| Addresses | Main Address | Update | Change Request |
1475 Kisker Road, Suite 180
St. Charles, MO 63304 |
1475 Kisker Road, Suite 180
Saint Peters, MO 63304 | 9/25/2024 9:59 AM |
| Details | Last Recertification Date | Update | Recertification | 9/11/2023 9:02:05 PM | 8/15/2024 1:53:14 PM | 8/15/2024 1:53 PM |
| Details | Entity Name | Update | Recertification | SSM DEPAUL HEALTH HOSPITAL | SSM HEALTH DEPAUL HOSPITAL | 8/15/2024 1:46 PM |
| Details | Entity Name | Update | Change Request | SSM DEPAUL HEALTH CENTER | SSM DEPAUL HEALTH HOSPITAL | 7/17/2024 12:48 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/13/2024 9:28 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 431704972001 | 6/13/2024 9:28 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | IL | 6/13/2024 9:28 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/13/2024 9:28 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 43170497240 | 6/13/2024 9:28 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | IL | 6/13/2024 9:28 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1598835308 | 6/13/2024 9:28 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | IL | 6/13/2024 9:28 PM |
| Contacts | Primary Contact | Update | PC Change Request | McAllister, Anita
System Director of 340B Operations
SSM Health
3149896778 | Herring, Holly
Director, 340B Center of Excellence
SSM Health
5805127188 | 10/2/2023 6:49 AM |
| Details | Last Recertification Date | Update | Recertification | 9/16/2022 1:06:22 PM | 9/11/2023 9:02:05 PM | 9/11/2023 9:02 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 12:07 PM |
| Addresses | Billing Address | Update | Change Request | SSMCC - North - SJMP Ste 180
1475 Kisker Road
Suite 180
St. Peters, MO 63304 | DePaul Hospital
12303 DePaul Drive
Bridgeton, MO 63044 | 10/24/2022 7:20 AM |
| Addresses | Shipping Address | Delete | Change Request | SSMCC - North - SJMP Ste 180
1475 Kisker Road
Suite 180
St. Peters, MO 63304 | | 10/24/2022 7:20 AM |
| Addresses | Shipping Address | Insert | Change Request | | DePaul Hospital
12303 DePaul Drive
Bridgeton, MO 63044 | 10/24/2022 7:20 AM |
| Details | Entity Subname | Update | Change Request | SSMCC - North - SJMP Ste 180 | SSMCC MP Infusion | 10/24/2022 7:20 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 11:10 AM |
| Details | Last Recertification Date | Update | Recertification | 9/10/2021 11:43:49 AM | 9/16/2022 1:06:22 PM | 9/16/2022 1:06 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 6:48 AM |
| 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 7:30 AM |
| Contacts | Primary Contact | Update | Change Request | Coffer, Denise
Sr. Financial Analysit
SSM Health
3149892289 | White, Tamika
Senior Financial Analyst
SSM Health
3149892320 | 12/7/2021 1:09 PM |
| Details | Last Recertification Date | Update | Recertification | 9/13/2020 10:05:42 PM | 9/10/2021 11:43:49 AM | 9/10/2021 11:43 AM |
| Contacts | Primary Contact | Update | Group Change Request | Peine, Jeffrey
Finance Director
SSM Health
3149893532 | Coffer, Denise
Sr. Financial Analysit
SSM Health
3149892289 | 7/2/2021 6:32 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | MO | 9/13/2020 10:05 PM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2019 11:16:42 PM | 9/13/2020 10:05:42 PM | 9/13/2020 10:05 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 1:02 PM |
| Details | Last Recertification Date | Update | Recertification | 8/25/2018 5:15:17 PM | 8/22/2019 11:16:42 PM | 8/22/2019 11:16 PM |
| Details | Last Recertification Date | Update | Recertification | 11/13/2017 10:09:53 AM | 8/25/2018 5:15:17 PM | 8/25/2018 5:15 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 11:23 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 3:18 PM |
| Details | Last Recertification Date | Update | Recertification | 8/11/2016 12:00:00 AM | 11/13/2017 10:09:53 AM | 11/13/2017 10:09 AM |
| Addresses | Billing Address | Insert | Change Request | | SSMCC - North - SJMP Ste 180
1475 Kisker Road
Suite 180
