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DSH260104AJ SSM HEALTH DEPAUL HOSPITAL (Active)
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Main Details
Name
SSM HEALTH DEPAUL HOSPITAL
Subdivision Name
SSM CANCER CARE - Radiation Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260104AJ
Medicare Provider Number
260104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/7/2015
Participating Start Date
10/1/2015
Participating Approval Date
9/9/2015
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
1475 KISKER ROAD
SUITE 180
ST CHARLES, MO 63304-8786
Billing Address
DePaul Hospital
12303 DePaul Drive
Bridgeton, MO 63044
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/31/15 Diba-AJ, B and K all look similar, can you check to see if AJ is a duplicate (and possibly K, which I already approved)?
08/31/2015
April 2025
April 2025
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