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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
CVS/PHARMACY # 10096
2100 1ST CAPITOL DR.
SAINT CHARLES, MO 63301
Pharmacy Comments
Contract Details
Approval Date
7/5/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen D. Rewerts, Regional VP of Financa/CFO
(314) 989-2034
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
7/5/2016
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