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DSH140113 OSF Heart of Mary Medical Center (Active)
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Main Details
Name
OSF Heart of Mary Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140113
Medicare Provider Number
140113
Additional Details
Current Program Status
Active
Registration Date
7/15/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/21/2015
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
OSF HealthCare
Sandra Salverson, SVP Pharmacy Services
(309) 624-8817
Primary Contact
OSF Healthcare
amy krantz, Manager Strategic Reimbursement
(309) 655-2865
Addresses
Street Address
1400 WEST PARK STREET
URBANA, IL 61801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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