Covered Entity Details

CH07043AA Big Springs Medical Association, Inc (Active) - information as of 6/3/2025 12:03:33 PM

Main Details

Name

Big Springs Medical Association, Inc

Subdivision Name

Missouri Highlands Health Care - Poplar Bluff

Type

HRSA-Funded Health Center

Site ID

BPS-H80-033119

340B ID

CH07043AA

Grant Number

H80CS00703

Additional Details

Current Program Status

Active

Registration Date

7/11/2022

Participating Start Date

10/1/2022

Participating Approval Date

7/11/2022

Last Recertification Date

2/13/2025

Contacts

Authorizing Official

Big Springs Medical Association Inc. dba MO Highlands Health Care
Karen R White, CEO
(573) 663-2313 Ext: 3965

Primary Contact

Big Springs Medical Association Inc.
Julie O'Neal, CFO
(573) 663-3957

Addresses

Street Address

2210 Barron Rd Ste 120
Poplar Bluff, MO 63901-1908

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	500217468	1083745475

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
Contract Detail	KEY DRUGS AT NORTHWEST LLC	2210 BARRON RD		POPLAR BLUFF	MO	63901-1908	10/12/2023	01/01/2024			01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH070430	Active	BPS-H80-000542	Big Springs Medical Association, Inc	MISSOURI HIGHLANDS HEALTH CARE	110 SOUTH SECOND STREET	ELLINGTON	MO
CH07043A	Active	BPS-H80-010510	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Ellington	61 St Highway Y Ste B	Ellington	MO
CH07043AA	Active	BPS-H80-033119	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Poplar Bluff	2210 Barron Rd Ste 120	Poplar Bluff	MO
CH07043AB	Active	BPS-H80-034155	Big Springs Medical Association, Inc	Missouri Highlands Clinical Lab	61 Highway Y Ste A	Ellington	MO
CH07043AC	Active	BPS-H80-032898	Big Springs Medical Association, Inc	Missouri Highlands Dental - Piedmont	1 Hals Plz Ste B	Piedmont	MO
CH07043AD	Active	BPS-H80-034956	Big Springs Medical Association, Inc	Missouri Highlands Lone Star School Clinic	3277 US Highway 160 W	Doniphan	MO
CH07043AE	Active	BPS-H80-034998	Big Springs Medical Association, Inc	Missouri Highlands Naylor School Clinic	101 E Batten St	Naylor	MO
CH07043AF	Active	BPS-H80-034999	Big Springs Medical Association, Inc	Missouri Highlands Neelyville School Clinic	289 Broadway St	Neelyville	MO
CH07043AG	Active	BPS-H80-035240	Big Springs Medical Association, Inc	Missouri Highlands Hillview School Clinic	11001 US-160	Harviell	MO
CH07043AH	Active	BPS-H80-037374	BIG SPRINGS MEDICAL ASSOCIATION INC.	Missouri Highlands Eugene Field Elementary School Clinic	711 Nickey St	Poplar Bluff	MO
CH07043AJ	Active	BPS-H80-037397	BIG SPRINGS MEDICAL ASSOCIATION INC.	Missouri Highlands Poplar Bluff Middle School Clinic	1300 Victory Ln	Poplar Bluff	MO
CH07043AK	Active	BPS-H80-037371	BIG SPRINGS MEDICAL ASSOCIATION INC.	Missouri Highlands Doniphan Elementary School Clinic	603 E Summit St	Doniphan	MO
CH07043AL	Active	BPS-H80-038425	BIG SPRINGS MEDICAL ASSOCIATION INC.	Missouri Highlands O'Neal Elementary School Clinic	2300 Baugh Ln	Poplar Bluff	MO
CH07043AM	Active	BPS-H80-036381	BIG SPRINGS MEDICAL ASSOCIATION INC.	Missouri Highlands Health Care - Poplar Bluff Administration	2755 Barron Road	Poplar Bluff	MO
CH07043B	Active	BPS-H80-009009	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Van Buren	405 Main Street	Van Buren	MO
CH07043C	Active	BPS-H80-011334	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Eminence	17959 Main Street	Eminence	MO
CH07043D	Active	BPS-H80-002629	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Annapolis	202 N Allen St	Annapolis	MO
CH07043E	Active	BPS-H80-003110	Big Springs Medical Association, Inc	Missouri Highlands Dental - Ellington	115 WALNUT STREET	ELLINGTON	MO
CH07043F	Active	BPS-H80-019655	Big Springs Medical Association, Inc	Missouri Highlands Mobile Dental Clinic	1407 N. Westwood Blvd	Poplar Bluff	MO
CH07043G	Active	BPS-H80-021101	Big Springs Medical Association, Inc	Missouri Highlands Dental - Pilot Knob	315 West Mulberry	Pilot Knob	MO
CH07043K	Active	BPS-H80-013586	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Viburnum	18 Viburnum Center Rd	Viburnum,	MO
CH07043M	Active	BPS-H80-008105	Big Springs Medical Association, Inc	Missouri Highlands Dental - Poplar Bluff	1407 N. Westwood Blvd	Poplar Bluff	MO
CH07043N	Active	BPS-H80-003549	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Naylor	220 E. Broad Street	Naylor	MO
CH07043P	Terminated	BPS-H80-008097	Big Springs Medical Association, Inc	Missouri Highlands Medical Clinic	225 Physicians Park Drive STE 303	Poplar Bluff	MO
CH07043Q	Active	BPS-H80-008159	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Pilot Knob	315 W. Mulberry	Pilot Knob	MO
CH07043T	Active	BPS-H80-024776	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Doniphan North	109 Leroux St	Doniphan	MO
CH07043U	Active	BPS-H80-029602	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Piedmont	1 Hals Plz	Piedmont	MO
CH07043V	Active	BPS-H80-030387	Big Springs Medical Association, Inc	Missouri Highlands Urgent Care - Doniphan	109 Plum St	Doniphan	MO
CH07043W	Active	BPS-H80-030834	Big Springs Medical Association, Inc	Missouri Highlands OB/GYN Clinic	2879 James Blvd	Poplar Bluff	MO
CH07043X	Active	BPS-H80-031008	Big Springs Medical Association, Inc	Poplar Bluff Regional Medical Center	3100 Oak Grove Rd	Poplar Bluff	MO
CH07043Y	Active	BPS-H80-032382	Big Springs Medical Association, Inc	Missouri Highlands Health Care - Doniphan South	109 Plum St Ste B	Doniphan	MO
CH07043Z	Active	BPS-H80-032628	Big Springs Medical Association, Inc	Missouri Highlands Urgent Care Lab	109 Plum St Ste C	Doniphan	MO

