| Details | State | Update | | To Be Terminated | Terminated | 7/1/2023 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 5/5/2023 12:00:00 AM | 5/11/2023 11:01 AM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 5/11/2023 11:01 AM |
| Terminations | Termination Comments | Update | Termination Request | | May 2023: informed final DSH% for FY22 = 7.12% which is below minimum threshold for RRC designation | 5/11/2023 11:01 AM |
| Terminations | Termination Date | Update | Termination Request | | 7/1/2023 12:00:00 AM | 5/11/2023 11:01 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 5/8/2023 12:00:00 AM | 5/11/2023 11:01 AM |
| Terminations | Termination Reason | Update | Termination Request | | DSH percentage below statutory minimum | 5/11/2023 11:01 AM |
| Details | Entity Subname | Update | Change Request | SMGS Centralia Surgery | SMC - Surgery | 1/19/2023 1:44 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 | 12/2/2022 6:31 AM |
| Addresses | Billing Address | Insert | Group Change Request | | St Mary's Hospital Centralia
400 North Pleasant Ave
Centralia, IL 62801 | 10/18/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Group Change Request | | St Mary's Hospital Centralia
400 North Pleasant Ave
Centralia, IL 62801 | 10/18/2022 9:40 AM |
| Contacts | Primary Contact | Update | Group Change Request | Sharrow, Nicholas
Director of 340B Operations
SSM Health
6087075611 | Violette, Chelsea
Director of Optimization
Spendmend
8452066019 | 10/10/2022 5:34 PM |
| Details | Last Recertification Date | Update | Recertification | 9/8/2021 4:43:32 PM | 9/16/2022 12:46:05 PM | 9/16/2022 12:46 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Sharrow, Nicholas
Director of Pharmacy
SSM Health
9203246757 | Sharrow, Nicholas
Director of 340B Operations
SSM Health
6087075611 | 8/17/2022 5:26 PM |
| Contacts | Primary Contact | Update | Group Change Request | Coultrip, Susan
340B Program Director
SSM of Oklahoma
4058123230 | Sharrow, Nicholas
Director of Pharmacy
SSM Health
9203246757 | 8/16/2022 11:32 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Harbison, Damon
President
SSM Health - St. Mary's Hospital Centralia, IL
6184368000 | Lamm, Eileen
Regional Vice President-Finance
SSM Health
3149946219 | 4/15/2022 9:24 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 | 2/14/2022 11:59 AM |
| Contacts | Primary Contact | Update | Change Request | Coffer, Denise
Sr. Financial Analysit
SSM Health
3149892289 | White, Tamika
Senior Financial Analyst
SSM Health
3149892320 | 12/3/2021 7:43 AM |
| Details | Last Recertification Date | Update | Recertification | 9/11/2020 10:39:30 AM | 9/8/2021 4:43:32 PM | 9/8/2021 4:43 PM |
| Contacts | Primary Contact | Update | Group Change Request | Peine, Jeffrey
Finance Director
SSM Health
3149893532 | Coffer, Denise
Sr. Financial Analysit
SSM Health
3149892289 | 7/8/2021 4:08 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1083617245 | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | IL | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1255391611 | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | IL | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1629003074 | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | IL | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1710105192 | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | IL | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1770687196 | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | IL | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1083617245 ( ) | | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1770687196 ( ) | | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1629003074 ( ) | | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1710105192 ( ) | | 9/11/2020 10:39 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1255391611 ( ) | | 9/11/2020 10:39 AM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2019 1:56:15 PM | 9/11/2020 10:39:30 AM | 9/11/2020 10:39 AM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2018 4:55:05 PM | 8/19/2019 1:56:15 PM | 8/19/2019 1:56 PM |
| Contacts | Authorizing Official | Update | Change Request | Swanson, Kerry
Regional President
SSM Health
6184366500 | Harbison, Damon
President
SSM Health - St. Mary's Hospital Centralia, IL
6184368000 | 7/1/2019 6:48 AM |
| Details | Last Recertification Date | Update | Recertification | 11/14/2017 11:32:15 AM | 8/21/2018 4:55:05 PM | 8/21/2018 4:55 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Peine, Jeffrey
