Covered Entity Details

RRC140179-01 OSF LITTLE COMPANY OF MARY MEDICAL CENTER (Terminated) - information as of 5/6/2025 12:02:39 AM

Main Details

Name

OSF LITTLE COMPANY OF MARY MEDICAL CENTER

Subdivision Name

LITTLE COMPANY OF MARY HOSPITAL CAR - Care Station East

Type

Rural Referral Center

Rural

340B ID

RRC140179-01

Medicare Provider Number

140179

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/12/2018

Participating Start Date

1/1/2019

Participating Approval Date

10/23/2018

Last Recertification Date

9/10/2020

Termination Date
Termination Reason

7/1/2021
Site closure

Contacts

Authorizing Official

OSF Healthcare
Diane L. McGrew, President
(309) 655-2850

Primary Contact

Little Company of Mary Hospital
Lisa Peters, Director of Pharmacy
(708) 229-5506

Addresses

Street Address

5660W 95TH ST
OAK LAWN, IL 60453-2380

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		1215572045

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
RRC140179-01	Child	RRC	OSF LITTLE COMPANY OF MARY MEDICAL CENTER	LITTLE COMPANY OF MARY HOSPITAL CAR - Care Station East	5660W 95TH ST	OAK LAWN	IL	Terminated
RRC140179-02	Child	RRC	OSF LITTLE COMPANY OF MARY MEDICAL CENTER	LITTLE COMPANY OF MARY HOSPITAL OUT - Care Station West	6700W 95TH ST	OAK LAWN	IL	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	McGrew, Diane Marie President OSF Healthcare 3096552850	McGrew, Diane L. President OSF Healthcare 3096552850	4/11/2022 5:02 PM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Edit Termination Info	7/1/2020 12:00:00 AM	7/1/2021 12:00:00 AM	10/4/2021 2:33 PM
Terminations	Termination Effective Date	Update	OPA Edit Termination Info	4/6/2020 12:00:00 AM	7/1/2021 12:00:00 AM	10/4/2021 2:33 PM
Details	State	Update		To Be Terminated	Terminated	7/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/1/2020 12:00:00 AM	4/9/2021 4:34 PM
Details	State	Update	Termination Request	Active	To Be Terminated	4/9/2021 4:34 PM
Terminations	Termination Comments	Update	Termination Request		This location closed due to low volume.	4/9/2021 4:34 PM
Terminations	Termination Date	Update	Termination Request		7/1/2021 12:00:00 AM	4/9/2021 4:34 PM
Terminations	Termination Effective Date	Update	Termination Request		4/6/2020 12:00:00 AM	4/9/2021 4:34 PM
Terminations	Termination Reason	Update	Termination Request		Site closure	4/9/2021 4:34 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	362246719001 (IL)		9/10/2020 12:37 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1215572045	9/10/2020 12:37 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/10/2020 12:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1598768780 ( )		9/10/2020 12:37 PM
Details	Last Recertification Date	Update	Recertification	9/9/2019 9:31:11 AM	9/10/2020 12:37:24 PM	9/10/2020 12:37 PM
Details	Entity Name	Update	Change Request	LITTLE COMPANY OF MARY	OSF LITTLE COMPANY OF MARY MEDICAL CENTER	4/21/2020 2:24 PM
Contacts	Authorizing Official	Update	AO Change Request	Kelleher, Timothy CFO Little Company of Mary Hospital 7082294946	McGrew, Diane Marie President OSF Healthcare 3096552850	4/13/2020 1:39 PM
Contacts	Primary Contact	Update	Recertification	Magnuson, Rita J Executive Director of Clinical Services Little Company of Mary Hospital 7082295501	Peters, Lisa Director of Pharmacy Little Company of Mary Hospital 7082295506	9/9/2019 9:31 AM
Details	Last Recertification Date	Update	Recertification		9/9/2019 9:31:11 AM	9/9/2019 9:31 AM
Contacts	Authorizing Official	Update	Change Request	Cordova, Veronica Director of Finance Little Company of Mary Hospital 7082295103	Kelleher, Timothy CFO Little Company of Mary Hospital 7082294946	7/10/2019 3:27 PM
Details	State	Update		Approved	Active	1/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Cordova, Veronica Director of Finance Little Company of Mary Hospital 7082295103	10/23/2018 12:48 PM
Details	340B ID	Update	New Registration		RRC140179-01	10/23/2018 12:48 PM
Details	Entity Subname	Update	New Registration	LITTLE COMPANY OF MARY HOSPITAL CAR	LITTLE COMPANY OF MARY HOSPITAL CAR - Care Station East	10/23/2018 12:48 PM
Dates	Participating Approval Date	Update	New Registration		10/23/2018 12:48:24 PM	10/23/2018 12:48 PM
Details	State	Update	New Registration	Pending	Approved	10/23/2018 12:48 PM
Dates	Signed By Date	Update	New Registration		10/12/2018 3:05:40 PM	10/23/2018 12:48 PM
Dates	Start Date	Update	New Registration		1/1/2019 12:00:00 AM	10/23/2018 12:48 PM
Addresses	Main Address	Insert	New Registration		5660W 95TH ST OAK LAWN, IL 60453-2380	10/12/2018 3:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2018 3:05 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		362246719001	10/12/2018 3:05 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	10/12/2018 3:05 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1598768780	10/12/2018 3:05 PM
Contacts	Primary Contact	Insert	New Registration		Magnuson, Rita J Executive Director of Clinical Services Little Company of Mary Hospital 7082295501	10/12/2018 3:05 PM
Contacts	Authorizing Official	Insert	New Registration		Cordova, Veronica Director of Finance Little Company of Mary Hospital 7082295103	10/12/2018 3:05 PM
Details	Last Recertification Date	Insert	New Registration			10/12/2018 3:05 PM
Details	Grant Number	Insert	New Registration			10/12/2018 3:05 PM
Details	340B ID	Insert	New Registration			10/12/2018 3:05 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2018 3:05 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2018 3:05 PM
Details	Medicare Provider Number	Insert	New Registration		140179	10/12/2018 3:05 PM
Details	Entity Name	Insert	New Registration		LITTLE COMPANY OF MARY	10/12/2018 3:05 PM
Details	Program Code	Insert	New Registration		RRC	10/12/2018 3:05 PM
Details	Entity Subname	Insert	New Registration		LITTLE COMPANY OF MARY HOSPITAL CAR	10/12/2018 3:05 PM
Dates	Participating Approval Date	Insert	New Registration			10/12/2018 3:05 PM
Details	State	Insert	New Registration		Pending	10/12/2018 3:05 PM
Dates	Registration Date	Insert	New Registration		10/12/2018 3:05:37 PM	10/12/2018 3:05 PM
Dates	Signed By Date	Insert	New Registration			10/12/2018 3:05 PM
Dates	Start Date	Insert	New Registration			10/12/2018 3:05 PM
Terminations	Termination Comments	Insert	New Registration			10/12/2018 3:05 PM
Terminations	Termination Date	Insert	New Registration			10/12/2018 3:05 PM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2018 3:05 PM
Terminations	Termination Reason	Insert	New Registration			10/12/2018 3:05 PM