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DSH140046U SSM HEALTH GOOD SAMARITAN HOSPITAL (ToBeTerminated)
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Main Details
Name
SSM HEALTH GOOD SAMARITAN HOSPITAL
Subdivision Name
Behavioral Health Clinic - MV Behavioral Health
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140046U
Medicare Provider Number
140046
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
10/2/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/13/2023
Last Recertification Date
8/15/2024
Termination Date
Termination Reason
7/1/2025
Change of covered entity type
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 410
Mt. Vernon, IL 62864
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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