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH070430	ALLCARE SPECIALTY PHARMACY, LLC	10620 COLONEL GLENN RD STE 300		LITTLE ROCK	AR	72204-8048	04/01/2020
CH070430	BROWN'S PHARMACY INC	BROWN'S PHARMACY	375 TRIMMER LN	ELLINGTON	MO	63638-7972	01/01/2015	05/23/2019
CH07043A	BROWN'S PHARMACY INC	BROWN'S PHARMACY	375 TRIMMER LN	ELLINGTON	MO	63638-7972	03/28/2006	10/01/2018
CH07043B	BROWN'S PHARMACY INC	BROWN'S PHARMACY	375 TRIMMER LN	ELLINGTON	MO	63638-7972	04/12/2011	10/01/2018
CH07043E	BROWN'S PHARMACY INC	BROWN'S PHARMACY	375 TRIMMER LN	ELLINGTON	MO	63638-7972	04/01/2006	10/01/2018
CH070430	BROWN'S PHARMACY INC	BROWN'S PHARMACY	375 TRIMMER LN	ELLINGTON	MO	63638-7972	01/01/2020	05/16/2023
CH070430	BROWNS PHARMACY	375 TRIMMER LN		ELLINGTON	MO	63638	05/16/2023
CH070430	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2023
CH070430	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2023
CH070430	CLARK'S RX FARMINGTON LLC	CLARK'S RX	124 W RUSSELL STREET	IRONTON	MO	63650	01/01/2014	05/23/2019
CH070430	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2022
CH070430	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2022
CH07043N	E & S PHARMACY INC	1105 WALNUT ST		DONIPHAN	MO	63935	10/23/2006
CH070430	E & S PHARMACY INC	1105 WALNUT ST		DONIPHAN	MO	63935	04/01/2020
CH07043Z	E & S PHARMACY INC	1105 WALNUT ST		DONIPHAN	MO	63935	01/01/2024
CH070430	EAST SIDE DISCOUNT PHARMACY	400 E PINE ST		POPLAR BLUFF	MO	63901-5401	10/01/2021
CH07043F	EAST SIDE DISCOUNT PHARMACY	400 E PINE ST		POPLAR BLUFF	MO	63901-5401	01/01/2024
CH070430	EASTSIDE PHARMACY, INC	400 E. PINE ST		POPLAR BLUFF	MO	63901	04/12/2024
CH070430	GENOA HEALTHCARE LLC	255 SPENCER ROAD, STE 202		SAINT PETERS	MO	63376	04/01/2023
CH070430	HOMETOWN PHARMACY	110 LEROUX ST		DONIPHAN	MO	63935	04/01/2020
CH07043T	HOMETOWN PHARMACY	110 LEROUX ST		DONIPHAN	MO	63935	01/01/2024
CH070430	HOMETOWN PHARMACY MANAGEMENT LLC	110 LEROUX ST		DONIPHAN	MO	63935	10/28/2024
CH07043T	HOMETOWN PHARMACY MANAGEMENT LLC	110 LEROUX ST		DONIPHAN	MO	63935	01/01/2025
CH070430	IRON COUNTY DRUG STORE	1 VIBURNUM CENTER RD STE B		VIBURNUM	MO	65566-7802	07/01/2016
CH07043K	IRON COUNTY DRUG STORE	1 VIBURNUM CENTER RD STE B		VIBURNUM	MO	65566-7802	01/01/2024
CH070430	KEY DRUGS	910 N WESTWOOD BLVD		POPLAR BLUFF	MO	63901-4242	10/01/2021
CH07043M	KEY DRUGS	910 N WESTWOOD BLVD		POPLAR BLUFF	MO	63901-4242	01/01/2024
CH070430	KEY DRUGS AT NORTHWEST LLC	2210 BARRON RD		POPLAR BLUFF	MO	63901-1908	10/01/2021
CH07043AA	KEY DRUGS AT NORTHWEST LLC	2210 BARRON RD		POPLAR BLUFF	MO	63901-1908	01/01/2024
CH070430	KROGER LIMITED PARTNERSHIP I	KROGER PHARMACY #386	2770 NORTH WESTWOOD	POPLAR BLUFF	MO	63901	01/01/2016
CH07043AF	KROGER LIMITED PARTNERSHIP I	KROGER PHARMACY #386	2770 NORTH WESTWOOD	POPLAR BLUFF	MO	63901	01/01/2024
CH070430	LEXI'S MEDICINE, INC	8499 ASH AVE		WINONA	MO	65588	01/01/2020
CH07043C	LEXI'S MEDICINE, INC	8499 ASH AVE		WINONA	MO	65588	01/01/2024
