Covered Entity Details

DSH260005C SSM HEALTH ST. JOSEPH HOSPITAL- SC (Active) - information as of 4/30/2025 10:54:52 PM

Main Details

Name

SSM HEALTH ST. JOSEPH HOSPITAL- SC

Subdivision Name

SSM Heart Institute Cardiac Imaging

Type

Disproportionate Share Hospital

Rural

340B ID

DSH260005C

Medicare Provider Number

260005

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

5/16/2012

Participating Start Date

7/1/2012

Participating Approval Date

6/18/2012

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

1475 Kisker Road, Suite 220
St. Charles, MO 63304

Billing Address

SSM ST. JOSEPH HEALTH CENTER
300 FIRST CAPITAL DRIVE
ST. CHARLES, MO 63301

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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
IL	430652671003,430652671403	1467521146
MO	010418101	1467521146

Shipping Addresses

Shipping Address 1

SSM St. Joseph Health Center
300 First Capitol Drive
St. Charles, MO 63301

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH260005A	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	WENTZVILLE	500 MEDICAL DRIVE	WENTZVILLE	MO	Active
DSH260005AA	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG St. Peters IM/FP	6994 Mexico Road	St. Peters	MO	Active
DSH260005AB	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM HEART INSTITUTE AT ST. CHARLES COUNTY MEDICAL GROUP	5401 Veterans Memorial Parkway	St. Peters	MO	Active
DSH260005AD	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SSMHI at SCCMG - Wall Street Ste 330 / Heart Institute	1551 Wall Street	St. Charles	MO	Terminated
DSH260005AE	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG Wall Street Pediatrics	711 Veterans Memorial Parkway	St. Charles	MO	Active
DSH260005AF	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG Wall Street Family Medicine & Internal Medicine	711 Veterans Memorial Parkway	St. Charles	MO	Active
DSH260005AG	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG SJMOB Gen Surg Ste 201	400 First Capitol Drive	St. Charles	MO	Active
DSH260005AH	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG SJMOB GI Ste 201	400 First Capitol Drive	St. Charles	MO	Active
DSH260005AJ	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG SJMOB OB/GYN Ste 201	400 First Capitol Drive	St. Charles	MO	Active
DSH260005AM	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SCCMG SJMOB GYN/Onc Ste 201	330 First Capitol Drive	St. Charles	MO	Terminated
DSH260005AN	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	CARDIO THORACIC SERVICES INC	1551 Wall Street	St. Charles	MO	Terminated
DSH260005AP	Child	DSH	SSM ST. JOSEPH HEALTH HOSPITAL- SC	SJHC Anesthesiology	500 Medical Drive	Wentzville	MO	Terminated
DSH260005AQ	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM St. Joseph Health Center Clinic / BHM OP GERO/SPMI - WZ	500 Medical Drive	Wentzville	MO	Active
DSH260005AR	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM St. Joseph Health Center / BHM OP Brief Treatment - WZ	600 Medical Drive	Wentzville	MO	Active
DSH260005AS	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJHC Emergency	500 Medical Drive	Wentzville	MO	Active
DSH260005AT	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SJHC Electroencephalography	500 Medical Drive	Wentzville	MO	Terminated
DSH260005AU	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SJHC Electrocardiology	500 Medical Drive	Wentzville	MO	Terminated
DSH260005AV	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SJHC Respiratory Therapy	500 Medical Drive	Wentzville	MO	Terminated
DSH260005AW	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SJHC Radiology - Therapeutic	500 Medical Drive	Wentzville	MO	Terminated
DSH260005AX	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJHC Radiology - Diagnostic	500 Medical Drive	Wentzville	MO	Active
DSH260005AY	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM PAIN CARE	1475 Kisker Road	SAINT CHARLES	MO	Active
DSH260005AZ	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM ST JOSEPH HEALTH CENTER/SSM PAIN	1601 WENTZVILLE PARKWAY	WENTZVILLE	MO	Active
DSH260005B	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Urgent Care Center	1475 Kisker Road, Suite 120	St. Charles	MO	Active
DSH260005BA	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCC 1st Capitol Pulmonary	400 First Capitol Drive	St. Charles	MO	Active
