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BIOSCRIP INFUSION SERVICES, LLC 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
BIOSCRIP INFUSION SERVICES, LLC PHARMACY
Pharmacy Address
6 VREELAND RD STE 103
FLORHAM PARK, NJ 07932
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Contract Pharmacy Representative
Option Care
Derek Bilyk, Program Manager, Health Systems
(224) 813-1283
Signed By Date
7/13/2020
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