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AFFILIATED HEALTH SERVICES, INC.
DSH140155 Presence St. Mary's Hospital
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Covered Entity Details
Entity Name
Presence St. Mary's Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140155
Entity Address
500 West Court Street
Kankakee, IL 60901
Medicare Provider Number
140155
Participating Start Date
10/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
AFFILIATED HEALTH SERVICES, INC.
Pharmacy Address
DBA ASCENSION RX 1303
30055 NORTHWESTERN HWY
STE 225
FARMINGTON HILLS, MI 48334
Pharmacy Comments
Contract Details
Approval Date
1/7/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/26/2022
Ownership change
Contacts
Covered Entity Signing Official
Yuesha Chen, Regional Chief Financial Officer
(815) 741-7667
Contract Pharmacy Representative
Ascension Michigan Pharmacy
Deborah Sopo, Pharmacy Manager
(248) 865-3770
Signed By Date
1/7/2021
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