340B Drug Pricing Program Database
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DSH370037M SSM ST ANTHONY HOSPITAL (Terminated)
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Main Details
Name
SSM ST ANTHONY HOSPITAL
Subdivision Name
St. Anthony Pulmonary Specialty Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370037M
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
9/9/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
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
6205 N. Santa Fe
Suite 201
Oklahoma CIty, OK 73118
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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