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DSH370037AF SSM ST ANTHONY HOSPITAL (Terminated)
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Main Details
Name
SSM ST ANTHONY HOSPITAL
Subdivision Name
St Anthony Physicians Endocrinology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370037AF
Medicare Provider Number
370037
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/12/2017
Last Recertification Date
8/21/2019
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
- SSM ST ANTHONY HOSPITAL
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Primary Contact
SSM of Oklahoma
Susan Coultrip, 340B Program Director
(405) 812-3230
Addresses
Street Address
13401 N WESTERN AVE, STE 407
ST. ANTHONY PHYSICIANS ENDOCRINOLOGY
OKLAHOMA CITY, OK 73114-1408
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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