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BANDY'S APOTHECARY SHOPS INC
RRC140046-00 SSM HEALTH GOOD SAMARITAN HOSPITAL
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Covered Entity Details
Entity Name
SSM HEALTH GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140046-00
Entity Address
1 GOOD SAMARITAN WAY
MT. VERNON, IL 62864
Medicare Provider Number
140046
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
BANDY'S APOTHECARY SHOPS INC
Pharmacy Address
BANDY'S PHARMACY II
207 E. HURON
PO BOX 526
IRVINGTON, IL 62848
Pharmacy Comments
Contract Details
Approval Date
5/5/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eileen Lamm, Regional Vice President-Finance
(314) 994-6219
Contract Pharmacy Representative
Bandy's
Eric Bandy, CFO
(618) 548-4000
Signed By Date
4/14/2025
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