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DSH140228AH SWEDISH AMERICAN HOSPITAL (Active)
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Main Details
Name
SWEDISH AMERICAN HOSPITAL
Subdivision Name
1340 CHARLES ST CLINIC - UWNI SAH CHARLES ST INFECTIOUS DISEASE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140228AH
Medicare Provider Number
140228
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/15/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/29/2019
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
1340 CHARLES ST
STE 404
ROCKFORD, IL 61104
Billing Address
SwedishAmerican Hospital
1401 E STATE STREET
ROCKFORD, IL 61104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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