Covered Entity Details

DSH140067AU SAINT FRANCIS MEDICAL CENTER (Active) - information as of 5/3/2025 11:33:24 PM

Main Details

Name

SAINT FRANCIS MEDICAL CENTER

Subdivision Name

SAINT FRANCIS MEDICAL CENTER - Children's Pulmonary

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH140067AU

Medicare Provider Number

140067

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/13/2020

Participating Start Date

10/1/2020

Participating Approval Date

7/20/2020

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

OSF HealthCare
Sandra Salverson, SVP Pharmacy Services
(309) 624-8817

Primary Contact

OSF Healthcare
amy krantz, Manager Strategic Reimbursement
(309) 655-2865

Addresses

Street Address

10 Saint Clare Court
Suite 200
Washington, IL 61571

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	370662569001	1043260482,1164463493

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
DSH140067A	Child	DSH	SAINT FRANCIS MEDICAL CENTER	Glen Avenue Diagnostic Center	4911 Executive Drive	Peoria	IL	Terminated
DSH140067AA	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Morton Health Center - OP Rad/Diag	435 Maxine Dr	Morton	IL	Active
DSH140067AB	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Morton Health Center - MRI	435 Maxine Dr	Morton	IL	Terminated
DSH140067AC	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Morton Health Center - SG Komen / Mammography	435 Maxine Dr	Morton	IL	Active
DSH140067AD	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Morton Health Center - Sonography	435 Maxine Dr	Morton	IL	Terminated
DSH140067AE	Child	DSH	SAINT FRANCIS MEDICAL CENTER	Saint Francis Medical INI Rehabilitation Services - OP Rehab Service	360 Wilmor Road	Washington	IL	Terminated
DSH140067AF	Child	DSH	SAINT FRANCIS MEDICAL CENTER	Saint Francis Medical INI Rehabilitation Services - Pediatric Dev Ctr	360 Wilmor Road	Washington	IL	Active
DSH140067AG	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Center for Health - Glen Park - DSC Imaging	5114 Glen Park Place	Peoria	IL	Active
DSH140067AH	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Center for Health - Glen Park - SG Komen / Mammography	5114 Glen Park Place	Peoria	IL	Active
DSH140067AJ	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Center for Health - Glen Park - MRI	5114 Glen Park Place	Peoria	IL	Terminated
DSH140067AK	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Center for Health - Glen Park - Sonography	5114 Glen Park Place	Peoria	IL	Terminated
DSH140067AL	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Center for Health - Glen Park - CT	5114 Glen Park Place	Peoria	IL	Terminated
DSH140067AM	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Medical Center Physical Therapy	5009 N Glen Park Place Rd	Peoria	IL	Terminated
DSH140067AN	Child	DSH	SAINT FRANCIS MEDICAL CENTER	Wound Healing and Hyperbaric Center	8600 North State Route 91	Peoria	IL	Active
DSH140067AP	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Medical Center-Outpatient Infusion Center/Intravenous Therapy	1310 N. Missouri Avenue	Peoria	IL	Active
DSH140067AQ	Child	DSH	SAINT FRANCIS MEDICAL CENTER	SAINT FRANCIS MEDICAL CENTER - Pediatric Diabetic Resource Center	530 NE GLEN OAK AVE	PEORIA	IL	Active
DSH140067AR	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF CENTER FOR HEALTH - PEKIN - Cardiology	3422A COURT ST	PEKIN	IL	Active
DSH140067AS	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF SAINT FRANCIS MULTIDISCIPLINARY - OSF Cancer Support Services	1001 MAIN ST	PEORIA	IL	Active
DSH140067AT	Child	DSH	SAINT FRANCIS MEDICAL CENTER	SAINT FRANCIS MEDICAL CENTER - Congenital Heart Center	420 NE GLEN OAK AVE	PEORIA	IL	Active
DSH140067AU	Child	DSH	SAINT FRANCIS MEDICAL CENTER	SAINT FRANCIS MEDICAL CENTER - Children's Pulmonary	10 Saint Clare Court	Washington	IL	Active
DSH140067AV	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF SAINT FRANCIS RADIATION ONCOLOG - OSF Radiation Oncology-Pekin	3500 COURT ST	PEKIN	IL	Active
DSH140067AW	Child	DSH	SAINT FRANCIS MEDICAL CENTER	SFMC Transplant Services - Transplant	420 N.E. Glen Oak Avenue	Peoria	IL	Active
DSH140067AX	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF SAINT FRANCIS MEDICAL CENTER OU - Sleep Lab	5405 N KNOXVILLE AVE	PEORIA	IL	Active
