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RRC140034-04 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS (Terminated)
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Main Details
Name
ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS
Subdivision Name
Weight Management Clinic
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140034-04
Medicare Provider Number
140034
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/23/2016
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
7/1/2023
DSH percentage below statutory minimum
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
SSM Health
Anita McAllister, System Director of 340B Operations
(314) 989-6778
Addresses
Street Address
432 N Pleasant Avenue
Centralia, IL 62801
Billing Address
St Mary's Hospital Centralia
400 North Pleasant Ave
Centralia, IL 62801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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