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RRC140046-10 GOOD SAMARITAN REGIONAL HEALTH CTR. (Terminated)
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Main Details
Name
GOOD SAMARITAN REGIONAL HEALTH CTR.
Subdivision Name
Mammography
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140046-10
Medicare Provider Number
140046
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/9/2015
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
1/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
Spendmend
Chelsea Violette, Director of Optimization
(845) 206-6019
Addresses
Street Address
4117 Veterans Memorial Drive
Suite 100
Mt. Vernon, IL 62864
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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