Covered Entity Details

CH070290 SAMUEL U RODGERS HEALTH CENTER, INC. (Active) - information as of 6/2/2025 8:32:35 AM

Main Details

Name

SAMUEL U RODGERS HEALTH CENTER, INC.

Subdivision Name

Samuel U. Rodgers Health Center Downtown Campus

Type

HRSA-Funded Health Center

Site ID

BPS-H80-001679

340B ID

CH070290

Grant Number

H80CS00784

Additional Details

Current Program Status

Active

Registration Date

12/1/1992

Participating Start Date

12/1/1992

Participating Approval Date

12/11/2003

Last Recertification Date

2/28/2025

Contacts

Authorizing Official

Samuel U. Rodgers Health Center
Bob Theis, CEO
(816) 889-4802

Primary Contact

Rodgers Health
Chris Walker, CFO
(816) 889-4801

Addresses

Street Address

825 EUCLID AVENUE
KANSAS CITY, MO 64124-2323

Billing Address
Same as Street Address

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

Comments

Comment	Last Updated On
6/18/09 MEDI # ADDED - NEW CONTACT, CHANGED MEDICAID INFO, ADDED CP	05/25/2011

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
MO	500859111,600588412	1265649388,1578570982

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	MISSOURI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08576	2435 E INDEPENDENCE	KANSAS CITY	MO	64124	10/13/2016	01/01/2017	08/09/2024	04/14/2025
Contract Detail	PRICE CHOPPER PHARMACY #11	207 NE ENGLEWOOD RD		KANSAS CITY	MO	64118	12/06/2012	12/06/2012	04/06/2016	01/06/2022
Contract Detail	RED CROSS PHARMACY	1030 MAIN ST		LEXINGTON	MO	64067	06/11/2012	06/11/2012	12/31/2018	02/08/2019
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/06/2022	04/01/2022	08/01/2022	07/06/2023
Contract Detail	WAL-MART PHARMACY 10-0234	8301 N CHURCH RD		KANSAS CITY	MO	64158	10/13/2016	01/01/2017	08/01/2022	07/06/2023
Contract Detail	WAL-MART PHARMACY 10-1120	7207 NORTH M-1 HWY		GLADSTONE	MO	64119	10/13/2016	01/01/2017	08/01/2022	07/06/2023
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/06/2022	04/01/2022	08/01/2022	07/06/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04212	2501 E LINWOOD BLVD	KANSAS CITY	MO	64128	07/23/2014	10/01/2014		07/23/2014
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04222	5400 INDEPENDENCE AVE	KANSAS CITY	MO	64123-2027	07/23/2014	10/01/2014		07/23/2014
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04236	2261 S STERLING AVE	INDEPENDENCE	MO	64052	07/23/2014	10/01/2014		07/23/2014
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04406	2630 NE VIVION RD.	KANSAS CITY	MO	64119	07/23/2014	10/01/2014		07/23/2014
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05278	3845 BROADWAY	KANSAS CITY	MO	64111	07/23/2014	10/01/2014		07/23/2014
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04210	1100 E. 63RD ST.	KANSAS CITY	MO	64110	04/06/2015	07/01/2015	09/30/2024	10/02/2024
Contract Detail	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	10/13/2023	01/01/2024		01/01/2024
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/23/2014	10/01/2014	07/07/2015	07/10/2015
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/23/2014	10/01/2014	07/07/2015	07/10/2015

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH070290	Active	BPS-H80-001679	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Downtown Campus	825 EUCLID AVENUE	KANSAS CITY	MO
CH07029B	Terminated	BPS-H80-000127	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Lafayette Family Medicine, Dental & WIC Services	811A SOUTH STATE HIGHWAY 13	LEXINGTON	MO
CH07029C	Terminated	BPS-H80-003311	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Therapeutic Intervention Center	2701 E. 31ST ST.	KANSAS CITY	MO
CH07029F	Active	BPS-H80-008122	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Clay County Family Medicine & Dental	800 Haines Drive	Liberty	MO
CH07029G	Active	BPS-H80-012960	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Cabot Westside	2121 Summit St	Kansas City	MO
CH07029H	Terminated	BPS-H80-018609	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Northland Family Medicine	5330 N Oak Trfwy.	Kansas City	MO
CH07029J	Active	BPS-H80-030424	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Northland Family Practice	5330 N Oak Trfy Ste 203	Kansas City	MO
CH07029K	Active	BPS-H80-030894	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Community Health Center - Mobile	825 EUCLID STREET	KANSAS CITY	MO

