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RRC140127-08 CARLE BROMENN MEDICAL CENTER (Active)
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Main Details
Name
CARLE BROMENN MEDICAL CENTER
Subdivision Name
CARLE BROMENN ENDOCRINOLOGY AND NEU - Neurology
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140127-08
Medicare Provider Number
140127
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/16/2023
Participating Start Date
4/1/2023
Participating Approval Date
2/1/2023
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Carle Foundation Hospital
Dennis P. Hesch, Executive VP and CFO
(217) 326-8231
Primary Contact
Carle Foundation Hospital
Katie Koch, Director of 340B and Retail Pharmacy Operations
(217) 904-7016
Addresses
Street Address
1302 FRANKLIN AVE
STE 2500
NORMAL, IL 61761-6526
Billing Address
Carle Health
611 West Park Street
Urbana, IL 61801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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