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RRC140043-04 CGH MEDICAL CENTER (Active)
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Main Details
Name
CGH MEDICAL CENTER
Subdivision Name
Dixon Medical Center - Wound Care
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140043-04
Medicare Provider Number
140043
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
11/4/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/9/2022
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
CGH Medical Center
Ben Schaab, VP, CFO
(815) 625-0400
Primary Contact
CGH Medical Center
Ed Pruis, Compliance Officer
(815) 625-0400 Ext: 6100
Addresses
Street Address
1321 N Galena Ave.
Dixon, IL 61021-1009
Billing Address
CGH Medical Center
100 E. Lefevre Rd.
Sterling, IL 61081
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2018, terminated 1/1/2019. Reinstated 1/1/2023.
11/09/2022
June 2025
June 2025
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