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DSH260011G SSM HEALTH-ST. MARYS-JEFFERSON CITY (ToBeTerminated)
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Main Details
Name
SSM HEALTH-ST. MARYS-JEFFERSON CITY
Subdivision Name
Outpatient Brief Treatment - Behavioral Health
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260011G
Medicare Provider Number
260011
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
4/15/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/16/2022
Last Recertification Date
8/31/2024
Termination Date
Termination Reason
7/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
- SSM ST ANTHONY HOSPITAL
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Primary Contact
SSM Health
Nathan Przybysz, 340b Program Manager
(314) 989-2214
Addresses
Street Address
2701 West Edgewood Dr
Suite 101
Jefferson City, MO 65109
Billing Address
St. Mary's Hospital - Jefferson City
2505 Mission Drive
Jefferson City, MO 65109
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/25/2021, terminated 10/1/2021. Reinstated 7/1/2022.
05/13/2022
June 2025
June 2025
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