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DSH260104X SSM HEALTH DEPAUL HOSPITAL (Active)
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Main Details
Name
SSM HEALTH DEPAUL HOSPITAL
Subdivision Name
DPMG Primary Care at DPHC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260104X
Medicare Provider Number
260104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
11/8/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/22/2022
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
12255 DePaul Drive
Suite 600
Bridgeton, MO 63044
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: (10/1/2015) until terminated effective date: ( 10/1/2020), reinstatement effective date: (01/1/2023)
11/22/2022
8/27/15 enrolled in 340B 10/1/14 thru 12/31/14 but did not purchase 340B drugs, terminated 1/1/15 thru 9/30/15 due to ineligibility, reinstated effective 10/1/15
08/27/2015
April 2025
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