Covered Entity Details

CH07029K SAMUEL U RODGERS HEALTH CENTER, INC. (Active) - information as of 5/29/2025 1:58:00 AM

Main Details

Name

SAMUEL U RODGERS HEALTH CENTER, INC.

Subdivision Name

Samuel U. Rodgers Community Health Center - Mobile

Type

HRSA-Funded Health Center

Site ID

BPS-H80-030894

340B ID

CH07029K

Grant Number

H80CS00784

Additional Details

Current Program Status

Active

Registration Date

1/5/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/18/2022

Last Recertification Date

3/3/2025

Contacts

Authorizing Official

Samuel U. Rodgers Health Center
Bob Theis, CEO
(816) 889-4802

Primary Contact

Rodgers Health
Chris Walker, CFO
(816) 889-4801

Addresses

Street Address

825 EUCLID STREET
KANSAS CITY, MO 64124-2323

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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	600588412,500108282	1265649388,1326674144

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.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH070290	Active	BPS-H80-001679	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Downtown Campus	825 EUCLID AVENUE	KANSAS CITY	MO
CH07029B	Terminated	BPS-H80-000127	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Lafayette Family Medicine, Dental & WIC Services	811A SOUTH STATE HIGHWAY 13	LEXINGTON	MO
CH07029C	Terminated	BPS-H80-003311	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Therapeutic Intervention Center	2701 E. 31ST ST.	KANSAS CITY	MO
CH07029F	Active	BPS-H80-008122	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Clay County Family Medicine & Dental	800 Haines Drive	Liberty	MO
CH07029G	Active	BPS-H80-012960	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Cabot Westside	2121 Summit St	Kansas City	MO
CH07029H	Terminated	BPS-H80-018609	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Northland Family Medicine	5330 N Oak Trfwy.	Kansas City	MO
CH07029J	Active	BPS-H80-030424	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Health Center Northland Family Practice	5330 N Oak Trfy Ste 203	Kansas City	MO
CH07029K	Active	BPS-H80-030894	SAMUEL U RODGERS HEALTH CENTER, INC.	Samuel U. Rodgers Community Health Center - Mobile	825 EUCLID STREET	KANSAS CITY	MO

