340B Drug Pricing Program Database
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DSH140067AM SAINT FRANCIS MEDICAL CENTER (Terminated)
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Main Details
Name
SAINT FRANCIS MEDICAL CENTER
Subdivision Name
OSF Saint Francis Medical Center Physical Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140067AM
Medicare Provider Number
140067
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2012
Participating Start Date
1/1/2013
Participating Approval Date
11/27/2012
Last Recertification Date
9/3/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
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
5009 N Glen Park Place Rd
Peoria, IL 61614
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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