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DSH370037L SSM ST ANTHONY HOSPITAL (Terminated)
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Main Details
Name
SSM ST ANTHONY HOSPITAL
Subdivision Name
St. Anthony Vascular Associates
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370037L
Medicare Provider Number
370037
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/29/2014
Last Recertification Date
12/5/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
- SSM ST ANTHONY HOSPITAL
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Primary Contact
SSM of Oklahoma
Susan Coultrip, 340B Program Director
(405) 812-3230
Addresses
Street Address
608 N.W. 9th St.
Suite 2200
Oklahoma City, OK 73102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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