Covered Entity Details

DSH140172AK FRANCISCAN HEALTH OLYMPIA FIELDS (Active) - information as of 4/25/2025 5:40:43 PM

Main Details

Name

FRANCISCAN HEALTH OLYMPIA FIELDS

Subdivision Name

Franciscan Health General Surgery Olympia Fields - Surgery Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH140172AK

Medicare Provider Number

140172

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/14/2024

Participating Start Date

10/1/2024

Participating Approval Date

7/24/2024

Last Recertification Date

Contacts

Authorizing Official

Franciscan Alliance
Frank J McHugh, VP Finance - CFO
(708) 747-4000 Ext: 82014

Primary Contact

Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900

Addresses

Street Address

3700 W 203rd St Suite 201
Olympia Fields, IL 60461

Billing Address

Franciscan Health Olympia Fields
20201 South Crawford Ave
Olympia Fields, IL 60461

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
IL	362167869011	1588771919
IN		1588771919

Shipping Addresses

Shipping Address 1

Franciscan Health Olympia Fields
20201 South Crawford Ave
Olympia Fields, IL 60461

Shipping Address 2

Franciscan Health General Surgery Olympia Fields
3700 W 203rd St Suite 201
Olympia Fields, IL 60461

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH140172AA	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Olympia Fields Outpatient Infusion - OF OP INFUSION	3900 203rd St	Olympia Fields	IL	Active
DSH140172AB	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Olympia Fields Breast Center - OF BREAST CENTER	3900 203rd St	Olympia Fields	IL	Active
DSH140172AC	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Congestive Heart Failure Clinic Olympia Fields - Congestive Heart Failure Clinic	3800 W 203rd St Suite 201	Olympia Fields	IL	Active
DSH140172AD	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Electrophysiology Cardiology Olympia Fields - Electrophysiology Cardiology Clinic	3800 W 203rd St Suite 201	Olympia Fields	IL	Active
DSH140172AE	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Cardiovascular Surgery Olympia Fields - Cardiovascular Surgery Clinic	3800 W 203rd St Suite 204	Olympia Fields	IL	Active
DSH140172AF	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Endocrinology Olympia Fields - Diabetes Clinic	3700 W 203rd St Suite 310	Olympia Fields	IL	Active
DSH140172AG	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Rheumatology Olympia Fields - Rheumatology Clinic	3800 W 203rd St Suite 209	Olympia Fields	IL	Active
DSH140172AH	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Gynecology Olympia Fields - Gynecology Clinic	3700 W 203rd St Suite 202	Olympia Fields	IL	Active
DSH140172AJ	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Gastroenterology Olympia Fields - Gastroenterology Clinic	3700 W 203rd St Suite 201	Olympia Fields	IL	Active
DSH140172AK	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health General Surgery Olympia Fields - Surgery Clinic	3700 W 203rd St Suite 201	Olympia Fields	IL	Active
DSH140172AL	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Internal Medicine Olympia Fields - Internal Medicine Clinic	3700 W 203rd St Suite 111	Olympia Fields	IL	Active
DSH140172AM	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Neurology Olympia Fields - Neurology Clinic	3700 W 203rd St Suite 201	Olympia Fields	IL	Active
DSH140172AN	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Oncology Olympia Fields - Oncology Clinic	3900 W 203rd St	Olympia Fields	IL	Active
DSH140172AP	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Pediatric Cardiology Olympia Fields - Pediatric Cardiology Clinic	3800 W 203rd St Suite 204	Olympia Fields	IL	Active
DSH140172AQ	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Nephrology Olympia Fields - Nephrology Clinic	3700 W 203rd St Suite 201	Olympia Fields	IL	Active
DSH140172AR	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Breast Surgery Olympia Fields - Breast Surgery Clinic	3900 W 203rd St	Olympia Fields	IL	Active
DSH140172AS	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Cardiology Olympia Fields - Cardiology Clinic	3800 W 203rd St Suite 202	Olympia Fields	IL	Active
DSH140172B	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / Surgery CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172C	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / Recovery CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172D	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / Anesthesia CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172E	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / Imaging CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172F	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / Nuclear Med CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172G	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / CT CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172H	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / Respiratory CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172J	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / Cardiology CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172K	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / OP Surgery CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172L	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / ER CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172M	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / Occupational Med CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172N	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / OT CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172P	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / Sleep Lab CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172Q	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS / PT CH	1423 CHICAGO ROAD	CHICAGO HEIGHTS	IL	Terminated
