340B Drug Pricing Program Database
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DSH140180A Presence Saints Mary and Elizabeth Medical Center (Terminated)
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Main Details
Name
Presence Saints Mary and Elizabeth Medical Center
Subdivision Name
Oncology Infusion Center: A service of Saints Mary and Elizabeth Medical Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140180A
Medicare Provider Number
140180
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/29/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/10/2012
Last Recertification Date
8/13/2024
Termination Date
Termination Reason
4/1/2025
For-Profit conversion
Contacts
Authorizing Official
Ascension Saint Mary & Elizabeth MEdical Center
Eric Zornow, CFO
(312) 770-2105
Primary Contact
Ascension
Rick Fischer, 340B Program Director
(630) 309-7828
Addresses
Street Address
ST JOSEPH HOSP CHEMO DOP 340B
331 W Surf
1300
Chicago, IL 60657-6274
Billing Address
Ascension Health Ministry Service Center
PO Box 33902
Indianapolis, IN 46203
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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