CH070430	MEDICAL CENTER PHARMACY	PREMIERE HEALTHCARE LLC	513 N GRAND AVE	DONIPHAN	MO	63935-6393	05/10/2011	05/23/2019
CH07043N	MEDICAL CENTER PHARMACY	PREMIERE HEALTHCARE LLC	513 N GRAND AVE	DONIPHAN	MO	63935-6393	04/27/2011	05/23/2019
CH07043C	MIKA'S MEDICINE		211 N ASH PO BOX 336	WINONA	MO	65588	01/10/2007	12/31/2015
CH070430	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11206	124 W RUSSELL STREET	IRONTON	MO	63650	01/19/2018
CH07043P	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10281	225 NORTH WESTWOOD BLVD.	POPLAR BLUFF	MO	63901	07/01/2020	10/01/2022
CH070430	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10281	225 NORTH WESTWOOD BLVD.	POPLAR BLUFF	MO	63901	07/01/2020
CH07043AG	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10281	225 NORTH WESTWOOD BLVD.	POPLAR BLUFF	MO	63901	01/01/2024
CH07043Q	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11206	124 W RUSSELL STREET	IRONTON	MO	63650	01/01/2024
CH070430	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	04/01/2023
CH070430	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/01/2023
CH070430	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/01/2023
CH070430	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/01/2023
CH070430	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/01/2023
CH070430	PARKLAND PHARMACY DEVELOPMENT LLC	DBA PARKLAND PHARMACY	1500 N HIGHWAY 21	IRONTON	MO	63650	04/01/2014
CH07043G	PARKLAND PHARMACY DEVELOPMENT LLC	DBA PARKLAND PHARMACY	1500 N HIGHWAY 21	IRONTON	MO	63650	01/01/2024
CH070430	PARKLAND PHARMACY DEVELOPMENT LLC	DBA PARKLAND PHARMACY	420 PIEDMONT AVE	PIEDMONT	MO	63957	07/01/2025
CH070430	PARKLAND PHARMACY DEVELOPMENT LLC	DBA PARKLAND PHARMACY	137 FRONT ST	GREENVILLE	MO	63944	07/01/2025
CH070430	PHYSICIAN'S PARK PHARMACY	225 PHYSICIANS PARK STE 100		POPLAR BLUFF	MO	63901-3918	01/01/2015	06/29/2021
CH07043B	PHYSICIANS PARK PHARMACY	PHYSICIANS PARK INVESTMENT	225 PHYSICIAN'S PARK DR. SUITE 100A	POPLAR BLUFF	MO	63901-3934	04/12/2011
CH07043M	PHYSICIANS PARK PHARMACY	PHYSICIANS PARK INVESTMENT	225 PHYSICIAN'S PARK DR. SUITE 100A	POPLAR BLUFF	MO	63901-3934	07/30/2009
CH07043P	PHYSICIANS PARK PHARMACY	PHYSICIANS PARK INVESTMENT	225 PHYSICIAN'S PARK DR. SUITE 100A	POPLAR BLUFF	MO	63901-3934	04/01/2009	10/01/2022
CH07043D	STEPHEN L LA FRANCE PHARMACY INC.	WALGREENS #15820	605 N MAIN STREET	IRONTON	MO	63650	03/28/2006	03/31/2019
CH07043K	STEPHEN L LA FRANCE PHARMACY INC.	WALGREENS #15820	605 N MAIN STREET	IRONTON	MO	63650	03/28/2006	03/31/2019
CH07043Q	STEPHEN L LA FRANCE PHARMACY INC.	WALGREENS #15820	605 N MAIN STREET	IRONTON	MO	63650	10/01/2009	03/31/2019
CH070430	SUPER SAVER PHARMACY	FREDS OF DONIPHAN, INC.	100 H AND S DR	DONIPHAN	MO	63935-1003	10/01/2021
CH07043Y	SUPER SAVER PHARMACY	FREDS OF DONIPHAN, INC.	100 H AND S DR	DONIPHAN	MO	63935-1003	01/01/2024
CH070430	TONEY DRUG & WELLNESS, LLC	DBA PIEDMONT FAMILY PHARMACY	1 HALS PLZ	PIEDMONT	MO	63957	04/01/2020
