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RRC140046-00 SSM HEALTH GOOD SAMARITAN HOSPITAL (Approved)
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Main Details
Name
SSM HEALTH GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140046-00
Medicare Provider Number
140046
Additional Details
Current Program Status
Approved
Registration Date
4/5/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/5/2025
Last Recertification Date
Contacts
Authorizing Official
SSM Health
Karen D. Rewerts, System VP of Finance
(557) 203-3614
Primary Contact
SSM Health
Michelle Nicole Schmitt, VP Pharmacy Financial Operations
(608) 294-6203
Addresses
Street Address
1 GOOD SAMARITAN WAY
MT. VERNON, IL 62864
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 10/1/2015, Termination 7/1/2023, Reinstatement 7/1/2025
05/02/2025
Participated starting 7/1/11, terminated 7/1/12 through 10/1/15 due to DSH percentage below statutory minimum, reinstated based on new registration submitted in July 2015
08/11/2015
June 2025
June 2025
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