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CAH141310-00 Mendota Community Hospital d/b/a OSF Saint Paul Medical Center (Active)
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Main Details
Name
Mendota Community Hospital d/b/a OSF Saint Paul Medical Center
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141310-00
Medicare Provider Number
141310
Additional Details
Current Program Status
Active
Registration Date
11/30/2010
Participating Start Date
1/1/2011
Participating Approval Date
11/30/2010
Last Recertification Date
9/3/2024
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
1401 E. 12th St.
MENDOTA, IL 61342
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/17/12 - Updated addr(was 1315 MEMORIAL DRIVE)
02/17/2012
April 2025
April 2025
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