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DSH140228AE SWEDISH AMERICAN HOSPITAL (Active)
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Main Details
Name
SWEDISH AMERICAN HOSPITAL
Subdivision Name
1340 CHARLES ST CLINIC - UWNI SAH HEART CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140228AE
Medicare Provider Number
140228
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/16/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/24/2017
Last Recertification Date
8/28/2024
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
(779) 696-4580
Addresses
Street Address
1340 CHARLES ST
STE 300
ROCKFORD, IL 61104
Billing Address
SwedishAmerican Hospital
1401 E STATE STREET
ROCKFORD, IL 61104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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