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DSH140046 SSM HEALTH GOOD SAMARITAN HOSPITAL (Active)
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Main Details
Name
SSM HEALTH GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140046
Medicare Provider Number
140046
Additional Details
Current Program Status
Active
Registration Date
4/6/2023
Participating Start Date
7/1/2023
Participating Approval Date
6/5/2023
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
1 GOOD SAMARITAN WAY
MT. VERNON, IL 62864
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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