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RRC140034-00 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS (Terminated)
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Main Details
Name
ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140034-00
Medicare Provider Number
140034
Additional Details
Current Program Status
Terminated
Registration Date
2/21/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/3/2011
Last Recertification Date
9/19/2022
Termination Date
Termination Reason
7/1/2023
DSH percentage below statutory minimum
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
SSM Health
Anita McAllister, System Director of 340B Operations
(314) 989-6778
Addresses
Street Address
400 NORTH PLEASANT AVENUE
CENTRALIA, IL 62801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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03/03/11 DOC RECD TO CONFIRM ELIG DSH ADJ %.04/29/11 DELETED MEDICAID#(WAS 370662580001 AND #370662580401)
04/29/2011
April 2025
April 2025
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