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RRC140185-00 MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC140185-00
Medicare Provider Number
140185
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/21/2024
Last Recertification Date
Termination Date
Termination Reason
7/1/2024
Change of covered entity type
Contacts
Authorizing Official
Christain Hospital - BJC
Susan Koesterer, VP, Chief Financial Officer
(314) 653-5715
Primary Contact
Memorial Hospital
Ryan Birk, Director of Pharmacy
(618) 606-0210
Addresses
Street Address
4500 MEMORIAL DRIVE
BELLEVILLE, IL 62226
Billing Address
BJC Healthcare
4249 Clayton Avenue
310
St. Louis, MO 63110
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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