340B Drug Pricing Program Database


DSH260113T MISSOURI DELTA MEDICAL CENTER (Active) - information as of 5/6/2025 12:02:45 AM

Main Details
MISSOURI DELTA MEDICAL CENTER
NEW MADRID COMMUNITY CARE CENTER
Disproportionate Share Hospital
Yes
DSH260113T
260113
268699


Additional Details
Active
1/9/2015
4/1/2015
3/6/2015
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

615 MAIN ST
NEW MADRID, MO 63869-1513

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
MO5900132951972944593
Shipping Addresses

Same as Street Address
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 9:14:05 AM8/14/2024 7:33:08 AM8/14/2024 7:33 AM
DetailsLast Recertification DateUpdateRecertification9/15/2022 5:29:09 PM8/21/2023 9:14:05 AM8/21/2023 9:14 AM
DetailsLast Recertification DateUpdateRecertification8/22/2021 9:21:15 AM9/15/2022 5:29:09 PM9/15/2022 5:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/15/2022 9:57 AM
Medicaid BillingMedicaid: NumberInsertChange Request 5900132953/15/2022 9:57 AM
Medicaid BillingMedicaid: StateInsertChange Request MO3/15/2022 9:57 AM
Medicaid BillingNPI: NumberInsertChange Request 19729445933/15/2022 9:57 AM
Medicaid BillingNPI: StateInsertChange Request MO3/15/2022 9:57 AM
DetailsLast Recertification DateUpdateRecertification9/14/2020 10:39:43 AM8/22/2021 9:21:15 AM8/22/2021 9:21 AM
Medicaid BillingMedicaid: NumberDeleteChange Request590013295 (MO) 6/15/2021 4:14 PM
Medicaid BillingNPI: NumberDeleteChange Request1972944593 (MO) 6/15/2021 4:14 PM
Medicaid BillingNPI: NumberDeleteRecertification1972944593 ( ) 9/14/2020 10:39 AM
Medicaid BillingNPI: NumberInsertRecertification 19729445939/14/2020 10:39 AM
Medicaid BillingNPI: StateInsertRecertification MO9/14/2020 10:39 AM
DetailsLast Recertification DateUpdateRecertification9/9/2019 4:40:37 PM9/14/2020 10:39:43 AM9/14/2020 10:39 AM
DetailsLast Recertification DateUpdateRecertification9/7/2018 12:51:06 AM9/9/2019 4:40:37 PM9/9/2019 4:40 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/23/2019 10:01 AM
Medicaid BillingMedicaid: NumberInsertChange Request 5900132954/23/2019 10:01 AM
Medicaid BillingMedicaid: StateInsertChange Request MO4/23/2019 10:01 AM
DetailsLast Recertification DateUpdateRecertification11/6/2017 12:04:23 PM9/7/2018 12:51:06 AM9/7/2018 12:51 AM
DetailsLast Recertification DateUpdateRecertification10/25/2017 10:02:33 AM11/6/2017 12:04:23 PM11/6/2017 12:04 PM
DetailsLast Recertification DateUpdateRecertification8/17/2016 12:00:00 AM10/25/2017 10:02:33 AM10/25/2017 10:02 AM
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 ContactInsert  Parker, Ryan Director of Pharmacy 57347274508/12/2017 7:50 AM
AddressesMain AddressInsert   615 MAIN ST NEW MADRID, MO 63869-15138/12/2017 7:40 AM
DetailsLast Recertification DateUpdate 8/13/2015 12:00:00 AM8/17/2016 12:00:00 AM8/17/2016 12:07 PM
DetailsLast Recertification DateUpdate  8/13/2015 12:00:00 AM8/13/2015 12:01 PM
DatesParticipating Approval DateUpdate  3/6/2015 12:00:00 AM3/6/2015 6:37 PM
DetailsStateUpdate PendingActive3/6/2015 6:37 PM
DatesStart DateUpdate  4/1/2015 12:00:00 AM3/6/2015 6:37 PM
Details340B IDUpdate OUTPATIENT_ONLINE_REG_48561DSH260113T1/10/2015 1:06 PM
Details340B IDUpdate  OUTPATIENT_ONLINE_REG_485611/9/2015 4:10 PM
Medicaid BillingNPI: NumberInsert  19729445931/9/2015 4:10 PM
DetailsLast Recertification DateInsert   1/9/2015 4:10 PM
DetailsGrant NumberInsert   1/9/2015 4:10 PM
Details340B IDInsert   1/9/2015 4:10 PM
DetailsIs Authorizing Official EHB DataInsert   1/9/2015 4:10 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/9/2015 4:10 PM
DetailsMedicare Provider NumberInsert  2601131/9/2015 4:10 PM
DetailsEntity NameInsert  MISSOURI DELTA MEDICAL CENTER1/9/2015 4:10 PM
DetailsProgram CodeInsert  DSH1/9/2015 4:10 PM
DetailsEntity SubnameInsert  NEW MADRID COMMUNITY CARE CENTER1/9/2015 4:10 PM
DatesParticipating Approval DateInsert   1/9/2015 4:10 PM
DetailsStateInsert  Pending1/9/2015 4:10 PM
DatesRegistration DateInsert  1/9/2015 12:00:00 AM1/9/2015 4:10 PM
DatesSigned By DateInsert  1/9/2015 12:00:00 AM1/9/2015 4:10 PM
DatesStart DateInsert   1/9/2015 4:10 PM
TerminationsTermination CommentsInsert   1/9/2015 4:10 PM
TerminationsTermination DateInsert   1/9/2015 4:10 PM
TerminationsTermination Effective DateInsert   1/9/2015 4:10 PM
TerminationsTermination ReasonInsert   1/9/2015 4:10 PM