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DSH260005AE SSM HEALTH ST. JOSEPH HOSPITAL- SC (Active)
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Main Details
Name
SSM HEALTH ST. JOSEPH HOSPITAL- SC
Subdivision Name
SCCMG Wall Street Pediatrics
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260005AE
Medicare Provider Number
260005
Outpatient Facility Provider Number
260005
Additional Details
Current Program Status
Active
Registration Date
7/7/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/10/2015
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
711 Veterans Memorial Parkway
Suite 200
St. Charles, MO 63303
Billing Address
St. Joseph Hospital
300 First Capitol Drive
St. Charles, MO 63301
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/10/15 Participated starting 10/1/14, terminated 1/1/15 through 10/1/15 due to No expenses/revenues on 2013 filed CR, reinstated based on new registration submitted 7/7/15
08/10/2015
April 2025
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