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DSH260104AC SSM DEPAUL HEALTH CENTER (Terminated)
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Main Details
Name
SSM DEPAUL HEALTH CENTER
Subdivision Name
NSI DePaul Ste 100
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260104AC
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
8/22/2019
Termination Date
Termination Reason
10/1/2020
Other
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
SSM Health
Jeffrey Peine, Finance Director
(314) 989-3532
Addresses
Street Address
12266 DePaul Drive
Suite 100
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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