340B Drug Pricing Program Database
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DSH140224E PRESENCE SAINT JOSEPH HOSP-CHICAGO (Active)
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Main Details
Name
PRESENCE SAINT JOSEPH HOSP-CHICAGO
Subdivision Name
Pain Center - Pain Management
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140224E
Medicare Provider Number
140224
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/5/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/9/2024
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Ascension St Joseph
Flavio Marin, CFO
(773) 665-6212
Primary Contact
Ascension Rx
Kelsey Fiser, 340B Program Director
(615) 222-5190
Addresses
Street Address
2913 N Commonwealth Avenue
400
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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April 2025
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