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RRC140110-00 OTTAWA REGIONAL HOSPITAL & HEALTHCAR (Terminated)
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Main Details
Name
OTTAWA REGIONAL HOSPITAL & HEALTHCAR
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC140110-00
Medicare Provider Number
140110
Additional Details
Current Program Status
Terminated
Registration Date
4/6/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/27/2015
Last Recertification Date
9/5/2019
Termination Date
Termination Reason
7/1/2020
Other
Contacts
Authorizing Official
OSF Healthcare
Diane L. McGrew, President
(309) 655-2850
Primary Contact
OSF Healthcare
Jerry Storm, Senior Vice President of Pharmacy Services
(309) 655-3489
Addresses
Street Address
1100 EAST NORRIS DRIVE
OTTAWA, IL 61350
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/27/15 previously participated as DSH140110 from 10/01/2011 thru 6/30/13
05/27/2015
April 2025
April 2025
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