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CH07137L Southeast Missouri Health Network (Active)
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Main Details
Name
Southeast Missouri Health Network
Subdivision Name
Otto Bean Dental Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-009586
340B ID
CH07137L
Grant Number
H80CS00557
Additional Details
Current Program Status
Active
Registration Date
10/11/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/7/2018
Last Recertification Date
2/24/2025
Contacts
Authorizing Official
SEMO Health Network
CHRIS JONES, CEO
(573) 313-2501
Primary Contact
Southeast Missouri Health Network
Mallory Matthews, Chief Clinical Officer
(573) 313-2500
Addresses
Street Address
500 Russell Street
Kennett, MO 63857
Billing Address
SEMO Health Network
6738 St. Hwy. 77
Benton, MO 63736
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Participated starting 4/1/2013, terminated 4/1/2015. Reinstated 1/1/2019.
11/06/2018
May 2025
May 2025
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