Covered Entity Details

SCH260097-10 WESTERN MISSOURI MEDICAL CENTER (Active) - information as of 4/29/2025 10:39:45 PM

Main Details

Name

WESTERN MISSOURI MEDICAL CENTER

Subdivision Name

RURAL HEALTH CLINIC IV - EXPRESS CARE

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH260097-10

Medicare Provider Number

260097

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/15/2015

Participating Start Date

10/1/2015

Participating Approval Date

8/25/2015

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Western Missouri Medical Center
Dean Ohmart, Chief Financial Officer
(660) 262-7307

Primary Contact

Western Missouri Medical Center
Mary E Chapa, 340B Coordinator
(660) 262-7257

Addresses

Street Address

427 Burkarth Rd
Warrensburg, MO 64093

Billing Address

Western Missouri Medical Center
PO Box 537
Warrensburg, MO 64093

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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
MO	500019931,590080369,500144899	1467859579,1942057393

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
SCH260097-01	Child	SCH	Western Missouri Medical Center	Western Missouri Specialty Services	427-B Burkarth Road	Warrensburg	MO	Terminated
SCH260097-02	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	RURAL HEALTH CLINIC VI - KNOB NOSTER	600 E. Allen	Knob Noster	MO	Active
SCH260097-03	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	Western Missouri Family Healthcare	807 W. 2nd Street	Holden	MO	Terminated
SCH260097-04	Child	SCH	Western Missouri Medical Center	Western Missouri Women's Health Center	415-A Burkarth Road	Warrensburg	MO	Terminated
SCH260097-05	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	Western Missouri Cardiology	427-A Burkarth Road	Warrensburg	MO	Terminated
SCH260097-06	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	INTERNAL MEDICINE	514 Burkarth Road	Warrensburg	MO	Terminated
SCH260097-07	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	SURGICAL SERVICES	407 Burkarth Rd	Warrensburg	MO	Active
SCH260097-08	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	WESTERN MO BONE & JOINT	407 Burkarth Rd	Warrensburg	MO	Active
SCH260097-09	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	AMBC	403 Burkarth	Warrensburg	MO	Terminated
SCH260097-10	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	RURAL HEALTH CLINIC IV - EXPRESS CARE	427 Burkarth Rd	Warrensburg	MO	Active
SCH260097-11	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	SLEEP STUDY	407 Burkarth Rd	Warrensburg	MO	Active
SCH260097-12	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	RURAL HEALTH CLINIC - WOMENS HEALTH	415 A Burkarth Rd	Warrensburg	MO	Active
SCH260097-13	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	WMMC - Emergency	403 Burkarth Rd	Warrensburg	MO	Terminated
SCH260097-14	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	WMMC - Infusion CTR	407 Burkarth Rd	Warrensburg	MO	Terminated
SCH260097-15	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	WMMC - Wound Center	403 Burkarth Rd	Warrensburg	MO	Terminated
SCH260097-16	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	PAIN CENTER	407 Burkarth Rd	Warrensburg	MO	Active
SCH260097-17	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	WARRENSBURG INTERNAL MEDICINE	511 BURKARTH ROAD	WARRENSBURG	MO	Active
SCH260097-18	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	RURAL HEALTH CLINIC III - HIGGINSVILLE	1200 West 22nd	Higginsville	MO	Active
SCH260097-19	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	RURAL HEALTH CLINIC II - WARRENSBURG	513 Burkarth Road	Warrensburg	MO	Active
SCH260097-20	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	EAR NOSE THROAT CLINIC	407 BURKARTH RD STE 302	WARRENSBURG	MO	Active
SCH260097-21	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	SPECIALTY CLINIC (RHEUMATOLOGY & NEPH)	407 BURKARTH RD STE 302	WARRENSBURG	MO	Active
SCH260097-22	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	Western MO Specialty Services - Nephrology	407 BURKARTH RD STE 302	WARRENSBURG	MO	Terminated
SCH260097-23	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	Neurology / .	427 BURKARTH ROAD	WARRENSBURG	MO	Terminated
SCH260097-24	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	PULMONOLOGY	407 Burkarth Rd	WARRENSBURG	MO	Active
SCH260097-25	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	BUILDING BLOCKS PEDIATRICS	510 Foster Lane	WARRENSBURG	MO	Active
SCH260097-26	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	Western MO Specialty Services - Vascular - Vascular	407 Burkarth Rd	WARRENSBURG	MO	Terminated
SCH260097-27	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	RURAL HEALTH CLINIC V - CFSM	407 E RUSSELL AVE BLDG C	WARRENSBURG	MO	Active
SCH260097-28	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	RURAL HEALTH CLINIC VII - CONCORDIA	905 S MAIN ST	CONCORDIA	MO	Active
SCH260097-29	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	UROLOGY CLINIC - UROLOGY	407 BURKARTH RD	WARRENSBURG	MO	Active
SCH260097-30	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	NON INTERVENTIONAL PAIN MEDICINE - NON INTERVENTIONAL PAIN MEDICINE	407 BURKARTH RD	WARRENSBURG	MO	Terminated
SCH260097-31	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	WESTERN MISSOURI INTERNAL MEDICINE - INTERNAL MEDICINE	502 BURKARTH RD	WARRENSBURG	MO	Active
