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SSM MEDICAL GROUP INC (SSM HEALTH PHARMA
DSH260105 SSM HEALTH SAINT LOUIS UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
SSM HEALTH SAINT LOUIS UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260105
Entity Address
1201 South Grand Blvd.
ST. LOUIS, MO 63104
Medicare Provider Number
260105
Participating Start Date
4/1/2016
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
SSM MEDICAL GROUP INC (SSM HEALTH PHARMA
Pharmacy Address
711 VETERANS MEMORIAL PKWY STE 102
SAINT CHARLES, MO 63303-2106
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
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
10/17/2022
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