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DSH260011D 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 - Wound Care - Wound Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260011D
Medicare Provider Number
260011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2021
Participating Start Date
1/25/2021
Participating Approval Date
1/25/2021
Last Recertification Date
Termination Date
Termination Reason
10/1/2021
Failure to recertify
Contacts
Authorizing Official
SSM Health
Becky Miller, Vice President-Hospital Operations
(573) 681-3136
Primary Contact
SSM Health
Tamika White, Senior Financial Analyst
(314) 989-2320
Addresses
Street Address
2505 Mission Drive
210
Jefferson City, MO 65109
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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