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH070290	MISSOURI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08576	2435 E INDEPENDENCE	KANSAS CITY	MO	64124	01/01/2017	08/09/2024
CH070290	PRICE CHOPPER PHARMACY #11	207 NE ENGLEWOOD RD		KANSAS CITY	MO	64118	12/06/2012	04/06/2016
CH070290	RED CROSS PHARMACY	1030 MAIN ST		LEXINGTON	MO	64067	06/11/2012	12/31/2018
CH070290	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2022	08/01/2022
CH070290	WAL-MART PHARMACY 10-0234	8301 N CHURCH RD		KANSAS CITY	MO	64158	01/01/2017	08/01/2022
CH070290	WAL-MART PHARMACY 10-1120	7207 NORTH M-1 HWY		GLADSTONE	MO	64119	01/01/2017	08/01/2022
CH070290	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2022	08/01/2022
CH070290	WALGREEN CO.	DBA: WALGREENS # 04212	2501 E LINWOOD BLVD	KANSAS CITY	MO	64128	10/01/2014
CH070290	WALGREEN CO.	DBA: WALGREENS # 04222	5400 INDEPENDENCE AVE	KANSAS CITY	MO	64123-2027	10/01/2014
CH070290	WALGREEN CO.	DBA: WALGREENS # 04236	2261 S STERLING AVE	INDEPENDENCE	MO	64052	10/01/2014
CH070290	WALGREEN CO.	DBA: WALGREENS # 04406	2630 NE VIVION RD.	KANSAS CITY	MO	64119	10/01/2014
CH070290	WALGREEN CO.	DBA: WALGREENS # 05278	3845 BROADWAY	KANSAS CITY	MO	64111	10/01/2014
CH070290	WALGREEN CO.	DBA: WALGREENS # 04210	1100 E. 63RD ST.	KANSAS CITY	MO	64110	07/01/2015	09/30/2024
CH070290	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	01/01/2024
CH070290	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	10/01/2014	07/07/2015
CH070290	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2014	07/07/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/20/2024 5:10:04 PM	2/28/2025 8:55:36 AM	2/28/2025 8:55 AM
Details	Last Recertification Date	Update	Recertification	2/14/2023 3:19:52 PM	2/20/2024 5:10:04 PM	2/20/2024 5:10 PM
Details	Last Recertification Date	Update	Recertification	2/4/2022 1:55:44 PM	2/14/2023 3:19:52 PM	2/14/2023 3:19 PM
Details	Last Recertification Date	Update	Recertification	2/25/2021 10:29:49 AM	2/4/2022 1:55:44 PM	2/4/2022 1:55 PM
Contacts	Authorizing Official	Update	AO Change Request	Theis, Bob CFO & COO SAmuel U. Rodgers Health Center 8168894802	Theis, Bob CEO Samuel U. Rodgers Health Center 8168894802	1/24/2022 11:06 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1265649388	2/25/2021 10:29 AM
Medicaid Billing	NPI: State	Insert	Recertification		MO	2/25/2021 10:29 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1578570982	2/25/2021 10:29 AM
Medicaid Billing	NPI: State	Insert	Recertification		MO	2/25/2021 10:29 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1265649388 ( )		2/25/2021 10:29 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1578570982 ( )		2/25/2021 10:29 AM
Details	Last Recertification Date	Update	Recertification	1/31/2020 9:56:32 AM	2/25/2021 10:29:49 AM	2/25/2021 10:29 AM
Details	Last Recertification Date	Update	Recertification	2/11/2019 11:18:00 AM	1/31/2020 9:56:32 AM	1/31/2020 9:56 AM
Addresses	Main Address	Update	Recertification	825 EUCLID STREET KANSAS CITY, MO 64124-2323	825 EUCLID AVENUE KANSAS CITY, MO 64124-2323	2/11/2019 11:18 AM
