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DSH140185L MEMORIAL HOSPITAL (Active)
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Main Details
Name
MEMORIAL HOSPITAL
Subdivision Name
MHE POSTOP PH I - Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140185L
Medicare Provider Number
140185
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/10/2024
Participating Start Date
7/1/2024
Participating Approval Date
6/3/2024
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Christain Hospital - BJC
Susan Koesterer, VP, Chief Financial Officer
(314) 653-5715
Primary Contact
Memorial Hospital
Ryan Birk, Director of Pharmacy
(618) 606-0210
Addresses
Street Address
1404 Cross St
Shiloh, IL 62269
Billing Address
BJC Healthcare
4249 Clayton Avenue 310
St. Louis, MO 63110
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2022, terminated 7/1/2023. Reinstated 7/1/2024.
04/30/2024
April 2025
April 2025
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