340B Drug Pricing Program Database
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SCH140064-06 ST. MARY MEDICAL CENTER (Active)
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Main Details
Name
ST. MARY MEDICAL CENTER
Subdivision Name
ST MARY MEDICAL CENTER - Center for Outpatient Services
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH140064-06
Medicare Provider Number
140064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2025
Participating Start Date
4/1/2025
Participating Approval Date
3/13/2025
Last Recertification Date
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
3333 N SEMINARY ST
GALESBURG, IL 61401-1251
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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