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SCHNUCKS PHARMACY
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
Pharmacy Address
SCHNUCK MARKET, INC.
#20 GRAVOIS DILLION PLAZA
HIGH RIDGE, MO 63049
Pharmacy Comments
Contract Details
Approval Date
4/19/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/25/2019
Agreement registered in error
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
4/19/2019
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