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SCHNUCKS PHARMACY #258
DSH260091 SSM HEALTH ST MARY'S HOSPITAL-STL
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Covered Entity Details
Entity Name
SSM HEALTH ST MARY'S HOSPITAL-STL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260091
Entity Address
6420 CLAYTON ROAD
ST. LOUIS, MO 63117
Medicare Provider Number
260091
Participating Start Date
10/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SCHNUCKS PHARMACY #258
Pharmacy Address
SCHNUCKS MARKETS INC
HAMPTON & CHIPPEWA
60 HAMPTON VILLAGE
SAINT LOUIS, MO 63109
Pharmacy Comments
Contract Details
Approval Date
4/17/2019
Contract Begin Date
4/17/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Karen D. Rewerts, Regional VP of Financa/CFO
(314) 989-2034
Contract Pharmacy Representative
Schnuck's Pharmacy
David Chism, Director of Pharmacy
(314) 344-9636
Signed By Date
4/17/2019
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