DSH260005BB	Child	DSH	SSM ST. JOSEPH HEALTH HOSPITAL- SC	BHM OP GERO/SPMI - WZ / Behavioral Health Gero/SPMI Clinic	600 Medical Drive	Wentzville	MO	Terminated
DSH260005BC	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SCC Endocrinology-Wall, Suite 430 / Endocrinology Clinic	1551 Wall Street, Suite 430	St. Charles	MO	Terminated
DSH260005BD	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM / Anticoagulation Clinic	711 Veterans Memorial Parkway	St. Charles	MO	Active
DSH260005BF	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM SCCMG / Primary Care WZ	1598 W. Meyer Rd	Wentzville	MO	Active
DSH260005BG	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM / Wound Center Suite 120	330 First Capitol Drive	St. Charles	MO	Active
DSH260005BH	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM / Endoscopy, lower Level	330 First Capitol Drive	St. Charles	MO	Active
DSH260005BJ	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SSM / Vascular Procedure Center, Suite 100	330 First Capitol MOB 1, Suite 100	St. Charles	MO	Terminated
DSH260005BK	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Wentzville / MRI	1598 West Meyer Rd	Wentzville	MO	Active
DSH260005BL	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Med Park / MRI	1475 Kisker Road, Floor 1	St. Charles	MO	Active
DSH260005BM	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Wentzville / CT Scan	1598 West Meyer Rd	Wentzville	MO	Active
DSH260005BN	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Med Park / CT Scan	1475 Kisker Road, Floor 1	St. Charles	MO	Active
DSH260005BP	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM SJOPC / Ultrasound	711 Veterans Memorial Parkway	St. Charles	MO	Active
DSH260005BQ	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Wentzville / Ultrasound	1598 West Meyer Rd	Wentzville	MO	Active
DSH260005BR	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Med Park / Ultrasound	1475 Kisker Road	St. Charles	MO	Active
DSH260005BS	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Maternal Fetal Med / Suite 210	330 First Capitol Drive, MOB 1 Suite 210	St. Charles	MO	Active
DSH260005BT	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM SJHC Infusion Center	330 First Capitol Drive	St. Charles	MO	Active
DSH260005BU	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJOPC MRI	711 Veterans Memorial Parkway	Saint Charles	MO	Active
DSH260005BV	Child	DSH	SSM ST. JOSEPH HEALTH HOSPITAL- SC	Behavioral Health Medicine Wentzville - Brief Treatment	500 Medical Drive	Saint Charles	MO	Terminated
DSH260005BW	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJOPC CT	711 Veterans Memorial Parkway	Saint Charles	MO	Active
DSH260005BX	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SSM Medical Group Pediatrics-Wentzville - Pediatrics	1598 West Meyer Road	Wentzville	MO	Terminated
DSH260005BY	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Wentzville - Mammography	1598 West Meyer Road	Wentzville	MO	Active
DSH260005BZ	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJOPC - Radiology	711 Veterans Memorial Parkway	St. Charles	MO	Active
DSH260005C	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Heart Institute Cardiac Imaging	1475 Kisker Road, Suite 220	St. Charles	MO	Active
DSH260005CA	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSMMG - Neurology - Kisker	1475 Kisker Road	St. Charles	MO	Active
DSH260005CB	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	Behavioral Health Services - Outpatient Substance Use Disorder	330 First Capitol Drive	St. Charles	MO	Active
DSH260005CC	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Med Park - Mammography & Bone Density	1475 Kisker Road	St. Charles	MO	Active
DSH260005CD	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Med Park - Radiology	1475 Kisker Road	St. Charles	MO	Active
DSH260005CE	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	St. Joseph Health Care - Women's Services	330 First Capitol Drive	St. Charles	MO	Terminated
DSH260005CF	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	St. Joseph Hospital - Cardiac Imaging	400 First Capitol Drive	St. Charles	MO	Active
DSH260005CG	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	St. Joseph Health - Infusion Clinic - Monoclonal Antibodies	330 First Capital Drive	St. Charles	MO	Terminated
