 3/13/2012 12:13 PM |
| Details | Entity Name | Update | | Samuel U. Rodgers Health Center, Inc | SAMUEL U. RODGERS HLTH CTR.,INC. | 3/13/2012 12:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 3/9/2012 10:07 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 600588412 | 3/9/2012 10:07 AM |
| Medicaid Billing | Medicaid: State | Insert | | | MO | 3/9/2012 10:07 AM |
| Details | Last Recertification Date | Insert | | | | 3/9/2012 10:07 AM |
| Details | Grant Number | Insert | | | H80CS00784 | 3/9/2012 10:07 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 3/9/2012 10:07 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 3/9/2012 10:07 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 3/9/2012 10:07 AM |
| Details | Medicare Provider Number | Insert | | | | 3/9/2012 10:07 AM |
| Details | Entity Name | Insert | | | Samuel U. Rodgers Health Center, Inc | 3/9/2012 10:07 AM |
| Details | Program Code | Insert | | | CH | 3/9/2012 10:07 AM |
| Details | Entity Subname | Insert | | | | 3/9/2012 10:07 AM |
| Dates | Participating Approval Date | Insert | | | | 3/9/2012 10:07 AM |
| Details | State | Insert | | | Pending | 3/9/2012 10:07 AM |
| Dates | Registration Date | Insert | | | 3/9/2012 12:00:00 AM | 3/9/2012 10:07 AM |
| Dates | Signed By Date | Insert | | | 3/9/2012 12:00:00 AM | 3/9/2012 10:07 AM |
| Dates | Start Date | Insert | | | | 3/9/2012 10:07 AM |
| Terminations | Termination Comments | Insert | | | | 3/9/2012 10:07 AM |
| Terminations | Termination Date | Insert | | | | 3/9/2012 10:07 AM |
| Terminations | Termination Effective Date | Insert | | | | 3/9/2012 10:07 AM |
| Terminations | Termination Reason | Insert | | | | 3/9/2012 10:07 AM |