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SCHNUCKS PHARMACY #258
DSH260032 BARNES-JEWISH HOSPITAL
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Covered Entity Details
Entity Name
BARNES-JEWISH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260032
Entity Address
One Barnes-Jewish Hospital Plaza
St. Louis, MO 63110
Medicare Provider Number
260032
Participating Start Date
7/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
SCHNUCKS PHARMACY #258
Pharmacy Address
SCHNUCKS MARKETS INC
HAMPTON & CHIPPEWA
60 HAMPTON VILLAGE
SAINT LOUIS, MO 63109
Pharmacy Comments
Contract Details
Approval Date
1/20/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/30/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Cannon, President
(314) 286-2118
Contract Pharmacy Representative
Schnuck's Pharmacy
David Chism, Director of Pharmacy
(314) 344-9636
Signed By Date
1/20/2015
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