340B Drug Pricing Program Database
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DSH140228AG SWEDISH AMERICAN HOSPITAL (Active)
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Main Details
Name
SWEDISH AMERICAN HOSPITAL
Subdivision Name
209 9TH ST CLINIC - UWNI SAH RKFRD VASC SURG AT SAHS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140228AG
Medicare Provider Number
140228
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/8/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/11/2018
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
209 9TH ST
STE 200
ROCKFORD, IL 61104
Billing Address
SwedishAmerican Hospital
1401 East State Street
Rockford, IL 61104-2315
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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