340B Drug Pricing Program Database

Name

ST. JOHNS HOSPITAL

Subdivision Name

Home Infusion

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH140053A

Medicare Provider Number

140053

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

7/12/2013

Participating Start Date

10/1/2013

Participating Approval Date

9/12/2013

Last Recertification Date

8/12/2014

Termination Date
Termination Reason

7/1/2015
Site closure

Authorizing Official

HSHS St. John's Hospital
E J Kuiper, President-CEO
(217) 814-4572

Primary Contact

Ann Derrick, Executive Director, Care Continuum
(217) 757-6580

Street Address

801 E Carpenter St
Springfield, IL 62703

Billing Address
Same as Street Address