340B Drug Pricing Program Database
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DSH260011Q SSM HEALTH-ST. MARYS-JEFFERSON CITY (ToBeTerminated)
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Main Details
Name
SSM HEALTH-ST. MARYS-JEFFERSON CITY
Subdivision Name
SMJMC Pulmonology - Pulmonology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260011Q
Medicare Provider Number
260011
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/8/2024
Participating Start Date
10/1/2024
Participating Approval Date
9/13/2024
Last Recertification Date
Termination Date
Termination Reason
7/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
- SSM ST ANTHONY HOSPITAL
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Primary Contact
SSM Health
Nathan Przybysz, 340b Program Manager
(314) 989-2214
Addresses
Street Address
2505 Mission Dr
Suite 130
Jefferson City, MO 65109
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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