Covered Entity Details

DSH140172Y FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS (Terminated) - information as of 4/25/2025 6:33:50 PM

Main Details

Name

FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS

Subdivision Name

Adults & Pediatrics

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH140172Y

Medicare Provider Number

140172

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/6/2016

Participating Start Date

1/1/2017

Participating Approval Date

10/27/2016

Last Recertification Date

8/29/2018

Termination Date
Termination Reason

4/1/2019
Site closure

Contacts

Authorizing Official

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

Primary Contact

Franciscan Health Olympia Fields and Chicago Heights
Kevin Karstens, Director of Pharmacy
(708) 756-1000 Ext: 56314

Addresses

Street Address

1423 Chicago Road
Chicago Heights, IL 60411-3400

Billing Address
Same as Street Address

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	3621678690211
		1588771919

Shipping Addresses

Same as Street Address

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
Contacts	Authorizing Official	Update	AO Change Request	demont, joseph henry CFO franciscan health olympia fields 7087474000-82014	McHugh, Frank J VP Finance - CFO Franciscan Alliance 7087474000-82014	1/28/2020 8:54 AM
Contacts	Authorizing Official	Update	Change Request	Banda, Tony CFO Franciscan Health Olympia Fields Chicago Heights 7087561000-56090	demont, joseph henry CFO franciscan health olympia fields 7087474000-82014	4/18/2019 9:23 AM
Details	State	Update		To Be Terminated	Terminated	4/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		9/7/2018 12:00:00 AM	3/8/2019 9:25 AM
Details	State	Update	Termination Request	Active	To Be Terminated	3/8/2019 9:25 AM
Terminations	Termination Date	Update	Termination Request		4/1/2019 12:00:00 AM	3/8/2019 9:25 AM
Terminations	Termination Effective Date	Update	Termination Request		9/7/2018 12:00:00 AM	3/8/2019 9:25 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	3/8/2019 9:25 AM
Details	Last Recertification Date	Update	Recertification	11/28/2017 10:51:29 AM	8/29/2018 2:17:15 PM	8/29/2018 2:17 PM
Details	Last Recertification Date	Update	Recertification		11/28/2017 10:51:29 AM	11/28/2017 10:51 AM
Contacts	Primary Contact	Update	Recertification	Karstens, Kevin Director of Pharmacy 7087561000-56314	Karstens, Kevin Director of Pharmacy Franciscan Health Olympia Fields and Chicago Heights 7087561000-56314	11/7/2017 11:26 AM
Contacts	Authorizing Official	Update		Banda, Tony CFO 7087561000-56090	Banda, Tony CFO Franciscan Health Olympia Fields Chicago Heights 7087561000-56090	11/6/2017 12:49 PM
Contacts	Signed By	Update		Banda, Tony CFO 7087561000-56090	Banda, Tony CFO Franciscan Health Olympia Fields Chicago Heights 7087561000-56090	11/6/2017 12:49 PM
Contacts	Primary Contact	Insert			Karstens, Kevin Director of Pharmacy 7087561000-56314	10/27/2016 10:25 AM
Contacts	Authorizing Official	Insert			Banda, Tony CFO 7087561000-56090	10/27/2016 10:25 AM
Contacts	Signed By	Insert			Banda, Tony CFO 7087561000-56090	10/27/2016 10:25 AM
Addresses	Main Address	Insert			1423 Chicago Road Chicago Heights, IL 60411-3400	10/27/2016 10:25 AM
Dates	Participating Approval Date	Update			10/27/2016 12:00:00 AM	10/27/2016 10:25 AM
Details	State	Update		Pending	Active	10/27/2016 10:25 AM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	10/27/2016 10:25 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_72557	DSH140172Y	10/19/2016 2:45 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_72557	10/6/2016 1:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/6/2016 1:25 PM
Medicaid Billing	Medicaid: Number	Insert			3621678690211	10/6/2016 1:25 PM
Medicaid Billing	Medicaid: State	Insert			IL	10/6/2016 1:25 PM
Medicaid Billing	NPI: Number	Insert			1588771919	10/6/2016 1:25 PM
Details	Last Recertification Date	Insert				10/6/2016 1:25 PM
Details	Grant Number	Insert				10/6/2016 1:25 PM
Details	340B ID	Insert				10/6/2016 1:25 PM
Details	Is Authorizing Official EHB Data	Insert				10/6/2016 1:25 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/6/2016 1:25 PM
Details	Medicare Provider Number	Insert			140172	10/6/2016 1:25 PM
Details	Entity Name	Insert			FRANCISCAN HEALTH OLYMPIA FIELDS & CHICAGO HEIGHTS	10/6/2016 1:25 PM
Details	Program Code	Insert			DSH	10/6/2016 1:25 PM
Details	Entity Subname	Insert			Adults & Pediatrics	10/6/2016 1:25 PM
Dates	Participating Approval Date	Insert				10/6/2016 1:25 PM
Details	State	Insert			Pending	10/6/2016 1:25 PM
Dates	Registration Date	Insert			10/6/2016 12:00:00 AM	10/6/2016 1:25 PM
Dates	Signed By Date	Insert			10/6/2016 12:00:00 AM	10/6/2016 1:25 PM
Dates	Start Date	Insert				10/6/2016 1:25 PM
Terminations	Termination Comments	Insert				10/6/2016 1:25 PM
Terminations	Termination Date	Insert				10/6/2016 1:25 PM
Terminations	Termination Effective Date	Insert				10/6/2016 1:25 PM
Terminations	Termination Reason	Insert				10/6/2016 1:25 PM