340B Drug Pricing Program Database
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DSH370149U St. Anthony Shawnee Hospital (Terminated)
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Main Details
Name
St. Anthony Shawnee Hospital
Subdivision Name
St Anthony Physicians Shawnee Nuclear Medicine - SPS NM
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH370149U
Medicare Provider Number
370149
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/26/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/8/2019
Last Recertification Date
9/9/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
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
3315 Kethley Road
Shawnee, OK 74804
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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