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DSH260104W SSM HEALTH DEPAUL HOSPITAL (Active)
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Main Details
Name
SSM HEALTH DEPAUL HOSPITAL
Subdivision Name
DPMG at North County
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260104W
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
1120 Shackelford Road
Florissant, MO 63031
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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