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DSH140012Z OSF Saint Katharine Medical Center (Active)
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Main Details
Name
OSF Saint Katharine Medical Center
Subdivision Name
Ashton Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140012Z
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
320 N First St.
Ashton, IL 61006
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
May 2025
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