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SSM HEALTH 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
SSM HEALTH PHARMACY
Pharmacy Address
SSM HEALTH PHARMACY LLC
12266 DE PAUL DR STE 105
BRIDGETON, MO 63044-2541
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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