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DSH140095 SAINT ANTHONY HOSPITAL (Active)
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Main Details
Name
SAINT ANTHONY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140095
Medicare Provider Number
140095
Additional Details
Current Program Status
Active
Registration Date
4/21/2008
Participating Start Date
7/1/2003
Participating Approval Date
4/21/2008
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Saint Anthony Hospital
JAMES RICHARD MACK, Vice President of Finance
(773) 484-4834
Primary Contact
Saint Anthony Hospital
DYLAN HUBER, Pharmacy Clinical Coordinator
(773) 484-4155
Addresses
Street Address
2875 WEST 19TH STREET
CHICAGO, IL 60623
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/21/08 MOVED ADDR LINE 2 TO SHIP TO
04/21/2008
May 2025
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