340B Drug Pricing Program Database
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RRC140046-23 GOOD SAMARITAN REGIONAL HEALTH CTR. (Terminated)
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Main Details
Name
GOOD SAMARITAN REGIONAL HEALTH CTR.
Subdivision Name
SMGS Palliative Care - Palliative Care
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140046-23
Medicare Provider Number
140046
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2021
Participating Start Date
4/1/2021
Participating Approval Date
1/27/2021
Last Recertification Date
9/9/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
SSM of Oklahoma
Susan Coultrip, 340B Program Director
(405) 812-3230
Addresses
Street Address
#2 GOOD SAMARITAN WAY SUITE 420
Mount Vernon, IL 62864
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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