SCH260097-32	Child	SCH	WESTERN MISSOURI MEDICAL CENTER	HEART CARE OF WARRENSBURG - WARRENSBURG HEART CARE	427 BURKARTH RD	WARRENSBURG	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/6/2025 11:04 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		500144899	2/6/2025 11:04 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	2/6/2025 11:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1942057393	8/16/2024 9:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		MO	8/16/2024 9:45 AM
Details	Last Recertification Date	Update	Recertification	8/22/2023 1:13:10 PM	8/16/2024 9:45:31 AM	8/16/2024 9:45 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 3:35:17 PM	8/22/2023 1:13:10 PM	8/22/2023 1:13 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 11:39:45 AM	9/7/2022 3:35:17 PM	9/7/2022 3:35 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 7:52:53 AM	8/24/2021 11:39:45 AM	8/24/2021 11:39 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	540421203 (MO)		6/8/2021 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/8/2021 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		500019931	6/8/2021 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	6/8/2021 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/8/2021 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		590080369	6/8/2021 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	6/8/2021 10:43 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1467859579 ( )		8/19/2020 7:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1467859579	8/19/2020 7:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		MO	8/19/2020 7:52 AM
Details	Last Recertification Date	Update	Recertification	8/20/2019 10:01:00 AM	8/19/2020 7:52:53 AM	8/19/2020 7:52 AM
Details	Entity Subname	Update	Recertification	RURAL HEALTH CLINIC IV	RURAL HEALTH CLINIC IV - EXPRESS CARE	8/19/2020 7:52 AM
Details	Entity Subname	Update	Change Request	Western MO Family Healthcare - Express Care	RURAL HEALTH CLINIC IV	4/15/2020 5:46 PM
Details	Last Recertification Date	Update	Recertification	8/28/2018 1:02:10 PM	8/20/2019 10:01:00 AM	8/20/2019 10:01 AM
Addresses	Billing Address	Insert	Change Request		Western Missouri Medical Center PO Box 537 Warrensburg, MO 64093	7/8/2019 3:25 PM
Addresses	Main Address	Update	Change Request	515 Burkarth Rd Warrensburg, MO 64093	427 Burkarth Rd Warrensburg, MO 64093	7/8/2019 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/8/2019 3:25 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		540421203	7/8/2019 3:25 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MO	7/8/2019 3:25 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1467859579	7/8/2019 3:25 PM
Contacts	Primary Contact	Update	Change Request	Hughes, Janis Pharmacy Clinical Manager Western Missouri Medical Center 6602627490	Chapa, Mary E 340B Coordinator Western Missouri Medical Center 6602627257	12/19/2018 3:09 PM
Details	Entity Subname	Update	Change Request	Express Care	Western MO Family Healthcare - Express Care	12/19/2018 3:09 PM
Details	Last Recertification Date	Update	Recertification	11/6/2017 2:16:04 PM	8/28/2018 1:02:10 PM	8/28/2018 1:02 PM
Contacts	Primary Contact	Insert	Change Request		Hughes, Janis Pharmacy Clinical Manager Western Missouri Medical Center 6602627490	11/6/2017 2:42 PM
Details	Last Recertification Date	Update	Recertification	8/22/2016 12:00:00 AM	11/6/2017 2:16:04 PM	11/6/2017 2:16 PM
Contacts	Authorizing Official	Insert	Change Request		Ohmart, Dean Chief Financial Officer Western Missouri Medical Center 6602627307	9/28/2017 2:19 PM
Contacts	Signed By	Insert			Gasparini, Michael Chief Operating Officer 6602627303	8/7/2017 3:26 PM
Addresses	Main Address	Insert			515 Burkarth Rd Warrensburg, MO 64093	8/1/2017 11:17 AM
Details	Last Recertification Date	Update			8/22/2016 12:00:00 AM	8/22/2016 6:47 AM
Dates	Participating Approval Date	Update			8/25/2015 12:00:00 AM	8/25/2015 2:03 PM
Details	State	Update		Pending	Active	8/25/2015 2:03 PM
Dates	Start Date	Update			10/1/2015 12:00:00 AM	8/25/2015 2:03 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_54033	SCH260097-10	8/4/2015 1:06 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_54033	7/15/2015 6:00 PM
Details	Last Recertification Date	Insert				7/15/2015 6:00 PM
Details	Grant Number	Insert				7/15/2015 6:00 PM
Details	340B ID	Insert				7/15/2015 6:00 PM
Details	Is Authorizing Official EHB Data	Insert				7/15/2015 6:00 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2015 6:00 PM
Details	Medicare Provider Number	Insert			260097	7/15/2015 6:00 PM
Details	Entity Name	Insert			WESTERN MISSOURI MEDICAL CENTER	7/15/2015 6:00 PM
Details	Program Code	Insert			SCH	7/15/2015 6:00 PM
Details	Entity Subname	Insert			Express Care	7/15/2015 6:00 PM
Dates	Participating Approval Date	Insert				7/15/2015 6:00 PM
Details	State	Insert			Pending	7/15/2015 6:00 PM
Dates	Registration Date	Insert			7/15/2015 12:00:00 AM	7/15/2015 6:00 PM
Dates	Signed By Date	Insert			7/15/2015 12:00:00 AM	7/15/2015 6:00 PM
Dates	Start Date	Insert				7/15/2015 6:00 PM
Terminations	Termination Comments	Insert				7/15/2015 6:00 PM
Terminations	Termination Date	Insert				7/15/2015 6:00 PM
Terminations	Termination Effective Date	Insert				7/15/2015 6:00 PM
Terminations	Termination Reason	Insert				7/15/2015 6:00 PM