340B Drug Pricing Program Database
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DSH140180B Presence Saints Mary and Elizabeth Medical Center (Terminated)
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Main Details
Name
Presence Saints Mary and Elizabeth Medical Center
Subdivision Name
PSMEMC d/b/a Presence Saint Elizabeth Hospital - Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140180B
Medicare Provider Number
140180
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/30/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/10/2013
Last Recertification Date
8/17/2018
Termination Date
Termination Reason
7/1/2019
Site closure
Contacts
Authorizing Official
AMITA Health Sts Mary - Kankakee
Michael James Mulay, CFO
(773) 990-8611
Primary Contact
Presence Health
Rick Fischer, System Director, 340B
(630) 914-2872
Addresses
Street Address
1431 N. Claremont
Chicago, IL 60622
Billing Address
Presence Saints Mary & Elizabeth Medical Center
2233 W. Division St
Chicago, IL 60622
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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