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DSH140068 ROSELAND COMMUNITY HOSPITAL (Active)
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Main Details
Name
ROSELAND COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140068
Medicare Provider Number
140068
Additional Details
Current Program Status
Active
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/16/2014
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Rosleand Community Hospital
Tim Egan, President
(773) 995-3015
Primary Contact
Roseland Community Hospital
Bob Vais, CFO
(773) 995-3044
Addresses
Street Address
45 WEST 111TH STREET
CHICAGO, IL 60628
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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