DSH260005CH	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJOPC - Mammography	711 Veterans Memorial Parkway	St. Charles	MO	Active
DSH260005CJ	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJHC - Obstetric Care Clinic	330 First Capitol Drive	St. Charles	MO	Active
DSH260005CK	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Wentzville - CT Scan	500 Medical Drive	Wentzville	MO	Active
DSH260005CL	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Med Park - PET Scan	1475 Kisker Road	St. Charles	MO	Active
DSH260005CM	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Wentzville - Radiology	1598 West Meyer Road	Wentzville	MO	Active
DSH260005CN	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJMP - Sleep Medicine	1475 Kisker Road	St. Charles	MO	Active
DSH260005CP	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJMP Pain Management - Kisker	1475 Kisker Road	St. Charles	MO	Active
DSH260005CQ	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJHC - Neurology Clinic	400 First Capitol Drive	St. Charles	MO	Active
DSH260005CR	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SSMMG - Cardiovascular Services - St. Charles	400 First Capitol Drive	St. Charles	MO	Terminated
DSH260005CS	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSMMG - Cardiovascular Services - First Capitol	400 First Capitol Drive	St. Charles	MO	Active
DSH260005CT	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SJOPC - Urgent Care	1551 Wall Street	St. Charles	MO	Terminated
DSH260005CU	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Health Sleep Services - SCCMG Pulmonary WZ	1603 Wentzville Pkwy	Wentzville	MO	Active
DSH260005CV	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	St. Joseph Behavioral Health Clinic- Wentzville - Long-acting injectable clinic	600 Medical Drive	Wentzville	MO	Active
DSH260005CW	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSMMG Endocrinology OFallon PBB - Endocrinology	1101 Highway K	OFallon	MO	Active
DSH260005CX	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSMMG FM/IM OFallon PBB - Family/Internal Medicine	1101 Highway K	OFallon	MO	Active
DSH260005CY	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSMMG OBGYN OFallon PBB - OB/GYN	1101 Highway K	OFallon	MO	Active
DSH260005CZ	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	Outpatient Surgery Center- Kisker - Ambulatory Surgery Center	1475 Kisker Road	St. Charles	MO	Active
DSH260005D	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Heart Institute Cardiac Diagnostics	400 First Capitol Drive Suite 401	St. Charles	MO	Active
DSH260005DA	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Health St. Joseph Urgent Care-Wentzville - Urgent Care	1601 Wentzville Parkway	Wentzville	MO	Active
DSH260005E	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM Heart Institute Cardiovascular Diagnostics	5401 Veterens Memorial Parkway, Suite 101A	St. Peters	MO	Active
DSH260005F	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM St. Joseph Health Center OP Infusion Center	400 First Capital Drive, Suite 201	St. Charles	MO	Terminated
DSH260005G	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SJSC OPC Urgent Care	711 Veterans Memorial Parkway	SAINT CHARLES	MO	Active
DSH260005K	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SCCMG Wall Street Podiatry Ste 400	1551 Wall Street, Suite 400	St. Charles	MO	Terminated
DSH260005L	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM ORTHOPEDICS INC - First Capitol	400 First Capitol Drive	St. Charles	MO	Active
DSH260005M	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SSMMG Allergy & Immunology Outpatient Center at St. Charles	711 Veterans Memorial Parkway	St. Charles	MO	Terminated
DSH260005N	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM ORTHOPEDICS INC. ST JOSEPH MED PARK	1475 Kisker Road	St. Charles	MO	Active
DSH260005P	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSM-ORTHOPEDICS - Wtz Ste 400	801 Medical Drive	Wentzville	MO	Active
DSH260005Q	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SCCMG IM - First Cap Ste 100	400 First Capitol Drive	St. Charles	MO	Terminated
DSH260005R	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG SJMOB Vasc Surgery Ste 100A	330 First Capitol Drive	St. Charles	MO	Active
DSH260005S	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG Wall Street Endo	711 Veterans Memorial Parkway	St. Charles	MO	Active
