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DSH140228E SWEDISH AMERICAN HOSPITAL (Terminated)
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Main Details
Name
SWEDISH AMERICAN HOSPITAL
Subdivision Name
SWEDISHAMERICAN HOME HEALTH CARE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140228E
Medicare Provider Number
140228
Outpatient Facility Provider Number
147448
Additional Details
Current Program Status
Terminated
Registration Date
5/27/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/15/2011
Last Recertification Date
8/25/2014
Termination Date
Termination Reason
7/1/2015
Site closure
Contacts
Authorizing Official
Swedish American Hospital
Patricia A. DeWane, Vice President, Finance and Treasurer
(779) 696-4727
Primary Contact
Tonya Gray, Director
(779) 696-7318
Addresses
Street Address
2550 CHARLES STREET
ROCKFORD, IL 61108-1673
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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