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CAH141310-05 Mendota Community Hospital d/b/a OSF Saint Paul Medical Center (Approved)
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Main Details
Name
Mendota Community Hospital d/b/a OSF Saint Paul Medical Center
Subdivision Name
MENDOTA COMMUNITY HOSPITAL - OSF Healthcare-Medical Group-Spring Valley
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141310-05
Medicare Provider Number
141310
Outpatient Facility Provider Number
148668
Additional Details
Current Program Status
Approved
Registration Date
4/14/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/27/2025
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
415 E 2ND ST
SPRING VALLEY, IL 61362-1517
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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