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RRC260180-05 CHRISTIAN HOSPITAL NORTHEAST (Active)
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Main Details
Name
CHRISTIAN HOSPITAL NORTHEAST
Subdivision Name
CHRISTIAN HOSPITAL NORTHEAST - RECOVERY CENTER - CHRISTIAN HOSPITAL NORTHEAST - RECOVERY CENTER
Type
Rural Referral Center
Rural
No
340B ID
RRC260180-05
Medicare Provider Number
260180
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/26/2024
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Barnes-Jewish Hospital
Paul John Irovic, Vice-president, Finance
(314) 265-8874
Primary Contact
Memorial Hospital
Ryan Birk, Director of Pharmacy
(618) 606-0210
Addresses
Street Address
11125 Dunn Rd
Ste 401
SAINT LOUIS, MO 63136
Billing Address
BJC Healthcare
4249 Clayton Avenue, 310
St. Louis, MO 63110
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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