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DSH140186D RIVERSIDE MEDICAL CENTER (Active)
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Main Details
Name
RIVERSIDE MEDICAL CENTER
Subdivision Name
RIVERSIDE CANCER CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140186D
Medicare Provider Number
140186
Outpatient Facility Provider Number
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
8/12/2024
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
200 Riverside Drive
Bourbonnais, IL 60914
Billing Address
Riverside Medical Center
350 NORTH WALL STREET
Kankakee, IL 60901
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/20/2009- REMOVED MEDICAID #;7/30/08 DOC RECD CONFIRM ELIG DSH ADJ %
07/20/2009
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