340B Drug Pricing Program Database
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DSH140186 RIVERSIDE MEDICAL CENTER (Active)
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Main Details
Name
RIVERSIDE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140186
Medicare Provider Number
140186
Additional Details
Current Program Status
Active
Registration Date
12/11/2006
Participating Start Date
1/1/2007
Participating Approval Date
12/12/2006
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Riverside Medical Center - Kankakee, IL
Patricia K. Vilt, Chief Financial Officer
(815) 935-7542 Ext: 37219
Primary Contact
Riverside Medical Center
Shari K. DePoister, 340B Program Coordinator
(815) 935-7256 Ext: 42154
Addresses
Street Address
350 N Wall Street
KANKAKEE, IL 60901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/19/2009-REMOVED MEDICAID NUMBER 7/30/08 DOC RECD CONFIRM ELIG DSH ADJ %
06/19/2009
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