DSH260005T	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	NSI First Capitol / Neurosciences Institute	330 First Capitol Drive	St. Charles	MO	Active
DSH260005V	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SSMMG Heart Institute	1475 Kisker Road	St. Charles	MO	Active
DSH260005W	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG SJMP OB/GYN Ste 200	1475 Kisker Road	St. Charles	MO	Active
DSH260005X	Child	DSH	SSM ST. JOSEPH HEALTH CENTER	SCCMG SJMP Pediatrics Ste 200	1475 Kisker Road	St. Charles	MO	Terminated
DSH260005Y	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG SJMP FM Ste 200	1475 Kisker Road	St. Charles	MO	Active
DSH260005Z	Child	DSH	SSM HEALTH ST. JOSEPH HOSPITAL- SC	SCCMG SJMP General Ste 200	1475 Kisker Road	St. Charles	MO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Entity Name	Update	Change Request	SSM ST. JOSEPH HEALTH HOSPITAL- SC	SSM HEALTH ST. JOSEPH HOSPITAL- SC	10/17/2024 10:20 AM
Details	Last Recertification Date	Update	Recertification	9/11/2023 4:14:30 PM	8/15/2024 2:06:21 PM	8/15/2024 2:06 PM
Details	Entity Name	Update	Change Request	SSM ST. JOSEPH HEALTH CENTER	SSM ST. JOSEPH HEALTH HOSPITAL- SC	7/16/2024 12:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/13/2024 3:37 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		430652671003	6/13/2024 3:37 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	6/13/2024 3:37 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/13/2024 3:37 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		430652671403	6/13/2024 3:37 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	6/13/2024 3:37 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1467521146	6/13/2024 3:37 PM
Medicaid Billing	NPI: State	Insert	Change Request		IL	6/13/2024 3:37 PM
Contacts	Primary Contact	Update	Recertification	McAllister, Anita System Director of 340B Operations SSM Health 3149896778	Herring, Holly Director, 340B Center of Excellence SSM Health 5805127188	9/11/2023 4:14 PM
Details	Last Recertification Date	Update	Recertification	9/16/2022 12:37:15 PM	9/11/2023 4:14:30 PM	9/11/2023 4:14 PM
Contacts	Primary Contact	Update	Profile Change Request	McAllister, Anita System Director of 340B Operations SSM Health 9193576357	McAllister, Anita System Director of 340B Operations SSM Health 3149896778	1/10/2023 9:39 AM
Contacts	Primary Contact	Update	Group Change Request	Violette, Chelsea Director of Optimization Spendmend 8452066019	McAllister, Anita System Director of 340B Operations SSM Health 9193576357	12/22/2022 10:20 AM
Addresses	Shipping Address	Delete	Change Request	SSM ST. JOSEPH HEALTH CENTER 300 FIRST CAPITAL DRIVE ST. CHARLES, MO 63301		12/15/2022 10:46 AM
Contacts	Primary Contact	Update	Group Change Request	Sharrow, Nicholas Director of 340B Operations SSM Health 6087075611	Violette, Chelsea Director of Optimization Spendmend 8452066019	9/28/2022 12:20 PM
Details	Last Recertification Date	Update	Recertification	9/9/2021 10:59:17 PM	9/16/2022 12:37:15 PM	9/16/2022 12:37 PM
Contacts	Primary Contact	Update	Group Change Request	Coultrip, Susan 340B Program Director SSM of Oklahoma 4058123230	Sharrow, Nicholas Director of 340B Operations SSM Health 6087075611	8/22/2022 6:53 AM
Addresses	Shipping Address	Insert	Group Change Request		SSM ST. JOSEPH HEALTH CENTER 300 FIRST CAPITAL DRIVE ST. CHARLES, MO 63301	7/21/2022 12:06 PM
Addresses	Billing Address	Update	Group Change Request	SSM St. Joseph Health Center 300 First Capitol Drive St. Charles, MO 63301	SSM ST. JOSEPH HEALTH CENTER 300 FIRST CAPITAL DRIVE ST. CHARLES, MO 63301	7/21/2022 12:06 PM
Contacts	Primary Contact	Update	Group Change Request	White, Tamika Senior Financial Analyst SSM Health 3149892320	Coultrip, Susan 340B Program Director SSM of Oklahoma 4058123230	2/18/2022 8:16 AM
Details	Last Recertification Date	Update	Recertification	9/13/2020 10:03:05 PM	9/9/2021 10:59:17 PM	9/9/2021 10:59 PM
Contacts	Primary Contact	Update	Group Change Request	Peine, Jeffrey Finance Director SSM Health 3149893532	White, Tamika Senior Financial Analyst SSM Health 3149892320	7/2/2021 8:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1467521146	9/13/2020 10:03 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/13/2020 10:03 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1467521146 ( )		9/13/2020 10:03 PM