DSH140067AY	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF CHOI OPHTHALMOLOGY - Pediatric Opthalmology	4927 N GLEN PARK PLACE RD	PEORIA	IL	Active
DSH140067AZ	Child	DSH	SAINT FRANCIS MEDICAL CENTER	SFMC BEHAVIORAL HEALTH SERVICES - Adult Behavioral Health	617 NE GLENDALE AVE	PEORIA	IL	Active
DSH140067B	Child	DSH	SAINT FRANCIS MEDICAL CENTER	Outpatient Rehabilitation	100 NE Randolph	Peoria	IL	Terminated
DSH140067BA	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF CHOI PLUM, ALLERGY & SLEEP - Pediatric Allergy & Pulmonology	2900 N KNOXVILLE AVE	PEORIA	IL	Active
DSH140067BB	Child	DSH	SAINT FRANCIS MEDICAL CENTER	Saint Francis Medical Center - OSF CHOI Pediatric Clinic	420 NE Glen Oak Ave	Peoria	IL	Active
DSH140067BC	Child	DSH	SAINT FRANCIS MEDICAL CENTER	Saint Francis Medical Center - Heart Failure Clinic	530 NE Glen Oak Ave	Peoria	IL	Active
DSH140067C	Child	DSH	SAINT FRANCIS MEDICAL CENTER	PM&R Associates	200 E Pennsylvania	Peoria	IL	Terminated
DSH140067D	Child	DSH	SAINT FRANCIS MEDICAL CENTER	Out Patient Rehabilitation	200 E. Pennsylvania Ave	Peoria	IL	Terminated
DSH140067E	Child	DSH	SAINT FRANCIS MEDICAL CENTER	Pekin Cancer Treatment Center	603 Thirteenth St	Pekin	IL	Terminated
DSH140067F	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Sisters Community HealthCare Center	320 E. Armstrong	Peoria	IL	Terminated
DSH140067G	Child	DSH	SAINT FRANCIS MEDICAL CENTER	Saint Clare Family Health Center	10 Saint Clare Court	Washington	IL	Active
DSH140067H	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Center for Health - Pain Program	8600-8800 Rt. 91 North	Peoria	IL	Active
DSH140067J	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Center for Health - Minor Plastic Surgery	8600-8800 Rt. 91 North	Peoria	IL	Active
DSH140067K	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Center for Health - EKG/ Phlebotomy	8600-8800 Rt. 91 North	Peoria	IL	Active
DSH140067L	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Center for Health - Diagnostic Radiology	8600-8800 Rt. 91 North	Peoria	IL	Active
DSH140067M	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Center for Health - MRI	8600-8800 Rt. 91 North	Peoria	IL	Terminated
DSH140067N	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Center for Health - SG Komen / Mammography	8600-8800 Rt. 91 North	Peoria	IL	Active
DSH140067P	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Center for Health - Ultrasonography	8600-8800 Rt. 91 North	Peoria	IL	Terminated
DSH140067Q	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Center for Health - CT Scan	8600-8800 Rt. 91 North	Peoria	IL	Terminated
DSH140067R	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Riverplex	600 N. E. Water Street	Peoria	IL	Active
DSH140067S	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Riverplex	600 N. E. Water Street	Peoria	IL	Terminated
DSH140067T	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Heart Hospital N Knoxville Cath and Lab Diagnostic Services - SG Komen / Mammography	5405 N. Knoxville Avenue	Peoria	IL	Terminated
DSH140067U	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Heart Hospital N Knoxville Cath and Lab Diagnostic Services - Sonography	5405 N. Knoxville Avenue	Peoria	IL	Terminated
DSH140067V	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Heart Hospital Diagnostic Center - Echocardiography - HCM	610 Park Avenue	Pekin	IL	Terminated
DSH140067W	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Heart Hospital Diagnostic Center - Stress Testing - HCM	610 Park Avenue	Pekin	IL	Active
DSH140067X	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Heart Hospital Diagnostic Center - Nuclear Medicine-HCM	610 Park Avenue	Pekin	IL	Terminated
DSH140067Y	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Heart Hospital Diagnostic Center - Sonography-HCM	610 Park Avenue	Pekin	IL	Terminated
DSH140067Z	Child	DSH	SAINT FRANCIS MEDICAL CENTER	OSF Saint Francis Radiation Oncology	8948 N. Wood Sage Road	Peoria	IL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/31/2023 11:17:21 AM	9/3/2024 8:56:06 AM	9/3/2024 8:56 AM
Contacts	Primary Contact	Update	Change Request	Salverson, Sandra SVP Pharmacy Services OSF HealthCare 3096248817	krantz, amy Manager Strategic Reimbursement OSF Healthcare 3096552865	6/28/2024 2:47 PM
