Contract Pharmacy Details

SSM HEALTH PHARMACY AT SAINT LOUIS UNIVE
DSH260104 SSM HEALTH DEPAUL HOSPITAL

Covered Entity Details

Entity Name

SSM HEALTH DEPAUL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH260104

Entity Address

12303 DePaul Dr
BRIDGETON, MO 63044

Medicare Provider Number

260104

Participating Start Date

10/1/2006

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

SSM HEALTH PHARMACY AT SAINT LOUIS UNIVE

Pharmacy Address

SSM-SLUH, INC
1225 S GRAND BLVD
1ST FLOOR - OUTPATIENT PHARMACY
SAINT LOUIS, MO 63104

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

340B Drug Pricing Program Database