| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 5/29/2025 12:00:00 AM | 6/5/2025 10:01 AM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 6/5/2025 10:01 AM |
| Terminations | Termination Date | Update | Termination Request | | 7/1/2025 12:00:00 AM | 6/5/2025 10:01 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 5/30/2025 12:00:00 AM | 6/5/2025 10:01 AM |
| Terminations | Termination Reason | Update | Termination Request | | DSH percentage below statutory minimum | 6/5/2025 10:01 AM |
| Contacts | Primary Contact | Update | PC Change Request | Schmitt, Michelle Nicole
VP Pharmacy Financial Operations
SSM Health
6082946203 | Przybysz, Nathan
340b Program Manager
SSM Health
3149892214 | 5/20/2025 10:22 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Schmitt, Michelle Nicole
Director of Business Operations
SSM Health
6082946203 | Schmitt, Michelle Nicole
VP Pharmacy Financial Operations
SSM Health
6082946203 | 5/19/2025 2:43 PM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2023 7:54:54 PM | 8/31/2024 2:02:30 PM | 8/31/2024 2:02 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Schmitt, Michelle Nicole
Director of Business Operations
SSM Health
6082846203 | Schmitt, Michelle Nicole
Director of Business Operations
SSM Health
6082946203 | 5/7/2024 9:40 AM |
| Contacts | Primary Contact | Update | PC Change Request | McAllister, Anita
System Director of 340B Operations
SSM Health
3149896778 | Schmitt, Michelle Nicole
Director of Business Operations
SSM Health
6082846203 | 9/19/2023 7:17 AM |
| Contacts | Authorizing Official | Update | Change Request | Rewerts, Karen D.
Regional VP of Financa/CFO
SSM Health
3149892034 | Manuel, Shasta
VP of Finance CFO
- SSM ST ANTHONY HOSPITAL
4052727282 | 8/31/2023 9:51 AM |
| Details | Last Recertification Date | Update | Recertification | 9/14/2022 1:27:04 PM | 8/22/2023 7:54:54 PM | 8/22/2023 7:54 PM |
| Addresses | Billing Address | Update | Change Request | St. Mary's Hospital - Jefferson City
2505 Mission Drive
Jefferson City, MO 65101 | St. Mary's Hospital - Jefferson City
2505 Mission Drive
Jefferson City, MO 65109 | 1/26/2023 7:17 AM |
| Addresses | Shipping Address | Update | Change Request | St. Mary's Hospital - Jefferson City
2505 Mission Drive
Jefferson City, MO 65101 | St. Mary's Hospital - Jefferson City
2505 Mission Drive
Jefferson City, MO 65109 | 1/26/2023 7:17 AM |
| Contacts | Primary Contact | Update | Profile Change Request | McAllister, Anita
System Director of 340B Operations
SSM Health
9193576357 | McAllister, Anita
System Director of 340B Operations
SSM Health
3149896778 | 1/10/2023 9:39 AM |
| Contacts | Primary Contact | Update | Group Change Request | Violette, Chelsea
Director of Optimization
Spendmend
8452066019 | McAllister, Anita
System Director of 340B Operations
SSM Health
9193576357 | 12/1/2022 6:46 AM |
| Addresses | Billing Address | Insert | Change Request | | St. Mary's Hospital - Jefferson City
2505 Mission Drive
Jefferson City, MO 65101 | 11/28/2022 8:06 AM |
| Addresses | Shipping Address | Insert | Change Request | | St. Mary's Hospital - Jefferson City
2505 Mission Drive
Jefferson City, MO 65101 | 11/28/2022 8:06 AM |
| Contacts | Primary Contact | Update | Group Change Request | Sharrow, Nicholas
Director of 340B Operations
SSM Health
6087075611 | Violette, Chelsea
Director of Optimization
Spendmend
8452066019 | 9/28/2022 9:57 AM |
| Details | Last Recertification Date | Update | Recertification | | 9/14/2022 1:27:04 PM | 9/14/2022 1:27 PM |
| Contacts | Primary Contact | Update | Group Change Request | Coultrip, Susan
340B Program Director
SSM of Oklahoma
4058123230 | Sharrow, Nicholas
Director of 340B Operations
SSM Health
6087075611 | 8/22/2022 6:53 AM |
| Details | State | Update | | Approved | Active | 7/1/2022 12:01 AM |
| Contacts | Authorizing Official | Update | Reinstatement | Miller, Becky
Vice President-Hospital Operations
SSM Health
5736813136 | Rewerts, Karen D.