Contacts	Authorizing Official	Update	Change Request	McGrew, Diane L. President OSF Healthcare 3096552850	Salverson, Sandra SVP Pharmacy Services OSF HealthCare 3096248817	6/27/2024 6:57 AM
Addresses	Main Address	Update	Change Request	530 NE GLEN OAK AVE ADULT HOSPITALIST SERVICE PEORIA, IL 61603-3133	10 Saint Clare Court Suite 200 Washington, IL 61571	4/17/2024 7:36 AM
Details	Last Recertification Date	Update	Recertification	9/12/2022 1:21:37 PM	8/31/2023 11:17:21 AM	8/31/2023 11:17 AM
Contacts	Primary Contact	Update	Group Change Request	Storm, Jerry Senior Vice President of Pharmacy Services OSF Healthcare 3096553489	Salverson, Sandra SVP Pharmacy Services OSF HealthCare 3096248817	4/26/2023 7:10 AM
Details	Last Recertification Date	Update	Recertification	8/30/2021 10:58:19 AM	9/12/2022 1:21:37 PM	9/12/2022 1:21 PM
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
Contacts	Signed By	Update	Profile Change Request	McGrew, Diane Marie President OSF Healthcare 3096552850	McGrew, Diane L. President OSF Healthcare 3096552850	4/11/2022 5:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/30/2021 10:58 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		370662569001	8/30/2021 10:58 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	8/30/2021 10:58 AM
Medicaid Billing	NPI: State	Update	Recertification		IL	8/30/2021 10:58 AM
Medicaid Billing	NPI: State	Update	Recertification		IL	8/30/2021 10:58 AM
Details	Last Recertification Date	Update	Recertification		8/30/2021 10:58:19 AM	8/30/2021 10:58 AM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Contacts	Signed By	Insert	New Registration		McGrew, Diane Marie President OSF Healthcare 3096552850	7/20/2020 7:35 AM
Details	340B ID	Update	New Registration		DSH140067AU	7/20/2020 7:35 AM
Details	Entity Subname	Update	New Registration	SAINT FRANCIS MEDICAL CENTER	SAINT FRANCIS MEDICAL CENTER - Children's Pulmonary	7/20/2020 7:35 AM
Dates	Participating Approval Date	Update	New Registration		7/20/2020 7:35:52 AM	7/20/2020 7:35 AM
Details	State	Update	New Registration	Pending	Approved	7/20/2020 7:35 AM
Dates	Signed By Date	Update	New Registration		7/13/2020 2:59:02 PM	7/20/2020 7:35 AM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	7/20/2020 7:35 AM
Addresses	Main Address	Insert	New Registration		530 NE GLEN OAK AVE ADULT HOSPITALIST SERVICE PEORIA, IL 61603-3133	7/13/2020 2:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1043260482	7/13/2020 2:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1164463493	7/13/2020 2:58 PM
Contacts	Primary Contact	Insert	New Registration		Storm, Jerry Senior Vice President of Pharmacy Services OSF Healthcare 3096553489	7/13/2020 2:58 PM
Contacts	Authorizing Official	Insert	New Registration		McGrew, Diane Marie President OSF Healthcare 3096552850	7/13/2020 2:58 PM
Details	Last Recertification Date	Insert	New Registration			7/13/2020 2:58 PM
Details	Grant Number	Insert	New Registration			7/13/2020 2:58 PM
Details	340B ID	Insert	New Registration			7/13/2020 2:58 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2020 2:58 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2020 2:58 PM
Details	Medicare Provider Number	Insert	New Registration		140067	7/13/2020 2:58 PM
Details	Entity Name	Insert	New Registration		SAINT FRANCIS MEDICAL CENTER	7/13/2020 2:58 PM
Details	Program Code	Insert	New Registration		DSH	7/13/2020 2:58 PM
Details	Entity Subname	Insert	New Registration		SAINT FRANCIS MEDICAL CENTER	7/13/2020 2:58 PM
Dates	Participating Approval Date	Insert	New Registration			7/13/2020 2:58 PM
Details	State	Insert	New Registration		Pending	7/13/2020 2:58 PM
Dates	Registration Date	Insert	New Registration		7/13/2020 2:58:59 PM	7/13/2020 2:58 PM
Dates	Signed By Date	Insert	New Registration			7/13/2020 2:58 PM
Dates	Start Date	Insert	New Registration			7/13/2020 2:58 PM
Terminations	Termination Comments	Insert	New Registration			7/13/2020 2:58 PM
Terminations	Termination Date	Insert	New Registration			7/13/2020 2:58 PM
Terminations	Termination Effective Date	Insert	New Registration			7/13/2020 2:58 PM
Terminations	Termination Reason	Insert	New Registration			7/13/2020 2:58 PM