340B Drug Pricing Program Database
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DSH260104BF SSM HEALTH DEPAUL HOSPITAL (Active)
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Main Details
Name
SSM HEALTH DEPAUL HOSPITAL
Subdivision Name
Wound Center - Wound Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260104BF
Medicare Provider Number
260104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/7/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/7/2024
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
12266 DePaul Dr
Suite 310
Bridgeton, MO 63044
Billing Address
DePaul Hospital
12303 DePaul Drive
Bridgeton, MO 63044
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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