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DSH140180C 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 Saint Elizabeth Hospital - OP Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140180C
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
8/13/2024
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
2216 West Thomas Street
Chicago, IL 60622
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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