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DSH260104P SSM DEPAUL HEALTH CENTER (Terminated)
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Main Details
Name
SSM DEPAUL HEALTH CENTER
Subdivision Name
SSMOI - DPHC Ste 220
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260104P
Medicare Provider Number
260104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/2/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/27/2015
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
1/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
Spendmend
Chelsea Violette, Director of Optimization
(845) 206-6019
Addresses
Street Address
12266 DePaul Drive
Suite 220
Bridgeton, MO 63044
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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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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