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MISSOURI CVS PHARMACY, L.L.C.
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
MISSOURI CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #18056
3740 MONTICELLO PLZ
SAINT CHARLES, MO 63304
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
CVS
Charles Basralian, Acct Manager
(401) 772-7343
Signed By Date
10/17/2022
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