340B Drug Pricing Program Database
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DSH140209H METHODIST MEDICAL CENTER OF ILLINOIS (Active)
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Main Details
Name
METHODIST MEDICAL CENTER OF ILLINOIS
Subdivision Name
Carle Health Methodist Atrium - Neurology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140209H
Medicare Provider Number
140209
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/4/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/24/2018
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Carle Foundation Hospital
Dennis P. Hesch, Executive VP and CFO
(217) 326-8231
Primary Contact
Carle Foundation Hospital
Katie Koch, Director of 340B and Retail Pharmacy Operations
(217) 904-7016
Addresses
Street Address
900 MAIN ST STE 250
PEORIA, IL 61602-5006
Billing Address
METHODIST MEDICAL CENTER OF ILLINOIS
221 NE Glen Oak Ave.
Peoria, IL 61636
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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