DSH140172R	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	Perinatology Clinic	1423 Chicago Road	Chicago Heights	IL	Terminated
DSH140172S	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	Renal Dialysis	1423 Chicago Road	Chicago Heights	IL	Terminated
DSH140172T	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	Electroencephalography	1423 Chicago Road	Chicago Heights	IL	Terminated
DSH140172U	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	Speech Pathology	1423 Chicago Road	Chicago Heights	IL	Terminated
DSH140172V	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	Laboratory	1423 Chicago Road	Chicago Heights	IL	Terminated
DSH140172W	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	MRI	1423 Chicago Road	Chicago Heights	IL	Terminated
DSH140172X	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	Adults & Pediatrics	1423 Chicago Road	Chicago Heights	IL	Terminated
DSH140172Y	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	Adults & Pediatrics	1423 Chicago Road	Chicago Heights	IL	Terminated
DSH140172Z	Child	DSH	FRANCISCAN HEALTH OLYMPIA FIELDS	Franciscan Health Olympia Fields Cardiology - OF CARDIOLOGY	3800 W 203rd St.	Olympia Fields	IL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Entity Name	Update	Change Request	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	FRANCISCAN HEALTH OLYMPIA FIELDS	2/5/2025 6:55 AM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		McHugh, Frank J VP Finance - CFO Franciscan Alliance 7087474000-82014	7/24/2024 10:28 PM
Details	340B ID	Update	New Registration		DSH140172AK	7/24/2024 10:28 PM
Details	Entity Name	Update	New Registration	FRANCISCAN ST. JAMES HEALTH	FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	7/24/2024 10:28 PM
Details	Entity Subname	Update	New Registration	Franciscan Health General Surgery Olympia Fields	Franciscan Health General Surgery Olympia Fields - Surgery Clinic	7/24/2024 10:28 PM
Dates	Participating Approval Date	Update	New Registration		7/24/2024 10:28:46 PM	7/24/2024 10:28 PM
Details	State	Update	New Registration	Pending	Approved	7/24/2024 10:28 PM
Dates	Signed By Date	Update	New Registration		7/15/2024 1:47:25 PM	7/24/2024 10:28 PM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	7/24/2024 10:28 PM
Addresses	Main Address	Insert	New Registration		3700 W 203rd St Suite 201 Olympia Fields, IL 60461	7/14/2024 2:26 PM
Addresses	Billing Address	Insert	New Registration		Franciscan Health Olympia Fields 20201 South Crawford Ave Olympia Fields, IL 60461	7/14/2024 2:26 PM
Addresses	Shipping Address	Insert	New Registration		Franciscan Health Olympia Fields 20201 South Crawford Ave Olympia Fields, IL 60461	7/14/2024 2:26 PM
Addresses	Shipping Address	Insert	New Registration		Franciscan Health General Surgery Olympia Fields 3700 W 203rd St Suite 201 Olympia Fields, IL 60461	7/14/2024 2:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/14/2024 2:26 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		362167869011	7/14/2024 2:26 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	7/14/2024 2:26 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1588771919	7/14/2024 2:26 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	7/14/2024 2:26 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1588771919	7/14/2024 2:26 PM
Medicaid Billing	NPI: State	Insert	New Registration		IN	7/14/2024 2:26 PM
Contacts	Primary Contact	Insert	New Registration		Shondell, Laura Administrative Director Medication Systems and Operations Franciscan Health 7654236900	7/14/2024 2:26 PM
Contacts	Authorizing Official	Insert	New Registration		McHugh, Frank J VP Finance - CFO Franciscan Alliance 7087474000-82014	7/14/2024 2:26 PM
Details	Assistance Received From Date	Insert	New Registration			7/14/2024 2:26 PM
Details	Assistance Received To Date	Insert	New Registration			7/14/2024 2:26 PM
Details	Last Recertification Date	Insert	New Registration			7/14/2024 2:26 PM
Details	Grant Number	Insert	New Registration			7/14/2024 2:26 PM
Details	340B ID	Insert	New Registration			7/14/2024 2:26 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/14/2024 2:26 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/14/2024 2:26 PM
Details	Medicare Provider Number	Insert	New Registration		140172	7/14/2024 2:26 PM
Details	Entity Name	Insert	New Registration		FRANCISCAN ST. JAMES HEALTH	7/14/2024 2:26 PM
Details	NOFO Number	Insert	New Registration			7/14/2024 2:26 PM
Details	Program Code	Insert	New Registration		DSH	7/14/2024 2:26 PM
Details	Entity Subname	Insert	New Registration		Franciscan Health General Surgery Olympia Fields	7/14/2024 2:26 PM
Dates	Participating Approval Date	Insert	New Registration			7/14/2024 2:26 PM
Details	State	Insert	New Registration		Pending	7/14/2024 2:26 PM
Dates	Registration Date	Insert	New Registration		7/14/2024 2:26:03 PM	7/14/2024 2:26 PM
Dates	Signed By Date	Insert	New Registration			7/14/2024 2:26 PM
Dates	Start Date	Insert	New Registration			7/14/2024 2:26 PM
Terminations	Termination Comments	Insert	New Registration			7/14/2024 2:26 PM
Terminations	Termination Date	Insert	New Registration			7/14/2024 2:26 PM
Terminations	Termination Effective Date	Insert	New Registration			7/14/2024 2:26 PM
Terminations	Termination Reason	Insert	New Registration			7/14/2024 2:26 PM