340B Drug Pricing Program Database
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DSH140209K METHODIST MEDICAL CENTER OF ILLINOIS (Active)
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Main Details
Name
METHODIST MEDICAL CENTER OF ILLINOIS
Subdivision Name
Carle Health Methodist Atrium - Cardiovascular Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140209K
Medicare Provider Number
140209
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/22/2019
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 660
Peoria, IL 61602
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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