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MISSOURI CVS PHARMACY, L.L.C.
DSH260005 SSM HEALTH ST. JOSEPH HOSPITAL- SC
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Covered Entity Details
Entity Name
SSM HEALTH ST. JOSEPH HOSPITAL- SC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260005
Entity Address
300 FIRST CAPITOL DRIVE
ST. CHARLES, MO 63301
Medicare Provider Number
260005
Participating Start Date
10/1/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 17410
1883 WENTZVILLE PKWY
WENTZVILLE, MO 63385
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen D. Rewerts, Regional VP of Financa/CFO
(314) 989-2034
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/16/2018
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