340B Drug Pricing Program Database
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DSH370149C St Anthony Shawnee Hospital (Active)
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Main Details
Name
St Anthony Shawnee Hospital
Subdivision Name
ST. ANTHONY PHYSICIANS SHAWNEE FAMILY MEDICINE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH370149C
Medicare Provider Number
370149
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/17/2016
Last Recertification Date
8/31/2024
Contacts
Authorizing Official
- SSM ST ANTHONY HOSPITAL
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Primary Contact
SSM Health
Nathan Przybysz, 340b Program Manager
(314) 989-2214
Addresses
Street Address
3214 KETHLEY ROAD
SHAWNEE, OK 74804-9625
Billing Address
St. Anthony Shawnee Hospital
1102 W Mac Arthur
Shawnee, OK 74804
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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