340B Drug Pricing Program Database
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DSH140155C Presence St. Mary's Hospital (Terminated)
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Main Details
Name
Presence St. Mary's Hospital
Subdivision Name
Occupational Health Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140155C
Medicare Provider Number
140155
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
5/8/2014
Last Recertification Date
9/4/2015
Termination Date
Termination Reason
1/1/2016
Site closure
Contacts
Authorizing Official
AMITA Health
Yuesha Chen, Regional Chief Financial Officer
(815) 741-7667
Primary Contact
Presence Health
Kimberly Janicek, Regional Directir of Pharmacy
(815) 741-7142
Addresses
Street Address
21 Heritage Drive
Bourbonnais, IL 60914
Billing Address
Presence St. Mary's Hospital
500 West Court
Kankakee, IL 60901
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/16/14 originally registered for a 7/1/14 start date then, prior to start date, terminated because hospital was not ready to implement 340B. Subsequently re-registered during July registration period and so the old record was re-instated effective 10/1/14
09/16/2014
April 2025
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