340B Drug Pricing Program Database
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DSH140224C PRESENCE SAINT JOSEPH HOSP-CHICAGO (Terminated)
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Main Details
Name
PRESENCE SAINT JOSEPH HOSP-CHICAGO
Subdivision Name
SJHC PCAC Surgery - Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140224C
Medicare Provider Number
140224
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/27/2021
Last Recertification Date
8/16/2023
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Ascension St Joseph
Flavio Marin, CFO
(773) 665-6212
Primary Contact
Ascension
Rick Fischer, 340B Program Director
(630) 309-7828
Addresses
Street Address
331 W Surf Street
#5
Chicago, IL 60657
Billing Address
Ascension Health Ministry Service Center
PO Box 33902
Indianapolis, IN 46203
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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