Regional VP of Financa/CFO
SSM Health
3149892034 | 5/16/2022 8:37 AM |
| Contacts | Primary Contact | Update | Reinstatement | White, Tamika
Senior Financial Analyst
SSM Health
3149892320 | Coultrip, Susan
340B Program Director
SSM of Oklahoma
4058123230 | 5/16/2022 8:37 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 9/30/2021 12:00:00 AM | | 5/16/2022 8:37 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 1/25/2021 8:07:33 AM | 5/16/2022 8:37:37 AM | 5/16/2022 8:37 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 5/16/2022 8:37 AM |
| Dates | Registration Date | Update | Reinstatement | 1/13/2021 7:15:53 PM | 4/15/2022 4:50:45 PM | 5/16/2022 8:37 AM |
| Dates | Signed By Date | Update | Reinstatement | 1/14/2021 11:55:49 AM | 4/15/2022 6:15:46 PM | 5/16/2022 8:37 AM |
| Dates | Start Date | Update | Reinstatement | 1/25/2021 12:00:00 AM | 7/1/2022 12:00:00 AM | 5/16/2022 8:37 AM |
| Terminations | Termination Date | Update | Reinstatement | 10/1/2021 12:00:00 AM | | 5/16/2022 8:37 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 10/1/2021 12:00:00 AM | | 5/16/2022 8:37 AM |
| Terminations | Termination Reason | Update | Reinstatement | Failure to recertify | | 5/16/2022 8:37 AM |
| Details | Comments Public | Insert | Reinstatement | | Participated starting 1/25/2021, terminated 10/1/2021. Reinstated 7/1/2022. | 5/13/2022 1:45 PM |
| Details | State | Update | | To Be Terminated | Terminated | 10/1/2021 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 9/30/2021 12:00:00 AM | 9/17/2021 7:41 AM |
| Details | State | Update | Recertification | Active | To Be Terminated | 9/17/2021 7:41 AM |
| Terminations | Termination Date | Update | Recertification | | 10/1/2021 12:00:00 AM | 9/17/2021 7:41 AM |
| Terminations | Termination Effective Date | Update | Recertification | | 10/1/2021 12:00:00 AM | 9/17/2021 7:41 AM |
| Terminations | Termination Reason | Update | Recertification | | Failure to recertify | 9/17/2021 7:41 AM |
| Contacts | Primary Contact | Update | Group Change Request | Peine, Jeffrey
Finance Director
SSM Health
3149893532 | White, Tamika
Senior Financial Analyst
SSM Health
3149892320 | 7/6/2021 6:57 AM |
| Details | State | Update | OPA Edit | Approved | Active | 1/25/2021 8:21 AM |
| Dates | Start Date | Update | OPA Edit | 4/1/2021 12:00:00 AM | 1/25/2021 12:00:00 AM | 1/25/2021 8:21 AM |
| Contacts | Signed By | Insert | New Registration | | Miller, Becky
Vice President-Hospital Operations
SSM Health
5736813136 | 1/25/2021 8:07 AM |
| Details | 340B ID | Update | New Registration | | DSH260011H | 1/25/2021 8:07 AM |
| Details | Entity Subname | Update | New Registration | SSM Health Medical Group - Tipton | SSM Health Medical Group - Tipton - Family Medicine | 1/25/2021 8:07 AM |
| Dates | Participating Approval Date | Update | New Registration | | 1/25/2021 8:07:33 AM | 1/25/2021 8:07 AM |
| Details | State | Update | New Registration | Pending | Approved | 1/25/2021 8:07 AM |
| Dates | Signed By Date | Update | New Registration | | 1/14/2021 11:55:49 AM | 1/25/2021 8:07 AM |
| Dates | Start Date | Update | New Registration | | 4/1/2021 12:00:00 AM | 1/25/2021 8:07 AM |
| Addresses | Main Address | Insert | New Registration | |
875 Hwy 5 South
Tipton, MO 65081 | 1/13/2021 7:15 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 1/13/2021 7:15 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 010322600 | 1/13/2021 7:15 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | MO | 1/13/2021 7:15 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1518065523 | 1/13/2021 7:15 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | MO | 1/13/2021 7:15 PM |
| Contacts | Primary Contact | Insert | New Registration | | Peine, Jeffrey
Finance Director
SSM Health
3149893532 | 1/13/2021 7:15 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Miller, Becky
Vice President-Hospital Operations
SSM Health
5736813136 | 1/13/2021 7:15 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Details | Grant Number | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Details | 340B ID | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 260011 | 1/13/2021 7:15 PM |
| Details | Entity Name | Insert | New Registration | | SSM HEALTH-ST. MARYS-JEFFERSON CITY | 1/13/2021 7:15 PM |
| Details | NOFO Number | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Details | Program Code | Insert | New Registration | | DSH | 1/13/2021 7:15 PM |
| Details | Entity Subname | Insert | New Registration | | SSM Health Medical Group - Tipton | 1/13/2021 7:15 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Details | State | Insert | New Registration | | Pending | 1/13/2021 7:15 PM |
| Dates | Registration Date | Insert | New Registration | | 1/13/2021 7:15:53 PM | 1/13/2021 7:15 PM |
| Dates | Signed By Date | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Dates | Start Date | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Terminations | Termination Date | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 1/13/2021 7:15 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 1/13/2021 7:15 PM |