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DSH140228AC SWEDISH AMERICAN HOSPITAL (Terminated)
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Main Details
Name
SWEDISH AMERICAN HOSPITAL
Subdivision Name
SWEDISH AMERICAN MEDICAL GROUP STATE-Stateline Clinic-Lab
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140228AC
Medicare Provider Number
140228
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
Last Recertification Date
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Swedish American Hospital
Patricia A. DeWane, Vice President, Finance and Treasurer
(779) 696-4727
Primary Contact
SwedishAmerican Hospital
Tom Carey, Director of Pharmacy Services
(815) 489-4580
Addresses
Street Address
4282 E ROCKTON RD STE 100
ROSCOE, IL 61073-7420
Billing Address
SWEDISH AMERICAN HOSPITAL
1401 EAST STATE STREET
Rockford, IL 61104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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