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DSH260104L SSM HEALTH DEPAUL HOSPITAL (Active)
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Main Details
Name
SSM HEALTH DEPAUL HOSPITAL
Subdivision Name
SSMHI at DPMG Ste 205 / Heart Institute
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260104L
Medicare Provider Number
260104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/2/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/27/2015
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
12266 DePaul Drive
Suite 205
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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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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