340B Drug Pricing Program Database
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DSH140053D ST. JOHNS HOSPITAL (Active)
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Main Details
Name
ST. JOHNS HOSPITAL
Subdivision Name
Imaging - South 6th Street
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140053D
Medicare Provider Number
140053
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/12/2013
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
HSHS
Michael Scialdone, SVP-Chief Financial Officer
(217) 492-6594
Primary Contact
HSHS St. John's Hospital
Erica Ridley, Pharmacy Manager
(217) 544-6464 Ext: 2044668
Addresses
Street Address
1100 E Lincolnshire Blvd
Springfield, IL 62703
Billing Address
Consolidated Services
PO Box 3646
Springfield, IL 62708
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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