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SSM HEALTH PHARMACY
DSH370149 St Anthony Shawnee Hospital
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Covered Entity Details
Entity Name
St Anthony Shawnee Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH370149
Entity Address
1102 West MacArthur St
SHAWNEE, OK 74804
Medicare Provider Number
370149
Participating Start Date
4/1/2010
Last Recertification Date
9/1/2024
Pharmacy Details
Pharmacy Name
SSM HEALTH PHARMACY
Pharmacy Address
SSM HEALTH CARE OF OKLAHOMA INC.
608 NW 9TH ST STE 3200
OKLAHOMA CITY, OK 73102
Pharmacy Comments
Contract Details
Approval Date
7/5/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Contract Pharmacy Representative
SSM HEALTH
Nicole Maywright, System Director - Community Pharmacy
(636) 947-5574
Signed By Date
7/5/2022
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