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SCH260064-08 SSM HEALTH-ST.MARY'S AUDRAIN (Terminated)
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Main Details
Name
SSM HEALTH-ST.MARY'S AUDRAIN
Subdivision Name
Family Medicine-Wellsville - Family Medicine
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH260064-08
Medicare Provider Number
260064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2018
Participating Start Date
7/1/2018
Participating Approval Date
6/12/2018
Last Recertification Date
8/24/2019
Termination Date
Termination Reason
10/1/2020
DSH percentage below statutory minimum
Contacts
Authorizing Official
SSM Health
Becky Miller, Vice President-Hospital Operations
(573) 681-3136
Primary Contact
SSM Health
Jeffrey Peine, Finance Director
(314) 989-3532
Addresses
Street Address
111 W Bates
Wellsville, MO 63384
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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