Details	Last Recertification Date	Update	Recertification	2/21/2018 4:51:42 PM	2/11/2019 11:18:00 AM	2/11/2019 11:18 AM
Details	Last Recertification Date	Update	Recertification	2/8/2017 12:00:00 AM	2/21/2018 4:51:42 PM	2/21/2018 4:51 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	Authorizing Official	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	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	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	Primary Contact	Update		Caro, Ralph COO 8168894620	Theis, Bob CFO & COO 8168894802	3/16/2017 11:14 AM
Addresses	Main Address	Insert			825 EUCLID STREET KANSAS CITY, MO 64124-2323	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
Medicaid Billing	Medicaid: Is Primary	Update		True	False	2/17/2016 2:52 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
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 3:10 PM
Details	Entity Name	Update		SAMUEL U. RODGERS HLTH CTR.,INC.	SAMUEL U RODGERS HEALTH CENTER, INC.	3/13/2014 3:10 PM
Details	Entity Subname	Update			Samuel U. Rodgers Health Center Downtown Campus	3/13/2014 3:10 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/14/2013 1:52 PM
Contacts	Primary Contact	Insert			Darby, Helen CCO 8168894756	12/20/2012 4:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/14/2012 11:40 AM
Medicaid Billing	Medicaid: Number	Insert			500859111	11/14/2012 11:40 AM
Medicaid Billing	Medicaid: State	Insert			MO	11/14/2012 11:40 AM
Medicaid Billing	NPI: Number	Insert			1265649388	11/14/2012 11:40 AM
Medicaid Billing	NPI: Number	Insert			1578570982	11/14/2012 11:40 AM
Details	Last Recertification Date	Insert				5/25/2011 3:17 PM
Details	Grant Number	Insert			H80CS00784	5/25/2011 3:17 PM
Details	340B ID	Insert			CH070290	5/25/2011 3:17 PM
Details	Is Authorizing Official EHB Data	Insert				5/25/2011 3:17 PM
Dates	Last Date That 340B Drugs Purchased	Insert				5/25/2011 3:17 PM
Details	Medicare Provider Number	Insert				5/25/2011 3:17 PM
Details	Entity Name	Insert			SAMUEL U. RODGERS HLTH CTR.,INC.	5/25/2011 3:17 PM
Details	Program Code	Insert			CH	5/25/2011 3:17 PM
Details	Entity Subname	Insert				5/25/2011 3:17 PM
Dates	Participating Approval Date	Insert			12/11/2003 12:00:00 AM	5/25/2011 3:17 PM
Details	State	Insert			Active	5/25/2011 3:17 PM
Dates	Registration Date	Insert			12/1/1992 12:00:00 AM	5/25/2011 3:17 PM
Dates	Signed By Date	Insert			6/18/2009 12:00:00 AM	5/25/2011 3:17 PM
Dates	Start Date	Insert			12/1/1992 12:00:00 AM	5/25/2011 3:17 PM
Terminations	Termination Comments	Insert				5/25/2011 3:17 PM
Terminations	Termination Date	Insert				5/25/2011 3:17 PM
Terminations	Termination Effective Date	Insert				5/25/2011 3:17 PM
Terminations	Termination Reason	Insert				5/25/2011 3:17 PM
Details	Comments Public	Insert			6/18/09 MEDI # ADDED - NEW CONTACT, CHANGED MEDICAID INFO, ADDED CP	5/25/2011 3:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	12/1/1992 12:00 AM
Medicaid Billing	Medicaid: Number	Insert			600588412	12/1/1992 12:00 AM
Medicaid Billing	Medicaid: State	Insert			MO	12/1/1992 12:00 AM

340B Drug Pricing Program Database