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CARDINAL GLENN CHILDREN'S HOS
DSH260105 SSM HEALTH SAINT LOUIS UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
SSM HEALTH SAINT LOUIS UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260105
Entity Address
1201 South Grand Blvd.
ST. LOUIS, MO 63104
Medicare Provider Number
260105
Participating Start Date
4/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CARDINAL GLENN CHILDREN'S HOS
Pharmacy Address
ATTENTION: PHARMACY
1465 S GRAND BLVD
SAINT LOUIS, MO 63104-1003
Pharmacy Comments
Contract Details
Approval Date
10/10/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/8/2019
Ownership change
Contacts
Covered Entity Signing Official
Karen D. Rewerts, Regional VP of Financa/CFO
(314) 989-2034
Contract Pharmacy Representative
SSM Health
Nicole Maywright, Phamaccy Team Leader
(636) 669-2223
Signed By Date
10/10/2018
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