340B Drug Pricing Program Database


DSH260104B SSM HEALTH DEPAUL HOSPITAL (Active) - information as of 5/4/2025 10:21:22 PM

Main Details
SSM HEALTH DEPAUL HOSPITAL
SSM Cancer Care at St. Joseph Medical Park
Disproportionate Share Hospital
No
DSH260104B
260104


Additional Details
Active
5/16/2012
7/1/2012
6/27/2012
8/15/2024

Contacts

SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219

SSM Health
Holly Herring, Director, 340B Center of Excellence
(580) 512-7188

Addresses

1475 Kisker Road
Suite 180
St. Charles, MO 63304

DePaul Hospital
12303 DePaul Drive
Bridgeton, MO 63044


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
IL431704972001,431704972401598835308
MO0104941021598835308
Shipping Addresses

DePaul Hospital
12303 DePaul Drive
Bridgeton, MO 63044
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH260104AChildDSHSSM HEALTH DEPAUL HOSPITALSSM Heart Institute Cardiac Imaging12266 DePaul DriveBridgetonMOActive
DSH260104AAChildDSHSSM HEALTH DEPAUL HOSPITALDPMG at Cross Keys / General14021 New Halls Ferry RoadFlorissantMOActive
DSH260104ABChildDSHSSM DEPAUL HEALTH CENTERDPMG Pediatrics - Cross Keys14021 New Halls Ferry RoadFlorissantMOTerminated
DSH260104ACChildDSHSSM DEPAUL HEALTH CENTERNSI DePaul Ste 10012266 DePaul DriveBridgetonMOTerminated
DSH260104ADChildDSHSSM DEPAUL HEALTH CENTERCTSI Elec Phy DPHC12266 DePaul DriveBridgetonMOTerminated
DSH260104AEChildDSHSSM HEALTH DEPAUL HOSPITALCTSI South LSL400 Medical PlazaLake St. LouisMOActive
DSH260104AFChildDSHSSM DEPAUL HEALTH CENTERDPMG Spec DPHC Gen12255 DePaul DriveBridgetonMOTerminated
DSH260104AGChildDSHSSM HEALTH DEPAUL HOSPITALSSM CANCER CARE12277 DePaul DriveBridgetonMOActive
DSH260104AHChildDSHSSM HEALTH DEPAUL HOSPITALSSM CANCER CARE - Radiation Oncology400 MEDICAL PLAZALAKE SAINT LOUISMOActive
DSH260104AJChildDSHSSM HEALTH DEPAUL HOSPITALSSM CANCER CARE - Radiation Oncology1475 KISKER ROADST CHARLESMOActive
DSH260104AKChildDSHSSM DEPAUL HEALTH CENTERSSM DePaul MOB / SSM DePaul Pain Management12255 DePaul Drive, Suite 120BridgetonMOTerminated
DSH260104ALChildDSHSSM HEALTH DEPAUL HOSPITALDePaul Infusion12277 DePaul Drive, Suite 100BridgetonMOActive
DSH260104AMChildDSHSSM HEALTH DEPAUL HOSPITALSSM Imaging Center3440 DePaul Lane #100BridgetonMOActive
DSH260104ANChildDSHSSM HEALTH DEPAUL HOSPITALSSM OB Care Clinic12277 DePaul Drive, Suite 504BridgetonMOActive
DSH260104APChildDSHSSM HEALTH DEPAUL HOSPITALSSM Ambulatory Surgery Center12266 DePaul Drive, Suite 10BridgetonMOActive
DSH260104AQChildDSHSSM HEALTH DEPAUL HOSPITALComplex Care Clinic - Surgical Evaluation Center12277 DePaul DrBridgetonMOActive
DSH260104ARChildDSHSSM HEALTH DEPAUL HOSPITALShackelford Urgent Care1120 ShackelfordFlorissantMOActive
DSH260104ASChildDSHSSM HEALTH DEPAUL HOSPITALSSMMG GI12277 DePaul DriveBridgetonMOActive
DSH260104ATChildDSHSSM HEALTH DEPAUL HOSPITALDePaul Hospital - Adolescent Behavioral Health12304 DePaul DriveBridgetonMOActive
