| Contacts | Primary Contact | Update | Change Request | Fischer, Rick
340B Program Director
Ascension
6303097828 | Fiser, Kelsey
340B Program Director
Ascension Rx
6152225190 | 2/25/2025 6:48 AM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2023 4:55:51 PM | 8/13/2024 6:36:08 PM | 8/13/2024 6:36 PM |
| Addresses | Shipping Address | Delete | Change Request | Safecor Health
4060 Business Park Drive
Columbus, OH 43204 | | 6/21/2024 7:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | Ascension RX
7701 Metropolis Drive
200C
Austin, TX 78744 | 6/20/2024 9:05 AM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 362235165015 (IL) | | 1/6/2024 1:54 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/6/2024 1:54 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 36-2235165 | 1/6/2024 1:54 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | IL | 1/6/2024 1:54 PM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2022 9:56:45 AM | 8/16/2023 4:55:51 PM | 8/16/2023 4:55 PM |
| Contacts | Authorizing Official | Update | Change Request | Marin, Flavio
CFO
Presence St. Francis Hospital
8473164190 | Marin, Flavio
CFO
Ascension St Joseph
7736656212 | 10/12/2022 10:02 AM |
| Contacts | Primary Contact | Update | Group Change Request | Fischer, Rick
System Director, 340B
Amita Health
6303097828 | Fischer, Rick
340B Program Director
Ascension
6303097828 | 9/28/2022 7:24 AM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2021 8:49:07 PM | 8/31/2022 9:56:45 AM | 8/31/2022 9:56 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Fischer, Rick
System Director, 340B
Amita Health
6309147828 | Fischer, Rick
System Director, 340B
Amita Health
6303097828 | 1/20/2022 2:41 PM |
| Addresses | Billing Address | Insert | Recertification | | Ascension Health Ministry Service Center
PO Box 33902
Indianapolis, IN 46203 | 8/29/2021 8:49 PM |
| Details | Last Recertification Date | Update | Recertification | | 8/29/2021 8:49:07 PM | 8/29/2021 8:49 PM |
| Details | State | Update | | Approved | Active | 7/1/2021 12:01 AM |
| Addresses | Shipping Address | Insert | Change Request | | Safecor Health
4060 Business Park Drive
Columbus, OH 43204 | 6/3/2021 3:07 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Reinstatement | | False | 4/5/2021 8:08 AM |
| Medicaid Billing | Medicaid: Number | Insert | Reinstatement | | 362235165015 | 4/5/2021 8:08 AM |
| Medicaid Billing | Medicaid: State | Insert | Reinstatement | | IL | 4/5/2021 8:08 AM |
| Medicaid Billing | Medicaid: Number | Delete | Reinstatement | 363200170003 (IL) | | 4/5/2021 8:08 AM |
| Medicaid Billing | NPI: State | Update | Reinstatement | | IL | 4/5/2021 8:08 AM |
| Contacts | Primary Contact | Update | Reinstatement | Spencer, Kimberly
Regional Director of Pharmacy
7736653145 | Fischer, Rick
System Director, 340B
Amita Health
6309147828 | 4/5/2021 8:08 AM |
| Contacts | Authorizing Official | Update | Reinstatement | Early, Elizabeth
Regional Chief Ambulatory and Ancillary Services Officer
8473163900 | Marin, Flavio
CFO
Presence St. Francis Hospital
8473164190 | 4/5/2021 8:08 AM |
| Contacts | Signed By | Update | Reinstatement | Early, Elizabeth
Regional Chief Ambulatory and Ancillary Services Officer
8473163900 | Marin, Flavio
CFO
Presence St. Francis Hospital
8473164190 | 4/5/2021 8:08 AM |
| Details | Last Recertification Date | Update | Reinstatement | 8/22/2016 12:00:00 AM | | 4/5/2021 8:08 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 9/16/2016 12:00:00 AM | | 4/5/2021 8:08 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 10/26/2015 12:00:00 AM | 4/5/2021 8:08:50 AM | 4/5/2021 8:08 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 4/5/2021 8:08 AM |
| Dates | Registration Date | Update | Reinstatement | 10/13/2015 12:00:00 AM | 4/1/2021 1:59:45 PM | 4/5/2021 8:08 AM |
| Dates | Signed By Date | Update | Reinstatement | 10/13/2015 12:00:00 AM | 4/1/2021 7:50:37 PM | 4/5/2021 8:08 AM |
| Dates | Start Date | Update | Reinstatement | 1/1/2016 12:00:00 AM | 7/1/2021 12:00:00 AM | 4/5/2021 8:08 AM |
