Contract Pharmacy Details

SCHNUCKS PHARMACY #399
DSH260005 SSM HEALTH ST. JOSEPH HOSPITAL- SC

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

SCHNUCKS PHARMACY #399

Pharmacy Address

12921 ENTERPRISE WAY
BRIDGETON, MO 63044-1206

Pharmacy Comments

Contract Details

Approval Date

10/15/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/13/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Karen D. Rewerts, Regional VP of Financa/CFO
(314) 989-2034

Contract Pharmacy Representative

Schnucks
Bob Buganski, Director Pharmacy Operations
(314) 994-2226

Signed By Date

10/15/2017

340B Drug Pricing Program Database