DSH260104AUChildDSHSSM HEALTH DEPAUL HOSPITALDePaul Hospital - Maternal Fetal Medicine12277 DePaul Dr.BridgetonMOActive
DSH260104AVChildDSHSSM HEALTH DEPAUL HOSPITALRadiation Oncology - Lake St. Louis400 Medical PlazaLake St. LouisMOActive
DSH260104AWChildDSHSSM HEALTH DEPAUL HOSPITALInfusion Center - Lake St. Louis400 Medical PlazaLake St. LouisMOActive
DSH260104AXChildDSHSSM HEALTH DEPAUL HOSPITALDePaul Hospital - Neuro Diagnostics12266 DePaul DrBridgetonMOActive
DSH260104BChildDSHSSM HEALTH DEPAUL HOSPITALSSM Cancer Care at St. Joseph Medical Park1475 Kisker RoadSt. CharlesMOActive
DSH260104BAChildDSHSSM HEALTH DEPAUL HOSPITALSCC Endocrinology - Dorsett2024 Dorsett VillageMaryland HeightsMOActive
DSH260104BBChildDSHSSM HEALTH DEPAUL HOSPITALSSMMG OBGYN - Florissant1120 Shackelford RoadFlorissantMOActive
DSH260104BCChildDSHSSM HEALTH DEPAUL HOSPITALUrgent Care - BHS12355 DePaul DriveBridgetonMOActive
DSH260104BDChildDSHSSM HEALTH DEPAUL HOSPITALSSM DEPAUL HEALTH CENTER - DPHC Anticoagulation Clinic12277 DePaul DriveBridgetonMOActive
DSH260104BEChildDSHSSM HEALTH DEPAUL HOSPITALOutpatient Behavioral Health Clinic - OP BHS LAI Clinic12355 DePaul DrBridgetonMOActive
DSH260104BFChildDSHSSM HEALTH DEPAUL HOSPITALWound Center - Wound Clinic12266 DePaul DrBridgetonMOActive
DSH260104BGChildDSHSSM HEALTH DEPAUL HOSPITALSSM Cancer Care Med Park RAD - Radiology1475 Kisker RoadSt. PetersMOActive
DSH260104CChildDSHSSM HEALTH DEPAUL HOSPITALSSM Cancer Care at Lake Saint Louis400 Medical Plaza, Suite 100Lake Saint LouisMOActive
DSH260104DChildDSHSSM HEALTH DEPAUL HOSPITALDPHC Rheumatology Infusion - Shackelford1120 Shackelford Rd, Suite BFlorissantMOActive
DSH260104EChildDSHSSM HEALTH DEPAUL HOSPITALDPHC Rheumatology Infusion - DePaul12255 DePaul Drive, Suite 501BridgetonMOActive
DSH260104FChildDSHSSM HEALTH DEPAUL HOSPITALDorsett Urgent Care2022 Dorsett VillageMaryland HeightsMOActive
DSH260104HChildDSHSSM HEALTH DEPAUL HOSPITALVascular Institute12266 DePaul Drive, Suite 315BridgetonMOActive
DSH260104JChildDSHSSM DEPAUL HEALTH CENTERSSMCC - North - LSL Ste 100 / SSM Cancer Care400 Medical Plaza, Suite 100Lake St. LouisMOTerminated
DSH260104KChildDSHSSM HEALTH DEPAUL HOSPITALSSMCC MP Infusion1475 Kisker Road, Suite 180Saint PetersMOActive
DSH260104LChildDSHSSM HEALTH DEPAUL HOSPITALSSMHI at DPMG Ste 205 / Heart Institute12266 DePaul DriveBridgetonMOActive
DSH260104MChildDSHSSM DEPAUL HEALTH CENTERSSMHI at DePaul Ste 400 / Heart Institute12255 DePaul DriveBridgetonMOTerminated
DSH260104NChildDSHSSM HEALTH DEPAUL HOSPITALSSMOI - Shackelford1120 Shackelford RoadFlorissantMOActive
DSH260104PChildDSHSSM DEPAUL HEALTH CENTERSSMOI - DPHC Ste 22012266 DePaul DriveBridgetonMOTerminated
DSH260104QChildDSHSSM HEALTH DEPAUL HOSPITALDPHC SSMOI12349 DePaul DriveBridgetonMOActive
