340B Drug Pricing Program Database
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DSH370037W SSM ST ANTHONY HOSPITAL (Terminated)
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Main Details
Name
SSM ST ANTHONY HOSPITAL
Subdivision Name
Saints Pediatric Associates
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370037W
Medicare Provider Number
370037
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/29/2014
Last Recertification Date
9/5/2019
Termination Date
Termination Reason
10/1/2020
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
608 N.W. 9th Street
Suite 5100
OKLAHOMA CITY, OK 73102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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