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DSH260091BT SSM ST MARY'S HEALTH CENTER (Terminated)
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Main Details
Name
SSM ST MARY'S HEALTH CENTER
Subdivision Name
SSM Cardinal Glennon Children's Hospital South County Mobile MRI - Radiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260091BT
Medicare Provider Number
260091
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2020
Participating Start Date
7/1/2020
Participating Approval Date
5/20/2020
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
SSM Health
Michelle Nicole Schmitt, Director of Business Operations
(608) 294-6203
Addresses
Street Address
13000 Butler Crest Drive
St. Louis, MO 63128
Billing Address
Cardinal Glennon Children's Hospital
1465 South Grand Blvd.
St. Louis, MO 63104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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