DSH260104RChildDSHSSM HEALTH DEPAUL HOSPITALNSI Neurology at DPHC Ste 10012266 DePaul DriveBridgetonMOActive
DSH260104SChildDSHSSM HEALTH DEPAUL HOSPITALDPMG Rheumatology at DPHC12255 DePaul DriveBridgetonMOActive
DSH260104TChildDSHSSM HEALTH DEPAUL HOSPITALDPMG Podiatry at DPHC12255 DePaul DriveBridgetonMOActive
DSH260104UChildDSHSSM HEALTH DEPAUL HOSPITALDPMG Pulmonary at DPHC12255 DePaul DriveBridgetonMOActive
DSH260104VChildDSHSSM HEALTH DEPAUL HOSPITALDPMG Rheumatology at DPHC1120 Shackelford RoadFlorissantMOActive
DSH260104WChildDSHSSM HEALTH DEPAUL HOSPITALDPMG at North County1120 Shackelford RoadFlorissantMOActive
DSH260104XChildDSHSSM HEALTH DEPAUL HOSPITALDPMG Primary Care at DPHC12255 DePaul DriveBridgetonMOActive
DSH260104YChildDSHSSM HEALTH DEPAUL HOSPITALDPMG at Dorsett Village2024 Dorsett Village Shopping CenterMaryland HeightsMOActive
DSH260104ZChildDSHSSM HEALTH DEPAUL HOSPITALDPMG Endocrinology at DPHC12277 DePaul DriveBridgetonMOActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsEntity NameUpdateRecertificationSSM DEPAUL HEALTH HOSPITALSSM HEALTH DEPAUL HOSPITAL8/15/2024 1:46 PM
DetailsLast Recertification DateUpdateRecertification9/11/2023 11:31:08 PM8/15/2024 1:21:12 PM8/15/2024 1:21 PM
DetailsEntity NameUpdateChange RequestSSM DEPAUL HEALTH CENTERSSM DEPAUL HEALTH HOSPITAL7/17/2024 12:48 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 4:41 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4317049720016/13/2024 4:41 PM
Medicaid BillingMedicaid: StateInsertChange Request IL6/13/2024 4:41 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 4:41 PM
Medicaid BillingMedicaid: NumberInsertChange Request 431704972406/13/2024 4:41 PM
Medicaid BillingMedicaid: StateInsertChange Request IL6/13/2024 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 15988353086/13/2024 4:41 PM
Medicaid BillingNPI: StateInsertChange Request IL6/13/2024 4:41 PM
ContactsPrimary ContactUpdatePC Change RequestMcAllister, Anita System Director of 340B Operations SSM Health 3149896778Herring, Holly Director, 340B Center of Excellence SSM Health 580512718810/2/2023 6:49 AM
DetailsLast Recertification DateUpdateRecertification9/14/2022 11:32:59 AM9/11/2023 11:31:08 PM9/11/2023 11:31 PM
ContactsPrimary ContactUpdateProfile Change RequestMcAllister, Anita System Director of 340B Operations SSM Health 9193576357McAllister, Anita System Director of 340B Operations SSM Health 31498967781/10/2023 9:39 AM
ContactsPrimary ContactUpdateGroup Change RequestViolette, Chelsea Director of Optimization Spendmend 8452066019McAllister, Anita System Director of 340B Operations SSM Health 919357635712/22/2022 12:07 PM
AddressesBilling AddressUpdateChange RequestSSM Cancer Care at St. Joseph Medical Park 1475 Kisker Road St. Peters, MO 63304DePaul Hospital 12303 DePaul Drive Bridgeton, MO 6304410/18/2022 4:28 PM
AddressesShipping AddressDeleteChange RequestSSM Cancer Care at St. Joseph Medical Park 1475 Kisker Road St. Peters, MO 63304 10/18/2022 4:28 PM