Details	Last Recertification Date	Update	Recertification	8/22/2019 11:00:40 PM	9/13/2020 10:03:05 PM	9/13/2020 10:03 PM
Contacts	Authorizing Official	Update	Change Request	Rewerts, Karen D. Regional VP of Financa/CFO SSM Health 3149892034	Lamm, Eileen Regional Vice President-Finance SSM Health 3149946219	4/30/2020 8:11 AM
Details	Last Recertification Date	Update	Recertification	8/25/2018 4:49:51 PM	8/22/2019 11:00:40 PM	8/22/2019 11:00 PM
Details	Last Recertification Date	Update	Recertification	11/10/2017 3:30:49 PM	8/25/2018 4:49:51 PM	8/25/2018 4:49 PM
Contacts	Primary Contact	Update	Change Request	Santee, Jennifer Senior Financial Analyst SSM Health 3149892225	Peine, Jeffrey Finance Director SSM Health 3149893532	5/14/2018 11:28 AM
Contacts	Primary Contact	Update	Change Request	Geringer, Greta Finance Director SSM Health 3149893518	Santee, Jennifer Senior Financial Analyst SSM Health 3149892225	3/1/2018 2:42 PM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	11/10/2017 3:30:49 PM	11/10/2017 3:30 PM
Contacts	Authorizing Official	Update		Rewerts, Karen D. Regional VP of Financa/CFO 3149892034	Rewerts, Karen D. Regional VP of Financa/CFO SSM Health 3149892034	9/19/2017 7:35 PM
Contacts	Primary Contact	Update		Geringer, Greta Finance Director 3149893518	Geringer, Greta Finance Director SSM Health 3149893518	9/19/2017 11:20 AM
Contacts	Signed By	Insert			Rewerts, Karen D. Regional VP of Financa/CFO 3149892034	8/9/2017 10:40 AM
Contacts	Primary Contact	Insert			Geringer, Greta Finance Director 3149893518	7/27/2017 3:23 PM
Contacts	Authorizing Official	Insert			Rewerts, Karen D. Regional VP of Financa/CFO 3149892034	7/27/2017 3:23 PM
Addresses	Main Address	Insert			1475 Kisker Road, Suite 220 St. Charles, MO 63304	7/13/2017 6:40 PM
Addresses	Billing Address	Insert			SSM St. Joseph Health Center 300 First Capitol Drive St. Charles, MO 63301	7/13/2017 6:40 PM
Addresses	Shipping Address	Insert			SSM St. Joseph Health Center 300 First Capitol Drive St. Charles, MO 63301	7/13/2017 6:40 PM
Details	Last Recertification Date	Update		8/13/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 2:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/5/2016 10:24 AM
Medicaid Billing	Medicaid: Number	Insert			010418101	7/5/2016 10:24 AM
Medicaid Billing	Medicaid: State	Insert			MO	7/5/2016 10:24 AM
Medicaid Billing	NPI: Number	Insert			1467521146	7/5/2016 10:24 AM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/13/2015 12:00:00 AM	8/13/2015 11:29 AM
Details	Last Recertification Date	Update		8/22/2013 12:20:09 PM	8/7/2014 12:00:00 AM	8/7/2014 2:04 PM
Details	Last Recertification Date	Update			8/22/2013 12:20:09 PM	8/22/2013 12:20 PM
Details	Entity Subname	Update		SSM Heath Institute Cardiac Imaging	SSM Heart Institute Cardiac Imaging	7/5/2013 10:36 AM
Details	340B ID	Update		IS-JH-DSH260005C	DSH260005C	6/18/2012 5:34 PM
Dates	Participating Approval Date	Update			6/18/2012 12:00:00 AM	6/18/2012 5:34 PM
Details	State	Update		Pending	Active	6/18/2012 5:34 PM
Dates	Start Date	Update			7/1/2012 12:00:00 AM	6/18/2012 5:34 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-JH-DSH260005C	5/31/2012 11:12 AM
Details	Last Recertification Date	Insert				5/16/2012 2:23 PM
Details	Grant Number	Insert				5/16/2012 2:23 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	5/16/2012 2:23 PM
Details	Is Authorizing Official EHB Data	Insert				5/16/2012 2:23 PM
Dates	Last Date That 340B Drugs Purchased	Insert				5/16/2012 2:23 PM
Details	Medicare Provider Number	Insert			260005	5/16/2012 2:23 PM
Details	Entity Name	Insert			SSM ST. JOSEPH HEALTH CENTER	5/16/2012 2:23 PM
Details	Program Code	Insert			DSH	5/16/2012 2:23 PM
Details	Entity Subname	Insert			SSM Heath Institute Cardiac Imaging	5/16/2012 2:23 PM
Dates	Participating Approval Date	Insert				5/16/2012 2:23 PM
Details	State	Insert			Pending	5/16/2012 2:23 PM
Dates	Registration Date	Insert			5/16/2012 12:00:00 AM	5/16/2012 2:23 PM
Dates	Signed By Date	Insert			5/16/2012 12:00:00 AM	5/16/2012 2:23 PM
Dates	Start Date	Insert				5/16/2012 2:23 PM
Terminations	Termination Comments	Insert				5/16/2012 2:23 PM
Terminations	Termination Date	Insert				5/16/2012 2:23 PM
Terminations	Termination Effective Date	Insert				5/16/2012 2:23 PM
Terminations	Termination Reason	Insert				5/16/2012 2:23 PM