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DSH260091BV SSM HEALTH ST MARY'S HOSPITAL-STL (Active)
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Main Details
Name
SSM HEALTH ST MARY'S HOSPITAL-STL
Subdivision Name
Maternal Fetal Medicine - Shiloh
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH260091BV
Medicare Provider Number
260091
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/16/2022
Participating Start Date
1/1/2023
Participating Approval Date
10/31/2022
Last Recertification Date
8/15/2024
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
1191 Fortune Ave
Shiloh, IL 62221
Billing Address
St. Mary's Hospital
6420 Clayton Road
St. Louis, MO 63117
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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