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DSH140224A PRESENCE SAINT JOSEPH HOSP-CHICAGO (Terminated)
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Main Details
Name
PRESENCE SAINT JOSEPH HOSP-CHICAGO
Subdivision Name
Infusion Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140224A
Medicare Provider Number
140224
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/26/2015
Last Recertification Date
8/22/2016
Termination Date
Termination Reason
10/1/2016
DSH percentage below statutory minimum
Contacts
Authorizing Official
Elizabeth Early, Regional Chief Ambulatory and Ancillary Services Officer
(847) 316-3900
Primary Contact
Kimberly Spencer, Regional Director of Pharmacy
(773) 665-3145
Addresses
Street Address
2845 North Sheridan Road
Chicago, IL 60657
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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