340B Drug Pricing Program Database
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DSH140053K ST. JOHNS HOSPITAL (Active)
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Main Details
Name
ST. JOHNS HOSPITAL
Subdivision Name
ST JOHN'S SURGERY SUITES, MONTVALE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140053K
Medicare Provider Number
140053
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/8/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/6/2015
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
2020 W ILES AVE
SPRINGFIELD, IL 62704
Billing Address
Consolidated Services
PO Box 3646
Springfield, IL 62708
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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