340B Drug Pricing Program Database
SSM HEALTH SPECIALTY PHARMACY
RRC140034-00 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS - information as of 5/30/2025 8:34:34 PM
Covered Entity Details
Entity Name
ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140034-00
Entity Address
400 NORTH PLEASANT AVENUE
CENTRALIA, IL 62801
Medicare Provider Number
140034
Participating Start Date
4/1/2011
Last Recertification Date
9/19/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
SSM HEALTH SPECIALTY PHARMACY
Pharmacy Address
SSM HEALTH CARE ST. LOUIS - OWNER
3662 PARK AVE STE 155
SAINT LOUIS, MO 63110
Pharmacy Comments
Contract Details
Approval Date
7/11/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Contract Pharmacy Representative
SSM Health
Eric Huckins, Pharmacy Manager
(608) 824-2682
Signed By Date
7/11/2022
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