Covered Entity Details

SCH260050-09 Mosaic Medical Center Maryville (Terminated) - information as of 5/23/2025 12:16:08 AM

Main Details

Name

Mosaic Medical Center Maryville

Subdivision Name

Mosaic Specialty Care East / Counseling Services

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH260050-09

Medicare Provider Number

260050

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/15/2015

Participating Start Date

1/1/2016

Participating Approval Date

11/2/2015

Last Recertification Date

8/17/2018

Termination Date
Termination Reason

10/1/2019
Business decision by the Covered Entity

Contacts

Authorizing Official

Heartland Regional Medical Center
Dwain Stilson, Chief Financial Officer
(816) 271-7070

Primary Contact

Heartland Regional Medical Center
Craig Gordon, Manager Pharmacy Strategic Sourcing
(816) 271-6069

Addresses

Street Address

114 E South Hills Drive
Maryville, MO 64468

Billing Address
Same as Street Address

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	010494508
		1598239790

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
SCH260050-01	Child	SCH	Mosaic Medical Center Maryville	Mosaic Specialty Care West	2016 S Main	Maryville	MO	Terminated
SCH260050-02	Child	SCH	Mosaic Medical Center Maryville	Mosaic Family Care Savannah	301 E Price Street	Savannah	MO	Terminated
SCH260050-03	Child	SCH	Mosaic Medical Center Maryville	Mosaic Family Care Bedford	408 Dodge Street	Bedford	IA	Terminated
SCH260050-04	Child	SCH	Mosaic Medical Center Maryville	Mosaic Specialty Care East	114 E South Hills Drive	Maryville	MO	Terminated
SCH260050-05	Child	SCH	Mosaic Medical Center Maryville	Mosaic Family Care Savannah / OB/GYN	301 E Price Street, Suite A	Savannah	MO	Terminated
SCH260050-06	Child	SCH	Mosaic Medical Center Maryville	Mosaic Family Care Savannah/Orthopedic Services	301 E Price Street, Suite A	Savannah	MO	Terminated
SCH260050-07	Child	SCH	Mosaic Medical Center Maryville	Mosaic Family Care Savannah / Family Practice	301 E Price Street, Suite A	Savannah	MO	Terminated
SCH260050-08	Child	SCH	Mosaic Medical Center Maryville	Mosaic Specialty Care East / Behavioral Health	114 E South Hills Drive	Maryville	MO	Terminated
SCH260050-09	Child	SCH	Mosaic Medical Center Maryville	Mosaic Specialty Care East / Counseling Services	114 E South Hills Drive	Maryville	MO	Terminated
SCH260050-10	Child	SCH	Mosaic Medical Center Maryville	Mosaic Specialty Care East / Family Practice	114 E South Hills Drive	Maryville	MO	Terminated
SCH260050-11	Child	SCH	Mosaic Medical Center Maryville	Mosaic Specialty Care East / Pediatrics	114 E South Hills Drive	Maryville	MO	Terminated
SCH260050-12	Child	SCH	Mosaic Medical Center Maryville	Mosaic Specialty Care East / Internal Medicine	114 E South Hills Drive	Maryville	MO	Terminated
SCH260050-13	Child	SCH	Mosaic Medical Center Maryville	Mosaic Family Care Bedford / OB/GYN	408 Dodge St	Bedford	IA	Terminated
SCH260050-14	Child	SCH	Mosaic Medical Center Maryville	Mosaic Family Care Bedford / Family Practice	408 Dodge Street	Bedford	IA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		8/1/2019 12:00:00 AM	8/13/2019 8:32 AM
Details	State	Update	Termination Request	Active	To Be Terminated	8/13/2019 8:32 AM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	8/13/2019 8:32 AM
Terminations	Termination Effective Date	Update	Termination Request		8/1/2019 12:00:00 AM	8/13/2019 8:32 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	8/13/2019 8:32 AM
Medicaid Billing	NPI: Number	Update	Change Request	1659331866	1598239790	4/16/2019 10:52 AM
Details	Entity Subname	Update	Change Request	St. Francis Family Health Care - East Clinic / Counseling Services	Mosaic Specialty Care East / Counseling Services	4/16/2019 10:52 AM
Contacts	Primary Contact	Update	Change Request	Peine, Jeffrey Finance Director SSM Health 3149893532	Gordon, Craig Manager Pharmacy Strategic Sourcing Heartland Regional Medical Center 8162716069	4/9/2019 12:28 PM