CH07043U	TONEY DRUG & WELLNESS, LLC	DBA PIEDMONT FAMILY PHARMACY	1 HALS PLZ	PIEDMONT	MO	63957	01/01/2024
CH070430	VAN BUREN DRUG	BARNES PHARMACY INC	406 MAIN ST PO BOX 361	VAN BUREN	MO	63965-0361	01/01/2015
CH07043A	VAN BUREN DRUG	BARNES PHARMACY INC	406 MAIN ST PO BOX 361	VAN BUREN	MO	63965-0361	04/05/2011
CH07043B	VAN BUREN DRUG	BARNES PHARMACY INC	406 MAIN ST PO BOX 361	VAN BUREN	MO	63965-0361	03/28/2006
CH07043E	VAN BUREN DRUG	BARNES PHARMACY INC	406 MAIN ST PO BOX 361	VAN BUREN	MO	63965-0361	01/01/2024
CH070430	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020
CH070430	WAL-MART PHARMACY 10-0019	333 S WESTWOOD BLVD		POPLAR BLUFF	MO	63901	04/01/2013
CH07043W	WAL-MART PHARMACY 10-0019	333 S WESTWOOD BLVD		POPLAR BLUFF	MO	63901	01/01/2024
CH070430	WAL-MART PHARMACY 10-0871	101 WEST HIGHWAY 60		MT VIEW	MO	65548	04/01/2020
CH07043B	WAL-MART PHARMACY 10-0871	101 WEST HIGHWAY 60		MT VIEW	MO	65548	01/01/2024
CH070430	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020
CH070430	WALGREEN CO.	WALGREENS #15801	310 W MAIN STREET	MALDEN	MO	63863	04/01/2019	05/12/2023
CH070430	WALGREEN CO.	WALGREENS #15820	605 N MAIN STREET	IRONTON	MO	63650	04/01/2019
CH070430	WALGREEN CO.	WALGREENS #15800	904 WEST BUSINESS HWY 60	DEXTER	MO	63841	04/01/2019
CH070430	WALGREEN CO.	DBA: WALGREENS # 09301	299 N MAIN	SIKESTON	MO	63801	04/01/2019
CH070430	WALGREEN CO.	DBA: WALGREENS #15054	124 W 2ND ST	MOUNTAIN VIEW	MO	65548	04/01/2019
CH070430	WALGREEN CO.	DBA: WALGREENS # 05624	600 W KARSCH	FARMINGTON	MO	63640	04/01/2019
CH070430	WALGREEN CO.	DBA: WALGREENS # 10153	110 N WESTWOOD BLVD	POPLAR BLUFF	MO	63901	04/01/2019
CH07043AE	WALGREEN CO.	WALGREENS #15800	904 WEST BUSINESS HWY 60	DEXTER	MO	63841	01/01/2024
CH07043D	WALGREEN CO.	WALGREENS #15820	605 N MAIN STREET	IRONTON	MO	63650	01/01/2024
CH07043N	WALGREEN CO.	DBA: WALGREENS # 10153	110 N WESTWOOD BLVD	POPLAR BLUFF	MO	63901	01/01/2024
CH070430	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	10/01/2022
CH070430	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH070430	WALMART PHARMACY 10-7127	3001 OAK GROVE ROAD		POPLAR BLUFF	MO	63901	01/01/2020
CH07043X	WALMART PHARMACY 10-7127	3001 OAK GROVE ROAD		POPLAR BLUFF	MO	63901	01/01/2024
CH070430	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH070430	WILKARE PHARMACY OF DONIPHAN	513B N GRAND AVE		DONIPHAN	MO	63935	07/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/13/2024 4:18:47 PM	2/13/2025 3:47:42 PM	2/13/2025 3:47 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1083745475	4/25/2024 2:28 PM
Medicaid Billing	NPI: State	Insert	Change Request		MO	4/25/2024 2:28 PM
Details	Last Recertification Date	Update	Recertification	2/3/2023 6:33:21 AM	2/13/2024 4:18:47 PM	2/13/2024 4:18 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/3/2023 6:33 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500217468	2/3/2023 6:33 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MO	2/3/2023 6:33 AM
