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CARDINAL GLENN CHILDREN'S HOS
DSH260005 SSM HEALTH ST. JOSEPH HOSPITAL- SC
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Covered Entity Details
Entity Name
SSM HEALTH ST. JOSEPH HOSPITAL- SC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260005
Entity Address
300 FIRST CAPITOL DRIVE
ST. CHARLES, MO 63301
Medicare Provider Number
260005
Participating Start Date
10/1/2010
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
7/11/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Contract Pharmacy Representative
SSM Health
Nicole Maywright, Phamaccy Team Leader
(636) 669-2223
Signed By Date
7/11/2022
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