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| Contract Detail | STERLING HEALTHCARE SERVICES | 808 HUNTER AVE STE 1 |
PO BOX 886
| SIKESTON | MO | 63801-2253 | 10/13/2023 | 01/01/2024 | | | 01/01/2024 |
| Details | Last Recertification Date | Update | Recertification | 2/6/2024 12:24:26 PM | 2/24/2025 9:12:01 AM | 2/24/2025 9:12 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Matthews, Mallory
Director of Clinical Operations
Southeast Missouri Health Network
5733132500 | Matthews, Mallory
Chief Clinical Officer
Southeast Missouri Health Network
5733132500 | 7/15/2024 3:26 PM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2023 4:11:40 PM | 2/6/2024 12:24:26 PM | 2/6/2024 12:24 PM |
| Contacts | Primary Contact | Update | Group Change Request | Girffin, Aaron
Policy Director
Southeast Missouri Health Network
5733132501 | Matthews, Mallory
Director of Clinical Operations
Southeast Missouri Health Network
5733132500 | 2/22/2023 11:17 AM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2022 11:00:36 AM | 2/21/2023 4:11:40 PM | 2/21/2023 4:11 PM |
| Details | Last Recertification Date | Update | Recertification | | 2/9/2022 11:00:36 AM | 2/9/2022 11:00 AM |
| Details | State | Update | | Approved | Active | 1/1/2022 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | JONES, CHRIS
CEO
SEMO Health Network
5733132501 | 10/15/2021 8:36 AM |
| Details | 340B ID | Update | New Registration | | CH07137Y | 10/15/2021 8:36 AM |
| Dates | Participating Approval Date | Update | New Registration | | 10/15/2021 8:36:53 AM | 10/15/2021 8:36 AM |
| Details | State | Update | New Registration | Pending | Approved | 10/15/2021 8:36 AM |
| Dates | Signed By Date | Update | New Registration | | 10/14/2021 3:31:56 PM | 10/15/2021 8:36 AM |
| Dates | Start Date | Update | New Registration | | 1/1/2022 12:00:00 AM | 10/15/2021 8:36 AM |
| Addresses | Main Address | Insert | New Registration | |
200 Pine St
Sikeston, MO 63801-3258 | 10/13/2021 11:26 AM |
| Addresses | Billing Address | Insert | New Registration | | SEMO Health Network Corporate Office
6738 St. Hwy 77
Benton, MO 63736 | 10/13/2021 11:26 AM |
| Contacts | Primary Contact | Insert | New Registration | | Girffin, Aaron
Policy Director
Southeast Missouri Health Network
5733132501 | 10/13/2021 11:26 AM |
| Contacts | Authorizing Official | Insert | New Registration | | JONES, CHRIS
CEO
SEMO Health Network
5733132501 | 10/13/2021 11:26 AM |
| Details | Assistance Received From Date | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Details | Assistance Received To Date | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Details | Last Recertification Date | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Details | Grant Number | Insert | New Registration | | H80CS00557 | 10/13/2021 11:26 AM |
| Details | 340B ID | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Details | Medicare Provider Number | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Details | Entity Name | Insert | New Registration | | Southeast Missouri Health Network | 10/13/2021 11:26 AM |
| Details | NOFO Number | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Details | Program Code | Insert | New Registration | | CH | 10/13/2021 11:26 AM |
| Details | Entity Subname | Insert | New Registration | | Sikeston High School Clinic | 10/13/2021 11:26 AM |
| Dates | Participating Approval Date | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Details | State | Insert | New Registration | | Pending | 10/13/2021 11:26 AM |
| Dates | Registration Date | Insert | New Registration | | 10/13/2021 11:26:26 AM | 10/13/2021 11:26 AM |
| Dates | Signed By Date | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Dates | Start Date | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Terminations | Termination Comments | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Terminations | Termination Date | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 10/13/2021 11:26 AM |
| Terminations | Termination Reason | Insert | New Registration | | | 10/13/2021 11:26 AM |