340B Drug Pricing Program Database
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DSH140228AV SWEDISH AMERICAN HOSPITAL (Active)
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Main Details
Name
SWEDISH AMERICAN HOSPITAL
Subdivision Name
209 9TH ST CLINIC - UWNI SAH UWH GEN SURG AT SAHS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140228AV
Medicare Provider Number
140228
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2023
Participating Start Date
4/1/2023
Participating Approval Date
2/9/2023
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
209 9TH ST
STE 200
ROCKFORD, IL 61104
Billing Address
SWEDISH AMERICAN HOSPITAL
1401 E STATE ST
ROCKFORD, IL 61104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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