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH070290	MISSOURI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08576	2435 E INDEPENDENCE	KANSAS CITY	MO	64124	01/01/2017	08/09/2024
CH070290	PRICE CHOPPER PHARMACY #11	207 NE ENGLEWOOD RD		KANSAS CITY	MO	64118	12/06/2012	04/06/2016
CH070290	RED CROSS PHARMACY	1030 MAIN ST		LEXINGTON	MO	64067	06/11/2012	12/31/2018
CH070290	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2022	08/01/2022
CH070290	WAL-MART PHARMACY 10-0234	8301 N CHURCH RD		KANSAS CITY	MO	64158	01/01/2017	08/01/2022
CH070290	WAL-MART PHARMACY 10-1120	7207 NORTH M-1 HWY		GLADSTONE	MO	64119	01/01/2017	08/01/2022
CH070290	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2022	08/01/2022
CH070290	WALGREEN CO.	DBA: WALGREENS # 04212	2501 E LINWOOD BLVD	KANSAS CITY	MO	64128	10/01/2014
CH070290	WALGREEN CO.	DBA: WALGREENS # 04222	5400 INDEPENDENCE AVE	KANSAS CITY	MO	64123-2027	10/01/2014
CH070290	WALGREEN CO.	DBA: WALGREENS # 04236	2261 S STERLING AVE	INDEPENDENCE	MO	64052	10/01/2014
CH070290	WALGREEN CO.	DBA: WALGREENS # 04406	2630 NE VIVION RD.	KANSAS CITY	MO	64119	10/01/2014
CH070290	WALGREEN CO.	DBA: WALGREENS # 05278	3845 BROADWAY	KANSAS CITY	MO	64111	10/01/2014
CH070290	WALGREEN CO.	DBA: WALGREENS # 04210	1100 E. 63RD ST.	KANSAS CITY	MO	64110	07/01/2015	09/30/2024
CH070290	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	01/01/2024
CH070290	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	10/01/2014	07/07/2015
CH070290	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2014	07/07/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/21/2024 6:27:27 AM	3/3/2025 11:34:43 AM	3/3/2025 11:34 AM
Details	Last Recertification Date	Update	Recertification	2/14/2023 3:21:35 PM	2/21/2024 6:27:27 AM	2/21/2024 6:27 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/14/2023 3:21 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		600588412	2/14/2023 3:21 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MO	2/14/2023 3:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/14/2023 3:21 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500108282	2/14/2023 3:21 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MO	2/14/2023 3:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1265649388	2/14/2023 3:21 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	2/14/2023 3:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326674144	2/14/2023 3:21 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	2/14/2023 3:21 PM
Details	Last Recertification Date	Update	Recertification		2/14/2023 3:21:35 PM	2/14/2023 3:21 PM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Theis, Bob CEO Samuel U. Rodgers Health Center 8168894802	1/18/2022 7:16 AM
Details	340B ID	Update	New Registration		CH07029K	1/18/2022 7:16 AM
Dates	Participating Approval Date	Update	New Registration		1/18/2022 7:16:57 AM	1/18/2022 7:16 AM
Details	State	Update	New Registration	Pending	Approved	1/18/2022 7:16 AM
Dates	Signed By Date	Update	New Registration		1/14/2022 11:40:26 AM	1/18/2022 7:16 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/18/2022 7:16 AM
Addresses	Main Address	Insert	New Registration		825 EUCLID STREET KANSAS CITY, MO 64124-2323	1/5/2022 4:24 PM
Contacts	Primary Contact	Insert	New Registration		Walker, Chris CFO Rodgers Health 8168894801	1/5/2022 4:24 PM
Contacts	Authorizing Official	Insert	New Registration		Theis, Bob CEO Samuel U. Rodgers Health Center 8168894802	1/5/2022 4:24 PM
Details	Assistance Received From Date	Insert	New Registration			1/5/2022 4:24 PM
Details	Assistance Received To Date	Insert	New Registration			1/5/2022 4:24 PM
Details	Last Recertification Date	Insert	New Registration			1/5/2022 4:24 PM
Details	Grant Number	Insert	New Registration		H80CS00784	1/5/2022 4:24 PM
Details	340B ID	Insert	New Registration			1/5/2022 4:24 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/5/2022 4:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/5/2022 4:24 PM
Details	Medicare Provider Number	Insert	New Registration			1/5/2022 4:24 PM
Details	Entity Name	Insert	New Registration		SAMUEL U RODGERS HEALTH CENTER, INC.	1/5/2022 4:24 PM
Details	NOFO Number	Insert	New Registration			1/5/2022 4:24 PM
Details	Program Code	Insert	New Registration		CH	1/5/2022 4:24 PM
Details	Entity Subname	Insert	New Registration		Samuel U. Rodgers Community Health Center - Mobile	1/5/2022 4:24 PM
Dates	Participating Approval Date	Insert	New Registration			1/5/2022 4:24 PM
Details	State	Insert	New Registration		Pending	1/5/2022 4:24 PM
Dates	Registration Date	Insert	New Registration		1/5/2022 4:24:20 PM	1/5/2022 4:24 PM
Dates	Signed By Date	Insert	New Registration			1/5/2022 4:24 PM
Dates	Start Date	Insert	New Registration			1/5/2022 4:24 PM
Terminations	Termination Comments	Insert	New Registration			1/5/2022 4:24 PM
Terminations	Termination Date	Insert	New Registration			1/5/2022 4:24 PM
Terminations	Termination Effective Date	Insert	New Registration			1/5/2022 4:24 PM
Terminations	Termination Reason	Insert	New Registration			1/5/2022 4:24 PM

340B Drug Pricing Program Database