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DSH140228AB SWEDISH AMERICAN HOSPITAL (Active)
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Main Details
Name
SWEDISH AMERICAN HOSPITAL
Subdivision Name
BELVIDERE HOSPITAL - UWNI BEH BREAST CENTER (SAB)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140228AB
Medicare Provider Number
140228
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/2/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/11/2015
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
SwedishAmerican Hospital
Patricia Ann DeWane, Vice President, Finance and Treasurer
(779) 696-4009
Primary Contact
SwedishAmerican Hospital
Tom Carey, Director of Pharmacy Services
(779) 696-4580
Addresses
Street Address
1625 S STATE ST
BELVIDERE, IL 61008
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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