340B Drug Pricing Program Database
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DSH140185AT MEMORIAL HOSPITAL (Active)
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Main Details
Name
MEMORIAL HOSPITAL
Subdivision Name
MHE CARDIAC CATH LAB
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140185AT
Medicare Provider Number
140185
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/9/2024
Last Recertification Date
8/17/2024
Contacts
Authorizing Official
Christain Hospital - BJC
Susan Koesterer, VP, Chief Financial Officer
(314) 653-5715
Primary Contact
Memorial Hospital
Ryan Birk, Director of Pharmacy
(618) 606-0210
Addresses
Street Address
1404 Cross St
Shiloh, IL 62269
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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