340B Drug Pricing Program Database
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DSH140155E Presence St. Mary's Hospital (Active)
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Main Details
Name
Presence St. Mary's Hospital
Subdivision Name
Bourbonnais Campus - OP Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140155E
Medicare Provider Number
140155
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
5/8/2014
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Prime Healthcare - Illinois
Sylvia Chen, Regional VP - Pharmacy Services
(630) 776-3455
Primary Contact
Prime Healthcare - Illinois
Nawal Hamdan, 340B Manager
(708) 469-8918
Addresses
Street Address
100 Provena Way
Bourbonnais, IL 60914
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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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
April 2025
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