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RRC140179-01 OSF LITTLE COMPANY OF MARY MEDICAL CENTER (Terminated)
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Main Details
Name
OSF LITTLE COMPANY OF MARY MEDICAL CENTER
Subdivision Name
LITTLE COMPANY OF MARY HOSPITAL CAR - Care Station East
Type
Rural Referral Center
Rural
No
340B ID
RRC140179-01
Medicare Provider Number
140179
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/23/2018
Last Recertification Date
9/10/2020
Termination Date
Termination Reason
7/1/2021
Site closure
Contacts
Authorizing Official
OSF Healthcare
Diane L. McGrew, President
(309) 655-2850
Primary Contact
Little Company of Mary Hospital
Lisa Peters, Director of Pharmacy
(708) 229-5506
Addresses
Street Address
5660W 95TH ST
OAK LAWN, IL 60453-2380
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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