Details	Last Recertification Date	Update	Recertification		2/3/2023 6:33:21 AM	2/3/2023 6:33 AM
Details	Entity Subname	Update	Recertification	Missouri Highlands Medical Clinic	Missouri Highlands Health Care - Poplar Bluff	2/3/2023 6:33 AM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		White, Karen R CEO Big Springs Medical Association Inc. dba MO Highlands Health Care 5736632313-3965	7/11/2022 2:20 PM
Details	340B ID	Update	New Registration		CH07043AA	7/11/2022 2:20 PM
Dates	Participating Approval Date	Update	New Registration		7/11/2022 2:20:08 PM	7/11/2022 2:20 PM
Details	State	Update	New Registration	Pending	Approved	7/11/2022 2:20 PM
Dates	Signed By Date	Update	New Registration		7/11/2022 11:41:09 AM	7/11/2022 2:20 PM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	7/11/2022 2:20 PM
Addresses	Main Address	Insert	New Registration		2210 Barron Rd Ste 120 Poplar Bluff, MO 63901-1908	7/11/2022 11:41 AM
Contacts	Authorizing Official	Insert	New Registration		White, Karen R CEO Big Springs Medical Association Inc. dba MO Highlands Health Care 5736632313-3965	7/11/2022 11:41 AM
Contacts	Primary Contact	Insert	New Registration		O'Neal, Julie CFO Big Springs Medical Association Inc. 5736633957	7/11/2022 11:41 AM
Details	Assistance Received From Date	Insert	New Registration			7/11/2022 11:41 AM
Details	Assistance Received To Date	Insert	New Registration			7/11/2022 11:41 AM
Details	Last Recertification Date	Insert	New Registration			7/11/2022 11:41 AM
Details	Grant Number	Insert	New Registration		H80CS00703	7/11/2022 11:41 AM
Details	340B ID	Insert	New Registration			7/11/2022 11:41 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/11/2022 11:41 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/11/2022 11:41 AM
Details	Medicare Provider Number	Insert	New Registration			7/11/2022 11:41 AM
Details	Entity Name	Insert	New Registration		Big Springs Medical Association, Inc	7/11/2022 11:41 AM
Details	NOFO Number	Insert	New Registration			7/11/2022 11:41 AM
Details	Program Code	Insert	New Registration		CH	7/11/2022 11:41 AM
Details	Entity Subname	Insert	New Registration		Missouri Highlands Medical Clinic	7/11/2022 11:41 AM
Dates	Participating Approval Date	Insert	New Registration			7/11/2022 11:41 AM
Details	State	Insert	New Registration		Pending	7/11/2022 11:41 AM
Dates	Registration Date	Insert	New Registration		7/11/2022 11:41:06 AM	7/11/2022 11:41 AM
Dates	Signed By Date	Insert	New Registration			7/11/2022 11:41 AM
Dates	Start Date	Insert	New Registration			7/11/2022 11:41 AM
Terminations	Termination Comments	Insert	New Registration			7/11/2022 11:41 AM
Terminations	Termination Date	Insert	New Registration			7/11/2022 11:41 AM
Terminations	Termination Effective Date	Insert	New Registration			7/11/2022 11:41 AM
Terminations	Termination Reason	Insert	New Registration			7/11/2022 11:41 AM

340B Drug Pricing Program Database