St. Peters, MO 63304 | 10/12/2017 12:41 PM |
| Addresses | Shipping Address | Insert | Change Request | | SSMCC - North - SJMP Ste 180
1475 Kisker Road
Suite 180
St. Peters, MO 63304 | 10/12/2017 12:41 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 180
St. Charles, MO 63304 | 7/13/2017 12:12 PM |
| Details | Last Recertification Date | Update | | | 8/11/2016 12:00:00 AM | 8/11/2016 3:54 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/5/2016 10:17 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 010494102 | 7/5/2016 10:17 AM |
| Medicaid Billing | Medicaid: State | Insert | | | MO | 7/5/2016 10:17 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1598835308 | 7/5/2016 10:17 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | 9/30/2014 12:00:00 AM | | 8/31/2015 4:58 PM |
| Dates | Participating Approval Date | Update | | 8/29/2014 12:00:00 AM | 8/31/2015 12:00:00 AM | 8/31/2015 4:58 PM |
| Details | State | Update | | Terminated | Active | 8/31/2015 4:58 PM |
| Dates | Registration Date | Update | | 7/7/2014 12:00:00 AM | 7/2/2015 12:00:00 AM | 8/31/2015 4:58 PM |
| Dates | Signed By Date | Update | | 7/7/2014 12:00:00 AM | 7/2/2015 12:00:00 AM | 8/31/2015 4:58 PM |
| Dates | Start Date | Update | | 10/1/2014 12:00:00 AM | 10/1/2015 12:00:00 AM | 8/31/2015 4:58 PM |
| Terminations | Termination Comments | Update | | No expenses/revenues on 2013 filed CR. | | 8/31/2015 4:58 PM |
| Terminations | Termination Date | Update | | 1/1/2015 12:00:00 AM | | 8/31/2015 4:58 PM |
| Terminations | Termination Effective Date | Update | | 10/1/2014 12:00:00 AM | | 8/31/2015 4:58 PM |
| Terminations | Termination Reason | Update | | Other | | 8/31/2015 4:58 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 9/30/2014 12:00:00 AM | 11/24/2014 2:54 PM |
| Details | State | Update | | Active | Terminated | 11/24/2014 2:54 PM |
| Terminations | Termination Comments | Update | | | No expenses/revenues on 2013 filed CR. | 11/24/2014 2:54 PM |
| Terminations | Termination Date | Update | | | 1/1/2015 12:00:00 AM | 11/24/2014 2:54 PM |
| Terminations | Termination Effective Date | Update | | | 10/1/2014 12:00:00 AM | 11/24/2014 2:54 PM |
| Terminations | Termination Reason | Update | | | Other | 11/24/2014 2:54 PM |
| Dates | Participating Approval Date | Update | | | 8/29/2014 12:00:00 AM | 8/29/2014 3:31 PM |
| Details | State | Update | | Pending | Active | 8/29/2014 3:31 PM |
| Dates | Start Date | Update | | | 10/1/2014 12:00:00 AM | 8/29/2014 3:31 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_44550 | DSH260104K | 8/22/2014 2:09 PM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_44550 | 7/7/2014 11:50 AM |
| Details | Last Recertification Date | Insert | | | | 7/7/2014 11:50 AM |
| Details | Grant Number | Insert | | | | 7/7/2014 11:50 AM |
| Details | 340B ID | Insert | | | | 7/7/2014 11:50 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/7/2014 11:50 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/7/2014 11:50 AM |
| Details | Medicare Provider Number | Insert | | | 260104 | 7/7/2014 11:50 AM |
| Details | Entity Name | Insert | | | SSM DEPAUL HEALTH CENTER | 7/7/2014 11:50 AM |
| Details | Program Code | Insert | | | DSH | 7/7/2014 11:50 AM |
| Details | Entity Subname | Insert | | | SSMCC - North - SJMP Ste 180 | 7/7/2014 11:50 AM |
| Dates | Participating Approval Date | Insert | | | | 7/7/2014 11:50 AM |
| Details | State | Insert | | | Pending | 7/7/2014 11:50 AM |
| Dates | Registration Date | Insert | | | 7/7/2014 12:00:00 AM | 7/7/2014 11:50 AM |
| Dates | Signed By Date | Insert | | | 7/7/2014 12:00:00 AM | 7/7/2014 11:50 AM |
| Dates | Start Date | Insert | | | | 7/7/2014 11:50 AM |
| Terminations | Termination Comments | Insert | | | | 7/7/2014 11:50 AM |
| Terminations | Termination Date | Insert | | | | 7/7/2014 11:50 AM |
| Terminations | Termination Effective Date | Insert | | | | 7/7/2014 11:50 AM |
| Terminations | Termination Reason | Insert | | | | 7/7/2014 11:50 AM |