| Terminations | Termination Comments | Update | Reinstatement | As filed Medicare cost report filed 5/23/16 showed we are below threshold. | | 4/5/2021 8:08 AM |
| Terminations | Termination Date | Update | Reinstatement | 10/1/2016 12:00:00 AM | | 4/5/2021 8:08 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 7/1/2016 12:00:00 AM | | 4/5/2021 8:08 AM |
| Terminations | Termination Reason | Update | Reinstatement | DSH percentage below statutory minimum | | 4/5/2021 8:08 AM |
| Details | Comments Public | Insert | Reinstatement | | Participating from effective date: (1/1/2016) until terminated effective date: (10/1/2016), reinstatement effective date: (07/01/2021) | 4/2/2021 6:39 AM |
| Contacts | Authorizing Official | Insert | | | Early, Elizabeth
Regional Chief Ambulatory and Ancillary Services Officer
8473163900 | 8/9/2017 2:18 PM |
| Contacts | Signed By | Insert | | | Early, Elizabeth
Regional Chief Ambulatory and Ancillary Services Officer
8473163900 | 8/9/2017 2:18 PM |
| Contacts | Primary Contact | Insert | | | Spencer, Kimberly
Regional Director of Pharmacy
7736653145 | 9/23/2016 12:11 PM |
| Addresses | Main Address | Insert | | |
2900 NORTH LAKE SHORE DRIVE
CHICAGO, IL 60657 | 9/23/2016 12:10 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 9/16/2016 12:00:00 AM | 9/23/2016 12:10 PM |
| Details | State | Update | | Active | Terminated | 9/23/2016 12:10 PM |
| Terminations | Termination Comments | Update | | | As filed Medicare cost report filed 5/23/16 showed we are below threshold. | 9/23/2016 12:10 PM |
| Terminations | Termination Date | Update | | | 10/1/2016 12:00:00 AM | 9/23/2016 12:10 PM |
| Terminations | Termination Effective Date | Update | | | 7/1/2016 12:00:00 AM | 9/23/2016 12:10 PM |
| Terminations | Termination Reason | Update | | | DSH percentage below statutory minimum | 9/23/2016 12:10 PM |
| Details | Last Recertification Date | Update | | | 8/22/2016 12:00:00 AM | 8/22/2016 3:27 PM |
| Dates | Participating Approval Date | Update | | | 10/26/2015 12:00:00 AM | 10/26/2015 12:55 PM |
| Details | State | Update | | Pending | Active | 10/26/2015 12:55 PM |
| Dates | Start Date | Update | | | 1/1/2016 12:00:00 AM | 10/26/2015 12:55 PM |
| Details | 340B ID | Update | | ONLINE_REG_55270 | DSH140224 | 10/19/2015 10:53 AM |
| Details | 340B ID | Update | | | ONLINE_REG_55270 | 10/13/2015 1:51 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 10/13/2015 1:51 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 363200170003 | 10/13/2015 1:51 PM |
| Medicaid Billing | Medicaid: State | Insert | | | IL | 10/13/2015 1:51 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1679659585 | 10/13/2015 1:51 PM |
| Details | Last Recertification Date | Insert | | | | 10/13/2015 1:51 PM |
| Details | Grant Number | Insert | | | | 10/13/2015 1:51 PM |
| Details | 340B ID | Insert | | | | 10/13/2015 1:51 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/13/2015 1:51 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/13/2015 1:51 PM |
| Details | Medicare Provider Number | Insert | | | 140224 | 10/13/2015 1:51 PM |
| Details | Entity Name | Insert | | | PRESENCE SAINT JOSEPH HOSP-CHICAGO | 10/13/2015 1:51 PM |
| Details | Program Code | Insert | | | DSH | 10/13/2015 1:51 PM |
| Details | Entity Subname | Insert | | | | 10/13/2015 1:51 PM |
| Dates | Participating Approval Date | Insert | | | | 10/13/2015 1:51 PM |
| Details | State | Insert | | | Pending | 10/13/2015 1:51 PM |
| Dates | Registration Date | Insert | | | 10/13/2015 12:00:00 AM | 10/13/2015 1:51 PM |
| Dates | Signed By Date | Insert | | | 10/13/2015 12:00:00 AM | 10/13/2015 1:51 PM |
| Dates | Start Date | Insert | | | | 10/13/2015 1:51 PM |
| Terminations | Termination Comments | Insert | | | | 10/13/2015 1:51 PM |
| Terminations | Termination Date | Insert | | | | 10/13/2015 1:51 PM |
| Terminations | Termination Effective Date | Insert | | | | 10/13/2015 1:51 PM |
| Terminations | Termination Reason | Insert | | | | 10/13/2015 1:51 PM |