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RRC140046-28 GOOD SAMARITAN REGIONAL HEALTH CTR. (Terminated)
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Main Details
Name
GOOD SAMARITAN REGIONAL HEALTH CTR.
Subdivision Name
SMGS - Endocrinology 5GS
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140046-28
Medicare Provider Number
140046
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/15/2022
Last Recertification Date
Termination Date
Termination Reason
7/1/2023
Change of covered entity type
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
SSM Health
Anita McAllister, System Director of 340B Operations
(314) 989-6778
Addresses
Street Address
5 GOOD SAMARITAN WAY
MOUNT VERNON, IL 62864-2402
Billing Address
Good Samaritan Hospital
1 Good Samaritan Way
Mount Vernon, IL 62864
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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