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DSH260104AP SSM HEALTH DEPAUL HOSPITAL (Active)
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Main Details
Name
SSM HEALTH DEPAUL HOSPITAL
Subdivision Name
SSM Ambulatory Surgery Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260104AP
Medicare Provider Number
260104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/6/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/13/2017
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
12266 DePaul Drive, Suite 10
Bridgeton, MO 63044
Billing Address
DePaul Hospital
12303 DePaul Drive
Bridgeton, MO 63044
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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