Sr. Financial Analyst 340B
SSM Health
3149893532 | Peine, Jeffrey
Finance Director
SSM Health
3149893532 | 4/12/2018 5:13 PM |
| Contacts | Authorizing Official | Update | Change Request | Sigsbury, John
PRESIDENT
SSM St. Mary's Hospital - Centralia
6184366525 | Swanson, Kerry
Regional President
SSM Health
6184366500 | 1/23/2018 7:42 AM |
| Contacts | Primary Contact | Update | Change Request | Geringer, Greta
Finance Director
SSM Health
3149893518 | Peine, Jeffrey
Sr. Financial Analyst 340B
SSM Health
3149893532 | 1/19/2018 2:16 PM |
| Details | Entity Name | Update | Recertification | SSM HEALTH ST. MARYS HOSPITAL | ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS | 11/16/2017 12:30 PM |
| Details | Last Recertification Date | Update | Recertification | | 11/14/2017 11:32:15 AM | 11/14/2017 11:32 AM |
| Contacts | Authorizing Official | Update | | Sigsbury, John
PRESIDENT
6184366525 | Sigsbury, John
PRESIDENT
SSM St. Mary's Hospital - Centralia
6184366525 | 10/17/2017 3:01 PM |
| Contacts | Primary Contact | Update | | Geringer, Greta
Finance Director
3149893518 | Geringer, Greta
Finance Director
SSM Health
3149893518 | 9/19/2017 11:20 AM |
| Contacts | Authorizing Official | Update | | Sigsbury, John
PRESIDENT
6184366525 | Sigsbury, John
PRESIDENT
6184366525 | 9/11/2017 3:29 PM |
| Contacts | Primary Contact | Insert | | | Geringer, Greta
Finance Director
3149893518 | 7/27/2017 3:23 PM |
| Contacts | Authorizing Official | Insert | | | Sigsbury, John
PRESIDENT
6184366525 | 5/23/2017 11:51 AM |
| Contacts | Signed By | Insert | | | Sigsbury, John
PRESIDENT
6184366525 | 5/23/2017 11:51 AM |
| Addresses | Main Address | Insert | | |
1054 Martin Luther King Jr. Drive, Suite 125
Centralia, IL 62801 | 5/1/2017 1:34 PM |
| Details | 340B ID | Update | | RRC140034-16 | RRC140034-05 | 5/1/2017 1:32 PM |
| Dates | Participating Approval Date | Update | | | 5/1/2017 12:00:00 AM | 5/1/2017 1:32 PM |
| Details | State | Update | | Pending | Active | 5/1/2017 1:32 PM |
| Dates | Start Date | Update | | | 7/1/2017 12:00:00 AM | 5/1/2017 1:32 PM |
| Details | 340B ID | Update | | RRC140046-16 | RRC140034-16 | 4/25/2017 8:13 AM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_76772 | RRC140046-16 | 4/19/2017 11:19 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1083617245 | 4/12/2017 5:12 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1770687196 | 4/12/2017 5:12 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1629003074 | 4/12/2017 5:12 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1710105192 | 4/12/2017 5:12 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1255391611 | 4/12/2017 5:12 PM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_76772 | 4/12/2017 5:12 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 4/12/2017 5:12 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 370662580001 | 4/12/2017 5:12 PM |
| Medicaid Billing | Medicaid: State | Insert | | | IL | 4/12/2017 5:12 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 4/12/2017 5:12 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 370662580401 | 4/12/2017 5:12 PM |
| Medicaid Billing | Medicaid: State | Insert | | | IL | 4/12/2017 5:12 PM |
| Details | Last Recertification Date | Insert | | | | 4/12/2017 5:12 PM |
| Details | Grant Number | Insert | | | | 4/12/2017 5:12 PM |
| Details | 340B ID | Insert | | | | 4/12/2017 5:12 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/12/2017 5:12 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/12/2017 5:12 PM |
| Details | Medicare Provider Number | Insert | | | 140034 | 4/12/2017 5:12 PM |
| Details | Entity Name | Insert | | | SSM HEALTH ST. MARYS HOSPITAL | 4/12/2017 5:12 PM |
| Details | Program Code | Insert | | | RRC | 4/12/2017 5:12 PM |
| Details | Entity Subname | Insert | | | SMGS Centralia Surgery | 4/12/2017 5:12 PM |
| Dates | Participating Approval Date | Insert | | | | 4/12/2017 5:12 PM |
| Details | State | Insert | | | Pending | 4/12/2017 5:12 PM |
| Dates | Registration Date | Insert | | | 4/12/2017 12:00:00 AM | 4/12/2017 5:12 PM |
| Dates | Signed By Date | Insert | | | 4/12/2017 12:00:00 AM | 4/12/2017 5:12 PM |
| Dates | Start Date | Insert | | | | 4/12/2017 5:12 PM |
| Terminations | Termination Comments | Insert | | | | 4/12/2017 5:12 PM |
| Terminations | Termination Date | Insert | | | | 4/12/2017 5:12 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/12/2017 5:12 PM |
| Terminations | Termination Reason | Insert | | | | 4/12/2017 5:12 PM |