340B Drug Pricing Program Database
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DSH140029Q COPLEY MEMORIAL HOSPITAL (Active)
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Main Details
Name
COPLEY MEMORIAL HOSPITAL
Subdivision Name
ENT - ENt
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140029Q
Medicare Provider Number
140029
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2025
Participating Start Date
4/1/2025
Participating Approval Date
2/20/2025
Last Recertification Date
Contacts
Authorizing Official
Rush University System for Health
Kate Marie Schaafsma, VP, Chief Pharmacy Officer
(815) 592-4299
Primary Contact
Copley Memorial Hospital
Stacey Ries, Deputy General Counsel
(630) 499-4721
Addresses
Street Address
2040 Ogden Avenue
STE 401
Aurora, IL 60504
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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