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RRC140046-31 SSM HEALTH GOOD SAMARITAN HOSPITAL (Approved)
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Main Details
Name
SSM HEALTH GOOD SAMARITAN HOSPITAL
Subdivision Name
SMGS - Medical Plaza Podiatry
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140046-31
Medicare Provider Number
140046
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/5/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/5/2025
Last Recertification Date
Contacts
Authorizing Official
SSM Health
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Primary Contact
SSM Health
Holly Herring, Director, 340B Center of Excellence
(580) 512-7188
Addresses
Street Address
2 Good Samaritan Way
Suite 235
Mount Vernon, IL 62864
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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Participating Start Date 1/1/2023, Termination Date 7/1/2023, Reinstatement 7/1/2025
04/21/2025
May 2025
May 2025
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