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DSH260091DG SSM HEALTH ST MARY'S HOSPITAL-STL (Terminated)
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Main Details
Name
SSM HEALTH ST MARY'S HOSPITAL-STL
Subdivision Name
SLUCare Vascular Surgery - SLUCare VAS St Clare
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260091DG
Medicare Provider Number
260091
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/19/2024
Last Recertification Date
Termination Date
Termination Reason
10/1/2024
Hospital Outpatient facility no longer eligible
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
1101 Bowles Avenue
425
Fenton, MO 63026
Billing Address
SSM Health St. Mary's Hospital- STL
6420 Clayton Road
St. Louis, MO 63117
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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