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DSH140067Y SAINT FRANCIS MEDICAL CENTER (Terminated)
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Main Details
Name
SAINT FRANCIS MEDICAL CENTER
Subdivision Name
OSF Heart Hospital Diagnostic Center - Sonography-HCM
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140067Y
Medicare Provider Number
140067
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/15/2012
Participating Start Date
1/1/2013
Participating Approval Date
11/27/2012
Last Recertification Date
8/30/2021
Termination Date
Termination Reason
10/1/2022
Site closure
Contacts
Authorizing Official
OSF Healthcare
Diane L. McGrew, President
(309) 655-2850
Primary Contact
OSF Healthcare
Jerry Storm, Senior Vice President of Pharmacy Services
(309) 655-3489
Addresses
Street Address
610 Park Avenue
Pekin, IL 61614
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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