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CH07137T Southeast Missouri Health Network (Active)
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Main Details
Name
Southeast Missouri Health Network
Subdivision Name
East Prairie Dental Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-021915
340B ID
CH07137T
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
111 Prairie Drive
East Prairie, MO 63845
Billing Address
Southeast Missouri 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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