340B Drug Pricing Program Database
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DSH140180F Presence Saints Mary and Elizabeth Medical Center (Terminated)
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Main Details
Name
Presence Saints Mary and Elizabeth Medical Center
Subdivision Name
PSMEMC Infusion
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140180F
Medicare Provider Number
140180
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/13/2016
Last Recertification Date
8/17/2018
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
AMITA Health Sts Mary - Kankakee
Michael James Mulay, CFO
(773) 990-8611
Primary Contact
Presence Health
Rick Fischer, System Director, 340B
(630) 914-2872
Addresses
Street Address
5600 West Addison Street
Suite 204B
Chicago, IL 60634
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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