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DSH140012AC OSF Saint Katharine Medical Center (Active)
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Main Details
Name
OSF Saint Katharine Medical Center
Subdivision Name
Town Square Centre/Internal Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140012AC
Medicare Provider Number
140012
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2024
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
102 S. Hennepin Ave.
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
Participated 7/1/2017 and terminated 7/1/2017. According to terminated record, entity decertified due to delays in the proper implementation of their split billing system. Participating starting 10/1/17.
07/12/2017
May 2025
May 2025
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