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DSH140179 OSF Little Company of Mary Medical Center (Active)
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Main Details
Name
OSF Little Company of Mary Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140179
Medicare Provider Number
140179
Additional Details
Current Program Status
Active
Registration Date
7/9/2021
Participating Start Date
10/1/2021
Participating Approval Date
9/1/2021
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
2800 WEST 95TH STREET
EVERGREEN PARK, IL 60805
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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