Details	Entity Name	Update	Change Request	SSM Regional Health Services owning and operating St.Francis Hospital & Health Services	Mosaic Medical Center Maryville	4/9/2019 11:25 AM
Contacts	Authorizing Official	Update	Change Request	Baumgartner, Michael President SSM Health 6605627900	Stilson, Dwain Chief Financial Officer Heartland Regional Medical Center 8162717070	4/4/2019 1:08 PM
Details	Last Recertification Date	Update	Recertification	11/6/2017 10:00:05 AM	8/17/2018 2:23:36 PM	8/17/2018 2:23 PM
Contacts	Primary Contact	Update	Profile Change Request	Peine, Jeffrey Sr. Financial Analyst 340B SSM Health 3149893532	Peine, Jeffrey Finance Director SSM Health 3149893532	4/12/2018 5:13 PM
Contacts	Primary Contact	Update	Change Request	Geringer, Greta Finance Director SSM Health 3149893518	Peine, Jeffrey Sr. Financial Analyst 340B SSM Health 3149893532	2/26/2018 3:30 PM
Details	Entity Name	Update	Recertification	ST. FRANCIS HOSPITAL & HEALTH SVCS.	SSM Regional Health Services owning and operating St.Francis Hospital & Health Services	11/8/2017 2:30 PM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	11/6/2017 10:00:05 AM	11/6/2017 10:00 AM
Contacts	Authorizing Official	Update		Baumgartner, Michael President 6605627900	Baumgartner, Michael President SSM Health 6605627900	10/13/2017 11:11 AM
Contacts	Primary Contact	Update		Geringer, Greta Finance Director 3149893518	Geringer, Greta Finance Director SSM Health 3149893518	9/19/2017 11:20 AM
Contacts	Signed By	Insert			Baumgartner, Michael President 6605627900	8/9/2017 10:46 AM
Contacts	Primary Contact	Insert			Geringer, Greta Finance Director 3149893518	7/27/2017 3:23 PM
Contacts	Authorizing Official	Insert			Baumgartner, Michael President 6605627900	7/10/2017 1:03 PM
Addresses	Main Address	Insert			114 E South Hills Drive Maryville, MO 64468	5/22/2017 9:41 AM
Details	Last Recertification Date	Update			8/11/2016 12:00:00 AM	8/11/2016 5:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/5/2016 9:43 AM
Medicaid Billing	Medicaid: Number	Insert			010494508	7/5/2016 9:43 AM
Medicaid Billing	Medicaid: State	Insert			MO	7/5/2016 9:43 AM
Medicaid Billing	NPI: Number	Insert			1659331866	7/5/2016 9:43 AM
Dates	Participating Approval Date	Update			11/2/2015 12:00:00 AM	11/2/2015 10:49 AM
Details	State	Update		Pending	Active	11/2/2015 10:49 AM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	11/2/2015 10:49 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_56108	SCH260050-09	10/19/2015 11:23 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_56108	10/15/2015 3:21 PM
Details	Last Recertification Date	Insert				10/15/2015 3:21 PM
Details	Grant Number	Insert				10/15/2015 3:21 PM
Details	340B ID	Insert				10/15/2015 3:21 PM
Details	Is Authorizing Official EHB Data	Insert				10/15/2015 3:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2015 3:21 PM
Details	Medicare Provider Number	Insert			260050	10/15/2015 3:21 PM
Details	Entity Name	Insert			ST. FRANCIS HOSPITAL & HEALTH SVCS.	10/15/2015 3:21 PM
Details	Program Code	Insert			SCH	10/15/2015 3:21 PM
Details	Entity Subname	Insert			St. Francis Family Health Care - East Clinic / Counseling Services	10/15/2015 3:21 PM
Dates	Participating Approval Date	Insert				10/15/2015 3:21 PM
Details	State	Insert			Pending	10/15/2015 3:21 PM
Dates	Registration Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 3:21 PM
Dates	Signed By Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 3:21 PM
Dates	Start Date	Insert				10/15/2015 3:21 PM
Terminations	Termination Comments	Insert				10/15/2015 3:21 PM
Terminations	Termination Date	Insert				10/15/2015 3:21 PM
Terminations	Termination Effective Date	Insert				10/15/2015 3:21 PM
Terminations	Termination Reason	Insert				10/15/2015 3:21 PM