340B Drug Pricing Program Database
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DSH140228V SWEDISH AMERICAN HOSPITAL (Terminated)
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Main Details
Name
SWEDISH AMERICAN HOSPITAL
Subdivision Name
SWEDISH AMERICAN MEDICAL CENTER BELVIDERE / Pulmonary Function
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140228V
Medicare Provider Number
140228
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/2/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/11/2015
Last Recertification Date
9/6/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
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
(815) 489-4580
Addresses
Street Address
1625 S STATE ST
BELVIDERE, IL 61008-5907
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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