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DSH140012 OSF Saint Katharine Medical Center (Active)
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Main Details
Name
OSF Saint Katharine Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140012
Medicare Provider Number
140012
Additional Details
Current Program Status
Active
Registration Date
4/9/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/1/2024
Last Recertification Date
8/29/2024
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
403 EAST FIRST STREET
DIXON, IL 61021
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 10/1/2017, Termination Date 7/1/2019, Reinstatement 7/1/2024
04/30/2024
April 2025
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