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RRC140034-08 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS (Terminated)
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Main Details
Name
ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS
Subdivision Name
SMGS Centralia Pulmonology - Pulmonology
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140034-08
Medicare Provider Number
140034
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/24/2020
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
1/1/2023
Site closure
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
Spendmend
Chelsea Violette, Director of Optimization
(845) 206-6019
Addresses
Street Address
1054 Martin Luther King Drive Suite 222
Centralia, IL 62801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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