340B Drug Pricing Program Database


DSH260113G MISSOURI DELTA MEDICAL CENTER (Active) - information as of 5/13/2025 1:40:55 AM

Main Details
MISSOURI DELTA MEDICAL CENTER
Missouri Delta Cancer and Infusion Center
Disproportionate Share Hospital
Yes
DSH260113G
260113


Additional Details
Active
10/10/2013
1/1/2014
12/13/2013
8/14/2024

Contacts

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

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

Addresses

1126 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

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailONCOMED THE ONCOLOGY PHARMACY OF BUFFALOD/B/A ONCO360 140 JOHN JAMES AUDUBON PKWY STE 101
AMHERSTNY1422804/06/201607/01/2016  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
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 
ContactsPrimary ContactUpdatePC Change RequestParker, Ryan Director of Pharmacy Missouri Delta Medical Center 5734727450White, Christopher Director of Pharmacy Missouri Delta Medical Center 57347274508/19/2024 1:42 PM
DetailsLast Recertification DateUpdateRecertification8/21/2023 9:13:32 AM8/14/2024 10:01:17 AM8/14/2024 10:01 AM
DetailsLast Recertification DateUpdateRecertification9/15/2022 5:27:56 PM8/21/2023 9:13:32 AM8/21/2023 9:13 AM
DetailsLast Recertification DateUpdateRecertification8/22/2021 9:24:08 AM9/15/2022 5:27:56 PM9/15/2022 5:27 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/15/2022 10:06 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0104189033/15/2022 10:06 AM
Medicaid BillingMedicaid: StateInsertChange Request MO3/15/2022 10:06 AM
Medicaid BillingNPI: NumberInsertChange Request 18312695393/15/2022 10:06 AM
Medicaid BillingNPI: StateInsertChange Request MO3/15/2022 10:06 AM
DetailsLast Recertification DateUpdateRecertification9/14/2020 11:26:38 AM8/22/2021 9:24:08 AM8/22/2021 9:24 AM
Medicaid BillingMedicaid: NumberDeleteChange Request010418903 (MO) 6/15/2021 4:19 PM
Medicaid BillingNPI: NumberDeleteChange Request1831269539 (MO) 6/15/2021 4:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1831269539 ( ) 9/14/2020 11:26 AM
Medicaid BillingNPI: NumberInsertRecertification 18312695399/14/2020 11:26 AM
Medicaid BillingNPI: StateInsertRecertification MO9/14/2020 11:26 AM
DetailsLast Recertification DateUpdateRecertification9/9/2019 4:37:50 PM9/14/2020 11:26:38 AM9/14/2020 11:26 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2019 4:37 PM
Medicaid BillingMedicaid: NumberInsertRecertification 0104189039/9/2019 4:37 PM
Medicaid BillingMedicaid: StateInsertRecertification MO9/9/2019 4:37 PM
DetailsLast Recertification DateUpdateRecertification9/7/2018 12:43:18 AM9/9/2019 4:37:50 PM9/9/2019 4:37 PM
DetailsLast Recertification DateUpdateRecertification11/6/2017 12:13:32 PM9/7/2018 12:43:18 AM9/7/2018 12:43 AM
DetailsLast Recertification DateUpdateRecertification10/25/2017 12:23:27 PM11/6/2017 12:13:32 PM11/6/2017 12:13 PM
DetailsLast Recertification DateUpdateRecertification8/17/2016 12:00:00 AM10/25/2017 12:23:27 PM10/25/2017 12:23 PM
ContactsAuthorizing OfficialUpdate SCHRUMPF, JASON CEO 5734727600SCHRUMPF, JASON CEO Missouri Delta Medical Center 57347276009/25/2017 3:37 PM
ContactsSigned ByUpdate 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
ContactsSigned ByInsert  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   1126 North Main Sikeston, MO 638018/12/2017 7:46 AM
ContactsPrimary ContactUpdate Dockins, Gini Administrative Assistant 5734727601Lacy, Barbara Administrative Assistant 57347276014/20/2017 5:14 PM
DetailsLast Recertification DateUpdate 8/13/2015 12:00:00 AM8/17/2016 12:00:00 AM8/17/2016 12:07 PM
Medicaid BillingNPI: NumberInsert  18312695398/13/2015 11:22 AM
DetailsLast Recertification DateUpdate 8/18/2014 12:00:00 AM8/13/2015 12:00:00 AM8/13/2015 11:22 AM
DetailsLast Recertification DateUpdate  8/18/2014 12:00:00 AM8/18/2014 2:23 PM
ContactsPrimary ContactInsert  Dockins, Gini Administrative Assistant 57347276017/3/2014 4:20 PM
DatesParticipating Approval DateUpdate  12/13/2013 12:00:00 AM12/13/2013 7:01 AM
DetailsStateUpdate PendingActive12/13/2013 7:01 AM
DatesStart DateUpdate  1/1/2014 12:00:00 AM12/13/2013 7:01 AM
Details340B IDUpdate OUTPATIENT_ONLINE_REGDSH260113G12/9/2013 11:18 AM
DetailsLast Recertification DateInsert   10/10/2013 4:00 PM
DetailsGrant NumberInsert   10/10/2013 4:00 PM
Details340B IDInsert  OUTPATIENT_ONLINE_REG10/10/2013 4:00 PM
DetailsIs Authorizing Official EHB DataInsert   10/10/2013 4:00 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/10/2013 4:00 PM
DetailsMedicare Provider NumberInsert  26011310/10/2013 4:00 PM
DetailsEntity NameInsert  MISSOURI DELTA MEDICAL CENTER10/10/2013 4:00 PM
DetailsProgram CodeInsert  DSH10/10/2013 4:00 PM
DetailsEntity SubnameInsert  Missouri Delta Cancer and Infusion Center10/10/2013 4:00 PM
DatesParticipating Approval DateInsert   10/10/2013 4:00 PM
DetailsStateInsert  Pending10/10/2013 4:00 PM
DatesRegistration DateInsert  10/10/2013 12:00:00 AM10/10/2013 4:00 PM
DatesSigned By DateInsert  10/10/2013 12:00:00 AM10/10/2013 4:00 PM
DatesStart DateInsert   10/10/2013 4:00 PM
TerminationsTermination CommentsInsert   10/10/2013 4:00 PM
TerminationsTermination DateInsert   10/10/2013 4:00 PM
TerminationsTermination Effective DateInsert   10/10/2013 4:00 PM
TerminationsTermination ReasonInsert   10/10/2013 4:00 PM