AddressesShipping AddressInsertChange Request DePaul Hospital 12303 DePaul Drive Bridgeton, MO 6304410/18/2022 4:28 PM
AddressesMain AddressUpdateChange Request 1475 Kisker Road St. Charles, MO 63304 1475 Kisker Road Suite 180 St. Charles, MO 6330410/18/2022 4:28 PM
ContactsPrimary ContactUpdateGroup Change RequestSharrow, Nicholas Director of 340B Operations SSM Health 6087075611Violette, Chelsea Director of Optimization Spendmend 84520660199/28/2022 11:10 AM
DetailsLast Recertification DateUpdateRecertification9/10/2021 11:32:30 AM9/14/2022 11:32:59 AM9/14/2022 11:32 AM
ContactsPrimary ContactUpdateGroup Change RequestCoultrip, Susan 340B Program Director SSM of Oklahoma 4058123230Sharrow, Nicholas Director of 340B Operations SSM Health 60870756118/22/2022 6:48 AM
ContactsPrimary ContactUpdateGroup Change RequestWhite, Tamika Senior Financial Analyst SSM Health 3149892320Coultrip, Susan 340B Program Director SSM of Oklahoma 40581232302/18/2022 7:30 AM
ContactsPrimary ContactUpdateChange RequestCoffer, Denise Sr. Financial Analysit SSM Health 3149892289White, Tamika Senior Financial Analyst SSM Health 314989232012/7/2021 1:13 PM
DetailsLast Recertification DateUpdateRecertification9/13/2020 9:52:20 PM9/10/2021 11:32:30 AM9/10/2021 11:32 AM
ContactsPrimary ContactUpdateGroup Change RequestPeine, Jeffrey Finance Director SSM Health 3149893532Coffer, Denise Sr. Financial Analysit SSM Health 31498922897/2/2021 6:32 AM
Medicaid BillingNPI: NumberInsertRecertification 15988353089/13/2020 9:52 PM
Medicaid BillingNPI: StateInsertRecertification MO9/13/2020 9:52 PM
Medicaid BillingNPI: NumberDeleteRecertification1598835308 ( ) 9/13/2020 9:52 PM
DetailsLast Recertification DateUpdateRecertification8/22/2019 11:05:05 PM9/13/2020 9:52:20 PM9/13/2020 9:52 PM
ContactsAuthorizing OfficialUpdateChange RequestRewerts, Karen D. Regional VP of Financa/CFO SSM Health 3149892034Lamm, Eileen Regional Vice President-Finance SSM Health 31499462194/30/2020 1:02 PM
DetailsLast Recertification DateUpdateRecertification8/25/2018 4:51:04 PM8/22/2019 11:05:05 PM8/22/2019 11:05 PM
DetailsLast Recertification DateUpdateRecertification11/9/2017 9:37:21 AM8/25/2018 4:51:04 PM8/25/2018 4:51 PM
ContactsPrimary ContactUpdateChange RequestSantee, Jennifer Senior Financial Analyst SSM Health 3149892225Peine, Jeffrey Finance Director SSM Health 31498935325/14/2018 11:20 AM
ContactsPrimary ContactUpdateChange RequestGeringer, Greta Finance Director SSM Health 3149893518Santee, Jennifer Senior Financial Analyst SSM Health 31498922253/1/2018 2:44 PM
DetailsLast Recertification DateUpdateRecertification8/11/2016 12:00:00 AM11/9/2017 9:37:21 AM11/9/2017 9:37 AM
AddressesBilling AddressInsertChange Request SSM Cancer Care at St. Joseph Medical Park 1475 Kisker Road St. Peters, MO 6330410/12/2017 12:43 PM
