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DSH260104AE SSM HEALTH DEPAUL HOSPITAL (Active)
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Main Details
Name
SSM HEALTH DEPAUL HOSPITAL
Subdivision Name
CTSI South LSL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260104AE
Medicare Provider Number
260104
Outpatient Facility Provider Number
260104
Additional Details
Current Program Status
Active
Registration Date
11/14/2022
Participating Start Date
1/1/2023
Participating Approval Date
12/5/2022
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
SSM Health
Holly Herring, Director, 340B Center of Excellence
(580) 512-7188
Addresses
Street Address
400 Medical Plaza
Suite 100
Lake St. Louis, MO 63367
Billing Address
DePaul Hospital
12303 DePaul Drive
Bridgeton, MO 63044
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/1/2014) until terminated effective date: (1/1/2015), reinstatement effective date: (01/1/2023)
12/01/2022
April 2025
April 2025
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