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CAH141310-02 Mendota Community Hospital d/b/a OSF Saint Paul Medical Center (Active)
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Main Details
Name
Mendota Community Hospital d/b/a OSF Saint Paul Medical Center
Subdivision Name
OSF Medical Group-Mendota
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141310-02
Medicare Provider Number
141310
Outpatient Facility Provider Number
148535
Additional Details
Current Program Status
Active
Registration Date
7/8/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/21/2020
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
OSF HealthCare
Sandra Salverson, SVP Pharmacy Services
(309) 624-8817
Primary Contact
OSF Healthcare
amy krantz, Manager Strategic Reimbursement
(309) 655-2865
Addresses
Street Address
1405 E. 12th ST
Suite 300, 600
Mendota, IL 61342-9010
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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