AddressesShipping AddressInsertChange Request SSM Cancer Care at St. Joseph Medical Park 1475 Kisker Road St. Peters, MO 6330410/12/2017 12:43 PM
ContactsAuthorizing OfficialUpdate Rewerts, Karen D. Regional VP of Financa/CFO 3149892034Rewerts, Karen D. Regional VP of Financa/CFO SSM Health 31498920349/19/2017 7:35 PM
ContactsPrimary ContactUpdate Geringer, Greta Finance Director 3149893518Geringer, Greta Finance Director SSM Health 31498935189/19/2017 11:20 AM
ContactsSigned ByInsert  Rewerts, Karen D. Regional VP of Financa/CFO 31498920348/9/2017 10:40 AM
ContactsPrimary ContactInsert  Geringer, Greta Finance Director 31498935187/27/2017 3:23 PM
ContactsAuthorizing OfficialInsert  Rewerts, Karen D. Regional VP of Financa/CFO 31498920347/27/2017 3:23 PM
AddressesMain AddressInsert   1475 Kisker Road St. Charles, MO 633047/13/2017 12:12 PM
DetailsLast Recertification DateUpdate 8/13/2015 12:00:00 AM8/11/2016 12:00:00 AM8/11/2016 3:54 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False7/5/2016 10:23 AM
Medicaid BillingMedicaid: NumberInsert  0104941027/5/2016 10:23 AM
Medicaid BillingMedicaid: StateInsert  MO7/5/2016 10:23 AM
Medicaid BillingNPI: NumberInsert  15988353087/5/2016 10:23 AM
DetailsLast Recertification DateUpdate 8/7/2014 12:00:00 AM8/13/2015 12:00:00 AM8/13/2015 11:03 AM
DetailsLast Recertification DateUpdate 8/22/2013 12:21:46 PM8/7/2014 12:00:00 AM8/7/2014 2:06 PM
DetailsLast Recertification DateUpdate  8/22/2013 12:21:46 PM8/22/2013 12:21 PM
Details340B IDUpdate IS-JH-DSH260104BDSH260104B6/27/2012 1:54 PM
DatesParticipating Approval DateUpdate  6/27/2012 12:00:00 AM6/27/2012 1:54 PM
DetailsStateUpdate PendingActive6/27/2012 1:54 PM
DatesStart DateUpdate  7/1/2012 12:00:00 AM6/27/2012 1:54 PM
Details340B IDUpdate OUTPATIENT_ONLINE_REGIS-JH-DSH260104B5/31/2012 11:45 AM
DetailsLast Recertification DateInsert   5/16/2012 1:59 PM
DetailsGrant NumberInsert   5/16/2012 1:59 PM
Details340B IDInsert  OUTPATIENT_ONLINE_REG5/16/2012 1:59 PM
DetailsIs Authorizing Official EHB DataInsert   5/16/2012 1:59 PM
DatesLast Date That 340B Drugs PurchasedInsert   5/16/2012 1:59 PM
DetailsMedicare Provider NumberInsert  2601045/16/2012 1:59 PM
DetailsEntity NameInsert  SSM DEPAUL HEALTH CENTER5/16/2012 1:59 PM
DetailsProgram CodeInsert  DSH5/16/2012 1:59 PM
DetailsEntity SubnameInsert  SSM Cancer Care at St. Joseph Medical Park5/16/2012 1:59 PM
DatesParticipating Approval DateInsert   5/16/2012 1:59 PM
DetailsStateInsert  Pending5/16/2012 1:59 PM
DatesRegistration DateInsert  5/16/2012 12:00:00 AM5/16/2012 1:59 PM
DatesSigned By DateInsert  5/16/2012 12:00:00 AM5/16/2012 1:59 PM
DatesStart DateInsert   5/16/2012 1:59 PM
TerminationsTermination CommentsInsert   5/16/2012 1:59 PM
TerminationsTermination DateInsert   5/16/2012 1:59 PM
TerminationsTermination Effective DateInsert   5/16/2012 1:59 PM
TerminationsTermination ReasonInsert   5/16/2012 1:59 PM