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DSH260011E SSM HEALTH-ST. MARYS-JEFFERSON CITY (Terminated)
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Main Details
Name
SSM HEALTH-ST. MARYS-JEFFERSON CITY
Subdivision Name
SSM Health Medical Group - Versailles - Family Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260011E
Medicare Provider Number
260011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/16/2022
Last Recertification Date
Termination Date
Termination Reason
7/1/2022
Site closure
Contacts
Authorizing Official
SSM Health
Karen D. Rewerts, System VP of Finance
(557) 203-3614
Primary Contact
SSM of Oklahoma
Susan Coultrip, 340B Program Director
(405) 812-3230
Addresses
Street Address
801 Kidwell Drive
Versailles, MO 65084
Billing Address
Same as Street Address
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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